Atributos essenciais da Atenção Primária à Saúde: resultados nacionais do PMAQ-AB

Abstract

RESUMO A concepção de uma Atenção Primária à Saúde (APS) abrangente e sua qualidade podem ser avaliadas por meio da efetivação dos atributos: primeiro contato, longitudinalidade, abrangência/integralidade e coordenação. O artigo teve por objetivo analisar a consecução dos atributos da APS na prática das equipes, na perspectiva dos profissionais e usuários, comparando-se os resultados do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB), entre os ciclos 1 e 2. Estudo quantitativo, com identificação das equipes participantes dos dois ciclos e operacionalização dos atributos da APS por meio da seleção de variáveis PMAQ-AB pertinentes a cada atributo. Foram comparados os resultados nacionais de 12.680 Unidades Básicas de Saúde (UBS), 15.668 equipes e 58.517 usuários. Apenas parte dos atributos apresentou melhorias do ciclo 1 para o ciclo 2. Os melhores resultados foram primeiro contato e integralidade, confirmando gradual constituição da UBS como serviço de porta de entrada acessível, com escopo diversificado de ações, ainda que insuficientes. Os atributos com pior avaliação foram longitudinalidade, com baixa continuidade e qualidade da relação profissional-paciente; e coordenação, por dificuldades de acesso às consultas especializadas e insuficientes registros compartilhados.PALAVRAS-CHAVE Atenção Primária à Saúde. Acesso. Integralidade.ABSTRACT The concept of a comprehensive Primary Health Care (PHC) and its quality can be evaluated by the effectiveness of the following attributes: first contact service, longitudinality, comprehensiveness and coordination. The objective of this article is to analyze the effectiveness of PHC attributes in team practice from the perspective of professionals and users, comparing the results of the National Program for Access and Quality Improvement in Primary Health Care (PMAQ-AB), between cycles 1 and 2. Quantitative study, with identification of the teams participating in the two cycles and operationalization of the PHS attributes through the selection of PMAQ-AB variables relevant to each attribute. We compared the national results of 12.680 Basic Health Units, 15.668 teams and 58.517 users. Some attributes improved from cycle 1 to cycle 2. The best results were first contact and comprehensiveness, confirming the gradual constitution of the Basic Health Units as an accessible first contact service, with a diversified scope of actions, although insufficient. The attributes with worse evaluation were longitudinality, with low continuity and quality of the professional-patient relationship; and coordination, due to difficulties of access to specialized care and insufficient shared records.

Care coordination and longitudinality in primary health care in the Brazilian Amazon

“…The time aspect in the professional-patient relationship may determine the acceptability, recognition and health action development (12,(17)(18) . Inherent problems to professional practice in PHC, such as accumulation of activities, lack of resources to perform their role, professional turnover, and professionals' profile (17,19) might affect the teampatient bonding, and disfavor the implementation of teamwork organization based on planning and on the perspective of continuous and comprehensive care over time.…”

Strategies For Strengthening High Risk Pregnancy Care In Primary Healthcare Services

“…pregnancy. Strategies such as the use of clinical practice and regulation protocols widely known by health professionals, and strengthening strategies such as matrix support and the use of health technologies can reduce the demand and the long waiting time for specialized care 29,30 .…”

Enfrentando desigualdades na saúde: impasses e dilemas do processo de regionalização no Brasil

“…Some policies stood out in responding to structural problems, including the construction of new infrastructure, such as the Emergency Care Units (UPAs) 28 , the More Doctors program, aimed at supplying more physicians, especially in underserved territories, alongside the expansion of medical schools 29 , the National Program to Improve Access and Quality of Basic Care (PMAQ-AB) 30,31 , and even expansion in the supply of essential medicines, such as the Popular Pharmacy Program, to cite a few examples. Still, these initiatives have typically specific characteristics rather than adopting rigorous territorial planning to build comprehensive, systemic heath care in the country.…”