Pré-natal no Brasil: estudo transversal do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica, 2014

Abstract

Objective: to describe the adequacy of primary health care center structure, requests for tests and prenatal care reported by female health service users within the scope of the Program for Improving Primary Care Access and Quality (PMAQ) in Brazil. Methods: this was a cross-sectional study using PMAQ Cycle II (2014) data. Results: data from 9,909 health centers, 9,905 teams, and 9,945 female health service users were included; 70.1% (95%CI 69.2;71.0) of health centers had adequate structure; 88.0% (95%CI 87.4;88.7) of the teams requested all tests; 59.8% (95%CI 58.8;60.8) of female health service users reported receiving total guidance, and 23.4% of them (95%CI 22.5;24.2) underwent all physical examination procedures; teams that participated in both Cycle I and Cycle II presented better results. Conclusion: in spite of shortcomings in Primary Care structure and work process in Brazil, PMAQ appears to positively affect prenatal care.

Desvelando o cuidado às gestantes de alto risco em serviços de atenção primária do Município de São Paulo, Brasil: a ótica dos profissionais

“…Do mesmo modo, os depoimentos alinham-se às recomendações sobre a garantia de um número mínimo de consultas e do acompanhamento do pré-natal de alto risco ser centralizado no atendimento médico. Por outro lado, o vínculo da mulher durante a gestação com toda a equipe de saúde, também, é um determinante para o adequado resultado no acompanhamento pré-natal 3,14,29 .…”

Spatiotemporal analysis of hospital admissions for primary care-sensitive conditions in women and children in the first 1000 days of life

“…Also, in this sense, a study that evaluated the quality of prenatal care carried out by PHC teams in Brazil points out that the North region had a lower prevalence of PHC facilities (UBS) with an adequate structure, while the South and Southeast regions had better structure, adequacy of test requests, and users receiving guidance [ 29 ]. These findings point to an improved prenatal care, but with the same differences related to the regions of the country, besides gaps related to the size of the municipality, population size, and HDI, and the structure was better in small municipalities with more extensive PHC coverage and the request for tests was more prevalent in larger municipalities with lower PHC coverage [ 29 ].…”

Evolution of the quality of prenatal care in the primary network of Brazil from 2012 to 2018: What can (and should) improve?

“…Problems in the completeness of health actions defined in protocols, consensuses, guides and official guidelines for specific health conditions reflect failures in the comprehensiveness of care and thus in the quality of PHC, as evidenced in studies on women’s and children’s health, of users with chronic conditions and elderly [ 14 – 16 ]. In this perspective, the assessment of the completeness of a repertoire of health actions is valuable to estimate the comprehensiveness of care and, thus, its quality [ 15 – 17 ].…”

“…The incentive to improve access and quality was associated with a complex certification, which included the self-assessment of professionals and managers, selected indicators from secondary sources and external assessment, resulting in the financial value to be transferred from the federal management to the municipalities.Currently, PMAQ has completed three cycles, obtaining information on various indicators of quality of health care in primary network, including prenatal care, however, publications on Cycle III and comparisons of the three assessment cycles are still rare [ 32 ]. Data from PMAQ Cycles I and II for the whole of Brazil revealed important deficits and inequalities in quality indicators [ 16 , 17 ]. In addition, there is evidence of sociodemographic inequities in access to prenatal care, with greater restrictions for young, black women with low education [ 33 ].…”