Atenção pré-natal na rede básica: uma avaliação da estrutura e do processo

Abstract

With the aim of describing the structure and process by which prenatal care is provided at the primary health care level in the city of Pelotas in southern Brazil, a descriptive cross-sectional study was conducted. All 31 urban health care facilities were visited and their structure analyzed. A total of 839 prenatal records from mothers who delivered in the six months prior to the beginning of the study were reviewed. The structure as a whole was classified as poor (only 70% of standard parameters were present), mainly due to deficiencies in the physical plant. Process assessment showed low coverage (53%) and an average of 5.3 visits. Only 37% of patient records showed adequate results (Kessner Index). Adding laboratory test results and routine procedures as complementary criteria, 31% and 5% of the records scored as adequate, respectively. In summary, overall quality of prenatal care provided at the primary health care level in Pelotas is poor. Mechanisms to increase staff adherence to both procedures and program logistics need to be developed.

Avaliação da adequação da assistência pré-natal na rede SUS do Município do Rio de Janeiro, Brasil

“…Outros estudos nacionais também encontraram problemas na captação precoce de gestantes, com valores que variaram de 14% a 82% 15,16,17,20,21,23,24,29 . Entretanto, é possível que esses resultados tenham determinantes diferentes, relacionadas às características das gestantes e da organização da rede de serviços de cada localidade.…”

“…Nas últimas duas décadas, diversos estudos nacionais têm proposto indicadores de adequação para avaliar a qualidade dos cuidados pré-natais, incorporando outros elementos além da época de início do acompanhamento e do núme-ro de consultas recebidas 16,17,18 . Após a publicação do Programa de Humanização do Pré-Natal e Nascimento (PHPN) pelo Ministério da Saúde 19 , que preconiza os parâmetros mínimos para uma adequada assistência pré-natal para gestantes de baixo risco, observa-se a utilização crescente desses parâmetros nos estudos de avaliação 20,21,22,23,24 .…”

Social determinants of hospitalizations for ambulatory care sensitive conditions in Guarulhos, São Paulo

“…This group is generally associated with the proportion of pregnant women who had seven or more prenatal consultations (there was a 6% increase of this indicator in Guarulhos), but it was noticed that the number of consultations does not ensure the quality of care (25) . Therefore, this percentage rise can be the result of the mothers' low education levels (26) , as well as the low family incomes, which is an evident fact seen in social evaluations of the city and is essential for the individual's health.…”

Violência física entre parceiros íntimos na gestação como fator de risco para a má qualidade do pré-natal

“…Among the national papers published in the last ten years that analyzed the moment of the beginning of prenatal care and the number of attended medical visits in the evaluation of the provided care, the prevalence of pregnant women whose care was classifi ed as inadequate and intermediate varied between 40% and 87%. 2,3,13,20,22,24 Among the strengths of this study, we highlight the classifi cation strategy used for assessing key variables of interest, the cautious fi eldwork and careful analysis model that was used. The Kotelchuck index, used to assess the quality of prenatal care, is employed in different studies and contexts, which allows comparison with other research studies.…”