Care coordination in PMAQ-AB: an Item Response Theory-based analysis

Abstract

OBJECTIVE Analyze the quality of the National Program for Primary Care Access and Quality Improvement variables to evaluate the coordination of primary care.METHODS A cross-sectional study based on data from 17,202 primary care teams that participated in the National Program for Primary Care Access and Quality Improvement in 2012. Based on the Item Response Theory, Samejima’s Gradual Response Model was used to estimate the score related to the level of coordination. The Cronbach’s alpha and Spearman’ coefficients and the point-biserial correlation were used to analyze the internal consistency and the correlation between the items and between the items and the total score. We evaluated the assumptions of unidimensionality and local independence of the items. Cloud-type word charts aided in the interpretation of coordination levels.RESULTS The Program items with the greatest discrimination in coordination level were: telephone/Internet existence, institutional communication flows, and matrix support actions. The specialists’ contact frequency with the primary care and integrated electronic medical record required a greater level of coordination among the teams. The Cronbach’ alpha was 0.8018. The institutional communication flows and telephone/Internet items had a higher correlation with the total score. Coordination scores ranged from -2.67 (minimum) to 2.83 (maximum). More communication, information exchange, matrix support, health care in the territory and the domicile had a significant influence on the levels of coordination.CONCLUSIONS The ability to provide information and the frequency of contact among professionals are important elements for a comprehensive, continuous and high-quality care.

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

“…Care coordination in PHC reflects the capacity to coordinate the actions within PHC itself, at other care levels or in institutions corresponding to other public policies involved in the care process. It is related to the continuity of care between professionals and services involved in the follow-up of clinic cases through informational and communication tools, and to the existence of referrals/flows between services (10)(11) .…”

“…As the questioned activities are based on the Brazilian Policy for Primary Care and foreseen within the role of professionals, a high percentage of teams fulfilling this role would be expected. The features of PHC are independent actions, because without longitudinality and care coordination, the professional-patient bond loses much of its potential and the other features become merely administrative functions (11)(12) .…”

Avaliação Do Processo De Trabalho Entre Equipes De Saúde Da Família De Um Município De Minas Gerais, Brasil

“…O território não é apenas a área de abrangência do serviço de saúde, mas agrega os espaços de poder, determinantes sociais do processo saúde-doença-cuidado e equipamentos sociais. Tal configuração deve integrar o rol de conhecimentos da equipe (Garcia et al, 2014) para que ela possa acompanhar os usuários, ao longo do tempo, por meio da vigilância constante das diversas condições de saúde (Souza et al, 2017).…”

“…Desse modo, conforme Bousquat et al (2017a), tais achados sinalizam a fragilidade da AB em se instituir como porta de entrada prioritária na rede do sistema público de saúde, bem como sua dificuldade em proporcionar a resolutividade no cuidado em saúde. A incipiente coordenação da assistência pela AB tem sido constatada em pesquisas nacionais (Protasio et al, 2014;Carneiro et al, 2014;Seidl et al, 2014;Fontana, Lacerda e Machado, 2016;Uchôa et al, 2016;Souza et al, 2017;Almeida, Marin e Casotti, 2017;Bousquat et al, 2017a;Chaves et al, 2018) e internacionais (Haggerty et al, 2003;Hudon et al, 2015;Lamothe, Sylvain e Sit, 2015;Tarrant et al, 2015).…”

“…Ademais, por meio do PMAQ-AB, as informações oriundas de momentos autoavaliativos das referidas equipes, que atuam em diferentes cenários, podem contribuir em avanços locais para a efetividade do cuidado, ao evidenciarem potencialidades, fragilidades e desafios no serviço (Souza et al, 2017). Na autoavaliação, a qualidade da AB pode ser mensurada pelo consenso dos profissionais da equipe, potencialmente habilitados para avaliar a realidade do processo de trabalho no contexto em que estão inseridos.…”