Children's health care assistance according to their families: a comparison between models of Primary Care

Abstract

Objective:To compare the health assistance models of Basic Traditional Units (UBS) with the Family Health Strategy (ESF) units for presence and extent of attributes of Primary Health Care (APS), specifically in the care of children. Method: A crosssectional study of a quantitative approach with families of children attended by the Public Health Service of Colombo, Paraná. The Primary Care Assessment Tool (PCA-Tool) was applied to parents of 482 children, 235 ESF units and 247 UBS units covering all primary care units of the municipality, between June and July 2012. The results were analyzed according to the PCA-Tool manual. Results: ESF units reached a borderline overall score for primary health care standards. However, they fared better in their attributes of Affiliation, Integration of care coordination, Comprehensiveness, Family Centeredness and Accessibility of use, while the attributes of Community Guidance/Orientation, Coordination of Information Systems, Longitudinality and Access attributes were rated as insufficient for APS. UBS units had low scores on all attributes. Conclusion: The ESF units are closer to the principles of APS (Primary Health Care), but there is need to review actions of child care aimed at the attributes of APS in both care models, corroborating similar studies from other regions of Brazil. DESCRIPTORS INTRODUCTIONAfter more than thirty years since the Alma Ata Conference, Primary Health Care (APS) has consolidated as one of the most equitable and efficient ways to organize a health system (1) by advocating equitable care with quality to the population, among other benefits. The Pan American Health Organization (PAHO) defines Primary Health Care as a "strategy for organizing health care systems in order to enable universal access to services and comprehensive and integrated care over time" (1)(2) .At the national level, the Ministry of Health adopted the Family Health Strategy (ESF) in 1994 to reorganize the Unified Health System (SUS) and expand the APS. According to the Ministry of Health in Brazil (3) , the number of family health teams deployed and funding for the expansion of the ESF have both increased, reaching/covering 52.1% of the Brazilian population.The scientific literature provides evidence of the association between greater APS orientation and increasing the effectiveness of health systems, promotion of fairness, user satisfaction and efficiency (4) . It is noteworthy that most of the studies are centered on the health systems of developed countries (4) . However, there is evidence of the positive impact of APS on the health systems of developing countries, primarily those which are located in Latin America.On the international scene, it has been observed (5-6) that increasing ESF coverage is linked to reducing infant mortality and promoting greater equity. Such evidence is present in the national results (7)(8) , studies which also indicate a higher quality of prenatal care, child care, offering use of health services, although in a low effectiveness context ...

Processos organizacionais na Estratégia Saúde da Família: uma análise pelos enfermeiros

“…(4) Favorable results are highlighted for its implementation in FHS units, however, contradictions are identified in the establishment of some principles such as longitudinally, community guidance, among others. (11) The incipience in this dimension confirms a study that identified an inappropriate level of apprehension and knowledge of the principles and guidelines of the FHS, demonstrating difficulty of progress towards its implementation. (12) These data demonstrate that continuous education for FHS teams is necessary, such as specialization degrees and residency programs in family health, for optimizing the approach of the health-disease process.…”

“…However, it is essential that actors and institutions responsible for education of mid-level professionals and higher education work to strengthen the principles of PHC in the practice of future professionals. (11) With regard to the local diagnosis, the results detected on the registration of the territorial population and the risk stratification of families, reinforces the importance of the CHWs as members of the health team, as recommended by the national primary health care policy of Brazil. (4) The incipient result of this dimension indicates that the moments of the work process can be more exploited for data collection and updating of the territory/families.…”

Atenção primária à criança com diabetes mellitus tipo 1: perspectiva de cuidadores

“…(25) These findings are in agreement with other studies with a context of children's health. (19,14,(20)(21)(22) Although the Derivative and Essential Elements scores did not attain satisfactory values, the specialized services presented better results than the PHC services, showing that, from the perception of the consumers significant differences between the services. The specialized services were perceived as regular sources of care, and better providers of health practices, based on the attributes of PHC.…”

“…(18) The attribute, Family Orientation, presupposes greater interaction between health professionals and the family, and the recognition of the potential of the family context being of extreme importance for comprehensive care.. (14) In the present investigation, this attribute attained an unsatisfactory score, indicating that health actions aimed at the family context are fragile and poorly recognized, corroborating other evaluative studies related to the child's health, which obtained similar results. (14,(19)(20)(21)(22) . Family health care with poor orientation can also lead to fragility of comprehensiveness; if the life contexts of individuals and their families are not perceived or known, the involvement and concern for extended care, with commitment to all their needs, may not be effective.…”

Orientação comunitária e enfoque familiar: avaliação de usuários e profissionais da estratégia saúde da família

“…Questionar as percepções da família da criança sobre a terapêutica realizada é uma forma de valorizá-la e corresponsabilizá-la pelo tratamento. Entretanto, perguntar a opinião dos cuidadores das crianças parece não ser uma prática rotineira nas ESFs estudadas, semelhantemente ao observado em outro estudo sobre o tema com menores de dois anos assistidos em serviços da atenção básica do município de Colombo (PR) 19 . Para uma atenção com enfoque na família, os profissionais de saúde devem conhecer as ferramentas de abordagem familiar 2 , a fim de reconhecerem problemas e compor o histórico de saúde da criança.…”