Estrutura das unidades básicas de saúde para atenção às pessoas com diabetes: Ciclos I e II do Programa Nacional de Melhoria do Acesso e da Qualidade

Abstract

The objective was to describe the necessary structure for treating diabetes patients in the primary healthcare system, as evaluated in Cycles I and II of the Brazilian National Program for the Improvement of Access and Quality (PMAQ) in 2012 and 2014, according to the municipalities' characteristics. A descriptive study was used to assess primary care units whose teams participated in Cycles I and II of the PMAQ in 2012 and 2014. The study used variables from Module I of the external evaluation of the PMAQ that addresses the primary care units' structure. Materials (150kg scale, sphygmomanometer, adult stethoscope, tape measure, blood glucose monitor, monofilament packs, ophthalmoscope, and capillary blood glucose strips); medicines (NPH and regular insulin, glyburide, and metformin); and physical space (clinical consultation room, pharmacy, reception/waiting room, and meeting room). All the medicines and the reception/waiting room increased by more than 10p.p. from 2012 to 2014. The prevalence rates for adequate structure of materials, medicines, and physical space in the primary care units were higher in 2014. Adequate structure increased as follows: for materials, from 3.9% to 7.8%, for medicines, from 31.3% to 49.9%, for physical space, from 15.3% to 23.3%. Municipalities with more than 300,000 inhabitants, higher Human Development Index (HDI), and lower coverage of the Family Health Strategy (FHS) showed higher prevalence rates for adequate primary care units. Units that adhered to Cycles I and II of the PMAQ showed improvement in their structures. However, there was a low prevalence of primary care units with adequate structures, besides differences in the services' structure according to population size, HDI, and FHS coverage.

Avaliação da satisfação de usuários da Atenção Básica portadores de hipertensão e diabetes

“…Romero et al (2016) ao avaliar a satisfação de usuários da atenção primária a saúde na Espanha, também identificou um aumento gradual da satisfação com o incremento da idade, e relata que este resultado independe da cultura, do país e do tipo de organização do serviço, podendo ser justificado pela maior necessidade e uso do serviço e pelo sentimento de gratidão acerca do cuidado recebido. Donabedian (2005) propôs a tríade estrutura, processo de trabalho e resultados para avaliar a qualidade dos serviços de saúde, sendo a infraestrutura e o processo de trabalho adequados indispensáveis para alcançar resultados satisfatórios na situação de saúde dos indivíduos e em seus níveis de satisfação (3,25). Estudos realizados no Brasil e no exterior para avaliação da satisfação dos usuários com o serviço ofertado na atenção básica também evidenciaram relação direta entre melhoria da infraestrutura do estabelecimento e do processo de trabalho das equipes e maior a satisfação manifestada pelos usuários (19,(26)(27).…”

Atualização intercensitária de estratificação de municípios brasileiros para avaliação de desempenho em saúde, 2015

“…Stratification seeks to increase the alternatives frequently used by researchers and services, based solely on population size [2][3][4] or who use, separately, another factor such as the municipal human development index (HDI-M) or Family Health Strategy coverage. [20][21][22] Based on the analysis presented, these options appear to be insufficient for indentifying homogenous strata of municipalities.…”

Qualidade da Atenção Primária à Saúde no Brasil: avanços, desafios e perspectivas

“…In 2005, about 70% of the BHU evaluated in cities with over 100.000 inhabitants in the Northeast and South regions, in the Baseline Study of Proesf, had structural problems and deficiencies 54 , in contrast to the external evaluation of PMAQ in 2012, which found 15% of the total BHU in the Country in poor infrastructure conditions, mainly installations and inputs 53 . Neves et al 37 , when analyzing the structure of BHU to care for people with diabetes between cycles 1 and 2 of PMAQ, observed that the prevalence of adequate structure of materials, medicines and physical were higher in 2014, compared to 2012. The adequate material and equipment went from 3.9% to 7.8%; medicines, from 31.3% to 49.9%; and service infrastructure, from 15.3% to 23.3%.…”

“…In 2011, the quality theme gained a major boost in the Brazilian PC with the implementation of the Access and Quality Improvement Program (PMAQ), which institutionalized the financial incentive of the MH to improve the standard of care offered to the user of the SUS in the Basic Health Units (BHU) and through family health teams 16,34,35 . The external evaluation of the PMAQ, conducted by a network of more than 40 universities and federal research centers, has promoted the expansion of the conceptions of Donabedian and Starfield 16 , when facing multiple theoretical and methodological challenges to estimate the quality of PHC services in Brazil 3,17,36,37 .…”