Evaluation of at-risk infant care: comparison between models of primary health care

Abstract

OBJECTIVES To analyze the health care network for at-risk infants in the western region of the city of São Paulo, with the primary health care as coordinator, and to compare the presence and extension of attributes of primary health care in the services provided, according to the service management model (Family Health Strategy and traditional basic health units).METHODS A survey was conducted with all at-risk infants born in the western region of São Paulo between 2013 and 2014. The children were then actively searched for a later application of the PCATool – child version. The total of 233 children were located in the territory; 113 guardians agreed to participate, and 81 composed the final sample.RESULTS Regarding the results of PCATool for overall and essential scores, the units with Family Health Strategy were better evaluated by users, when compared with traditional basic health units, showing a statistically significant difference. However, these scores were low for both management models. Regarding attributes, the Family Health Strategy presented better performance compared with traditional basic health units for most of them, except for coordination of information systems. Of ten assessed attributes, seven reached values ≥6.6 for Family Health Strategy and two for the traditional basic health unit.CONCLUSIONS Regardless of the type of management model, low overall and essential scores were found, indicating that guardians of at-risk infants rated some attributes as unsatisfactory, with emphasis on accessibility, integrality and family guidance. Such a performance may have negative consequences for the quality and integrality of these infants’ health care.

Strengths and weaknesses in the high-risk baby care network

“…To this end, the identification of high risk for pregnant women and/or fetus must be carried out from the first consultation and must be reviewed at each return visit, i.e., continuously. The team must keep informed through the counter-referral of other health equipment and also through the active search of pregnant women in their territory of operation (20)(21)(22) .…”

“…Therefore, awareness of prenatal care, childbirth and postpartum information, as well as its formal registration, done properly, becomes essential for an effective work by FHS. The moment of prenatal care is highly representative in premature labor prevention, such as the identification of high-risk factors, actions to prevent injuries, conventional and protocol care practices and health promotion actions (19)(20)(21)(22)(23) .…”

“…In this research, the beginning of the flow or prenatal period was called the set of questions applied about the events that occurred with subjects in health services during the entire prenatal period. Among these issues, it can be observed that only three variables showed a statistically significant difference, apparently indicating a divergence of responses between the two groups: having a link with according to pre-established high-risk criteria (20)(21)(22)(23)(24)(25) . The NASF team will also be able to participate in this process as a support team for FHS so that it takes place in time and satisfactorily, in order to contribute to the broader perspective of different professional categories (20)(21)(22)(23)(24)(25)(26) .…”

Atributos da Atenção Primária à Saúde e fatores associados na perspectiva de cirurgiões-dentistas

“…Se ha realizado el análisis de asociación y regresión logística binaria utilizándose las variables profesionales y el valor de la extensión de los atributos. Resultados: A partir de la muestra de 50 cirujanos dentistas vinculados a la Atención Primaria de Salud, los resultados indicaron que los servicios de salud bucal tienen fuerte orientación para la Atención Primaria de Salud (7,22) con la más baja puntuación para el atributo acceso (3,48) y la mayor para el atributo integralidad -servicios ofrecidos (9,70). El mayor valor de los atributos se asoció con el aumento del valor del sueldo bruto y con el hecho de no tener otra actividad de pago.…”

“…O PCATool é reconhecido e validado em outros países, além de apresentar uma avaliação segura sobre a APS, visto que o questionário permite a coleta de informações que possibilitam mensurar seu caráter operacional, prático e estrutural (7) . É importante destacar que, quando há profissionais com orientação mais forte para APS, se observa maior probabilidade de melhores níveis de saúde a custos mais baixos, além de melhores indicadores de saúde (6) .…”