Avaliação da qualidade dos serviços públicos de atenção primária à saúde em Fortaleza-CE

Abstract

In Brazil, PHC aims to be the gateway to the Universal Health System (SUS) and its structuring axis. For this, it is necessary to strengthen its attributes systematized by Barbara Starfield. The PCATool (Primary Care Assessment Tool) is an instrument validated for Brazil that allows the evaluation of health services from the user's perspective. The present study has as main objective to evaluate the quality of public services of Primary Care in Fortaleza, Ceará, from the perspective of adult users regarding the attributes of PHC through the scores obtained with the PCATool. A cross-sectional study with a quantitative approach was carried out between June and December 2019 with a sample of 233 adult users registered in the FHS of 19 Primary Health Care Units (UAPS) from 5 Regional Health Districts in Fortaleza. Participants answered the PCATool Brazil version for adult users (87 items divided into 10 components related to PHC attributes, which generate a score ranging from 0 to 10) and a questionnaire on sociodemographic and epidemiological characteristics. Data on the UAPS structure and work processes were also collected. The data were tabulated using Microsoft Excel 2016 software. Then, they were imported into the statistical software IBM-SPSS (Statistical Package for the Social Sciences) version 24, for due analytical treatment. The calculation of independent quantitative variables (PCATool scores for each interviewed user and the average scores of each UAPS) and independent categorical variables (sociodemographic and epidemiological characteristics of users and structural characteristics of UAPS) were performed. Descriptive statistics were used in tabular form, where the frequencies and percentages of categorical variables were counted, in the mean quantitative with their respective 95% confidence interval were calculated. After initial data evaluations, statistical methods were applied to verify associations and correlations between variables. For comparisons between means, the KruskalWallis non-parametric method was used. Finally, multilevel linear regression modeling was applied to analyze the predictive factors that are capable of explaining the PHC score. A 5% level of significance was adopted. The study presents the opinion of the Research Ethics Committee of the Federal University of Ceará with approval (No. 3,705,918). The participants were mostly women (69.5%), aged between 30 and 59 years (55.3%), mixed-race, with complete secondary education (38.2%), who did not have a private health plan (89.3%), homeowners (68.7%), house type (88%) and belonging to families of up to 4 members (87.9%). The “First Contact Access - Accessibility” component had the lowest score, 2.8, and the “First Contact Access -Use” component, which had the highest score, 8.1. The other attributes had thefollowing score: “Coordination - Integration of care” 7.0; “Coordination - Information system” 5.90; “Comprehensiveness - Services available 5.3; “Integrality - Services provided” 3,6; “Family orientation” 4,9; and “Community orientation” 4.0. The PHC Essential Score (average of the first eight components) was 6.0, while the General Score (average of all attributes) was 5.7. Also, the factors (p <0.05 in the multilevel model) had a positive influence on the General Score: complete Family Health teams, a greater number of Community Health Agents and the presence of the Family and Community Medicine Program. It is concluded that public services in Fortaleza have low PHC performance from the perspective of adult users, as they did not reach the cut-off point of 6.60 to be considered igh performance. A series of strategies can be implemented to improve the quality of PHC in Fortaleza and, consequently, user satisfaction, such as increased financing, expanded access, offering comprehensive health actions and services, expanding the clinical-care performance of all professionals health teams, expansion of full computerization of the assistance network, improvement of the regulation system, optimization of the supply of human resources with qualified training, assistance support to health teams and encouragement of the participation of people and social actors and the evaluation of services.