Análise da efetividade do acesso e utilização dos serviços de saúde de pacientes com COVID-19

Abstract

Throughout the COVID-19 pandemic, several factors directly influenced the access and use of health services by patients with COVID-19. Thus, the general objective is to evaluate the effectiveness of access and use of health services by patients diagnosed with COVID-19 in the Brazilian Northeast. Analytical, cross-sectional study with a quantitative approach, developed in three states (Ceará, Maranhão and Pernambuco), with a sample of 968 patients. Data collection carried out from August 2021 to March 2022, using the Software for monitoring patients with COVID-19, which generated a link and sent it to the patient through the telephone message application, containing two instruments: Sociodemographic data and social determinants of (DSS) and the Primary Care Assessment Tool (PCATool-Brasil), which was adapted to assess the effectiveness of access and use of health services by people with COVID-19. This instrument has 58 items, divided into nine domains, classified as High (score ≥ 6.6) and Low (score < 6.6), whose high value reveals better patterns of access and use of health services. The chi-square test was used for comparative analysis of the PCATool domains with DSS. Study approved by the ethics and research committee. As a result, there was a predominance of females (59.9%); young adult (49.1%), with a mean age of 42.7±15.3 years; non-white skin color (72.3%). Comparing the DSS with the PCATool domains, there was a significant difference (p<0.05) in some domains when compared with age, race, tobacco use, body mass index, states of residence, origin, education, employment relationship employment, services close to home, first service, income and means of transport. The overall score obtained an average of 3.71 and an essential score of 3.70, characterizing low scores. Ceará had the highest averages in the general (5.90±1.70) and essential (6.14±1.22) scores, with three domains with a score ≥ 6.6, namely: use (6.75±1.46 ), accessibility (6.62±1.57) and available services (7.13±1.90). Maranhão had lower averages in the general score (3.26±1.35), essential score (3.20±0.98) and in all domains. Pernambuco had low averages in the overall score (5.47±1.66) and in the essential score (5.70±1.24), whose only domain with a high average score was available services (6.91±2.25) . In evaluating the indicators of the effectiveness of access and use of health services, most patients stated that they managed to get a consultation on the same day (87.2%) and considered the service easy (86.5%) and satisfactory (83.4% ). However, few stated the existence of referral and counter-referral actions/services (17%). It is concluded that the effectiveness of access and use of health services had low scores, characterizing low effectiveness of health services in caring for patients with COVID-19. In addition, it directly depends on several factors, which are individual, cultural, social and also correlated with the structural and organizational aspects of the health services offered by the three states of the Brazilian Northeast.