Coordination between Primary Care Teams and Family Health Support Units and influence on Primary Care delivery

Brito, Geraldo Eduardo Guedes de; Forte, Franklin Delano Soares; Freire, Júlio César Guimarães; Moreira, Lorrane Brunelle; Paredes, Suyene de Oliveira; Silva, Silvia Lanziotti Azevedo da

Geraldo Eduardo Guedes de Brito

Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade Federal da Paraíba (UFPB). Campus I, Lot. Cidade Universitária. 58051-900 João Pessoa PB Brasil. geraldo.eduardo@academico.ufpb.br

Programa de Pós-Graduação em Saúde Coletiva, Faculdade de Medicina, Departamento de Saúde Coletiva, Universidade Federal de Juiz de Fora. Juiz de Fora MG Brasil.

http://orcid.org/0000-0002-3059-3164

Franklin Delano Soares Forte

Programa de Pós-Graduação em Odontologia, Centro de Ciências da Saúde, UFPB. João Pessoa PB Brasil.

http://orcid.org/0000-0003-4237-0184

Júlio César Guimarães Freire

Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade Federal da Paraíba (UFPB). Campus I, Lot. Cidade Universitária. 58051-900 João Pessoa PB Brasil. geraldo.eduardo@academico.ufpb.br

http://orcid.org/0000-0002-4287-3278

Lorrane Brunelle Moreira

Programa de Pós-Graduação em Ciências da Reabilitação, Instituto de Ciências da Motricidade, Universidade Federal de Alfenas. Alfenas MG Brasil.

http://orcid.org/0000-0002-6754-2184

Suyene de Oliveira Paredes

Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade Federal da Paraíba (UFPB). Campus I, Lot. Cidade Universitária. 58051-900 João Pessoa PB Brasil. geraldo.eduardo@academico.ufpb.br

http://orcid.org/0000-0002-8068-5729

Silvia Lanziotti Azevedo da Silva

Programa de Pós-Graduação em Saúde Coletiva, Faculdade de Medicina, Departamento de Saúde Coletiva, Universidade Federal de Juiz de Fora. Juiz de Fora MG Brasil.

http://orcid.org/0000-0002-2323-2029

Collaborations

GEG Brito participated in the conception and design of the study, organization of data, and participation of the discussion of the study’s results; critical revision of its contents; approving the manuscript’s final version. FDS Forte participated in the conception and design of the study and participation of the discussion of the study’s results; critical revision of its contents; approving the manuscript’s final version. JCG Freire participated in the discussion of the study’s results; critical revision of its contents; approving the manuscript’s final version. LB Moreira participated in the discussion of the study’s results; critical revision of its contents; approving the manuscript’s final version. SO Paredes participated in the discussion of the study’s results; critical revision of its contents; approving the manuscript’s final version. SLA Silva participated in the conception and design of the study, organization of data, statistical analysis, and participation of the discussion of the study’s results; critical revision of its contents; approving the manuscript’s final version.

Chief editors:

Romeu Gomes, Antônio Augusto Moura da Silva

Questions		Northeast “Yes” N (%)	Brazil “Yes” N(%)	p
Block 1: Coordination with other points of care
	Actions/meetings with other health services (e.g. PSCC, polyclinics)	7,704 (66.2)	18,100 (66.5)	0.518
	Actions/meetings with other sectors (e.g. SARC, SSARC, school)	9,384 (80.5)	21,484 (78.9)	0.000*
	Participation in local health council meetings or other spaces of public participation	7,132 (61.2)	15,490 (56.9)	<0.000*
Block 2: Organization of demand
	Organization of demand for individual appointments	10,631 (91.3)	24,412 (89.7)	0.001*
	Organization of demand for home appointments	10,777 (92.5)	24,967 (91.7)	0.007*
	Management of referrals and/or specialist appointment waiting lists	8,343 (71.6)	18,415 (67.6)	<0.000*
	Definition of access criteria, case prioritization, staff roles and responsibilities	9,707 (83.3)	21,901 (80.4)	<0.000*
	Analysis of requests for support, identifying main demands	9,834 (84.4)	22,344 (82.1)	<0.000*
Block 3: Improving care quality
	Case conferences	10,802 (92.7)	25,429 (93.4)	0.017*
	Joint construction of singular therapy plans for complex cases	8,066 (69.2)	18,229 (66.9)	0.001*
	Analysis of concluded cases treated by the NASF	9,593 (82.3)	21,729 (79.8)	<0.000*
Block 4: Care delivery
	Shared appointments with professionals from the NASF and FH/PC teams	10,382 (89.1)	23,923 (87.9)	0.000*
	Shared appointments with professionals from the NASF team	9,967 (85.6)	22,548 (82.8)	<0.000*
	Health education activities	11,095 (95.2)	25,319 (93.0)	<0.000*
	Therapy groups	9,106 (78.2)	21,374 (78.5)	0.472
	Health surveillance	9,452 (81.8)	20,964 (77.0)	<0.000*
Block 5: Improving work processes
	Continuing education for FH/PC teams	9,809 (84.2)	21,904 (80.4)	<0.000*
	Discussions about FH/PC team work process	9,638 (82.7)	21,436 (78.7)	<0.000*
	Results monitoring	9,398 (80.7)	20,608 (75.7)	<0.000*

Collaborative working		Readiness¹		Support²		Resolvability³
Mean (±standard deviation)		9.15(±1.34)		9.03 (±1.02)		8.79 (±2.33)
Coordinated actions		Beta	p	Beta	p	Beta	p
Block 1: Coordination with other points of care
	Intercept	8.65	<0.000	8.20	<0.000	8.03	<0.000
	Actions/meetings with other health services (e.g. PSCC, polyclinics)	0.19	<0.000	0.23	<0.000	0.23	<0.000
	Actions/meetings with other sectors (e.g. SARC, SSARC, school)	0.29	<0.000	0.58	<0.000	0.48	<0.000
	Participation in local health council meetings or other spaces of public participation	0.22	<0.000	0.33	<0.000	0.33	<0.000
	Adjusted R-squared	5.4%			10.5%		9.3%
Block 2: Organization of demand
	Intercept	8.17	<0.000	7.33	<0.000	7.32	<0.000
	Organization of demand for individual appointments	0.25	<0.000	0.55	<0.000	0.47	<0.000
	Organization of demand for home appointments	0.36	<0.000	0.61	<0.000	0.50	<0.000
	Management of referrals and/or specialist appointment waiting lists	0.25	<0.000	0.33	<0.000	0.34	<0.000
	Definition of access criteria, case prioritization, staff roles and responsibilities	0.18	<0.000	0.17	<0.000	0.15	0.009
	Analysis of requests for support, identifying main demands	0.08	0.011	0.28	<0.000	0.22	<0.000
	Adjusted R-squared	7.1%			14.3%		11.6%
Block 3: Improving care quality
	Intercept	8.21	<0.000	7.41	<0.000	7.45	<0.000
	Case conferences	0.46	<0.000	0.87	<0.000	0.65	<0.000
	Joint construction of singular therapy plans for complex cases	0.36	<0.000	0.46	<0.000	0.44	<0.000
	Analysis of concluded cases treated by the NASF	0.30	<0.000	0.59	<0.000	0.51	<0.000
	Adjusted R-squared	8.7%			16.9%		12.9%
Block 4: Care delivery
	Intercept	8.09	<0.000	7.16	<0.000	7.26	<0.000
	Shared appointments with professionals from the NASF and FH/PC teams	0.40	<0.000	0.65	<0.000	0.49	<0.000
	Shared appointments with professionals from the NASF team	0.13	0.003	0.30	<0.000	0.27	<0.000
	Health education activities	0.17	0.000	0.40	<0.000	0.24	0.005
	Therapy groups	0.29	<0.000	0.36	<0.000	0.33	<0.000
	Health surveillance	0.22	<0.000	0.45	<0.000	0.42	<0.000
	Adjusted R-squared	8.2%			17.2%		13.4%
Block 5: Improving work processes
	Intercept	0.38	<0.000	7.72	<0.000	7.66	<0.000
	Continuing education for FH/PC teams	0.25	<0.000	0.48	<0.000	0.40	<0.000
	Discussions about FH/PC team work process	0.27	<0.000	0.49	<0.000	0.35	<0.000
	Results monitoring	0.39	<0.000	0.61	<0.000	0.59	<0.000
	Adjusted R-squared	7.7%		16.0%		12.58%

Intercept		Model 1 Beta (p)	Model 2 Beta (p)	Model 3 Beta (p)	Model 4 Beta (p)
Intercept		8.13 (<0.000)	7.96 (<0.000)	7.86 (<0.000)	7.88 (<0.000)
Block 1: Coordination with other points of care
	Actions/meetings with other health services (e.g. PSCC. polyclinics)	0.12 (<0.000)	0.09 (0.004)	0.08 (0.000)	0.07 (0.000)
	Actions/meetings with other sectors (e.g. SARC. SSARC. school)	0.12 (0.005)	0.07 (0.014)	0.04 (0.184)	0.03 (0.310)
	Participation in local health council meetings or other spaces of public participation	0.14 (<0.000)	0.09 (<0.000)	0.08 (0.007)	0.07 (0.000)
Block 2: Organization of demand
	Organization of demand for individual appointments	0.22 (<0.000)	0.15 (0.000)	0.11 (0.003)	0.09 (0.013)
	Organization of demand for home appointments	0.33 (<0.000)	0.20 (<0.000)	0.13 (0.002)	0.12 (0.005)
	Management of referrals and/or specialist appointment waiting lists	0.17 (<0.000)	0.12 (<0.000)	0.11 (<0.000)	0.09 (0.000)
	Definition of access criteria. case prioritization. staff roles and responsibilities	0.11 (0.001)	0.05 (0.150)	0.03 (0.363)	0.01 (0.606)
	Analysis of requests for support. identifying main demands	0.02 (0.524)	-0.09 (0.008)	-0.12 (0.001)	-0.14 (0.000)
Block 3: Improving care quality
	Case conferences		0.36 (<0.000)	0.29 (<0.000)	0.26 (<0.000)
	Joint construction of singular therapy plans for complex cases		0.25 (<0.000)	0.20 (<0.000)	0.19 (<0.000)
	Analysis of concluded cases treated by the NASF		0.13 (0.004)	0.10 (0.001)	0.02 (0.401)
Block 4: care delivery
	Shared appointments with professionals from the NASF and FH/PC teams			0.24 (<0.000)	0.23 (<0.000)
	Shared appointments with professionals from the NASF team			0.00 (0.902)	-0.01 (0.748)
	Health education activities			0.06 (0.174)	0.04 (0.390)
	Therapy groups			0.11 (0.001)	0.10 (<0.000)
	Health surveillance			0.04 (0.159)	0.01 (0.630)
Block 5: Improving work processes
	Continuing education for FH/PC teams				0.06 (0.064)
	Discussions about FH/PC team work process				0.04 (0.130)
	Results monitoring				0.16 (<0.000)
	Adjusted R-squared	8.2%	10.3%	10.9%	11.1%
	VIF*	<10	<10	<10	<10

Intercept		Model 1 Beta(p)	Model 2 Beta(p)	Model 3 Beta(p)	Model 4 Beta(p)
Intercept		7.25 (<0.000)	6.93 (<0.000)	6.71 (<0.000)	6.75 (<0.000)
Block 1: Coordination with other points of care
	Actions/meetings with other health services (e.g. PSCC, polyclinics)	0.12 (<0.000)	0.08 (0.000)	0.06 (0.011)	0.05 (0.030)
	Actions/meetings with other sectors (e.g. SARC, SSARC, school)	0.30 (<0.000)	0.22 (<0.0000)	0.15 (0.000)	0.13 (0.006)
	Participation in local health council meetings or other spaces of public participation	0.21 (<0.000)	0.14 (<0.000)	0.12 (0.000)	0.10 (0.001)
Block 2: Organization of demand
	Organization of demand for individual appointments	0.50 (<0.000)	0.38 (<0.000)	0.29 (<0.000)	0.26 (<0.000)
	Organization of demand for home appointments	0.56 (<0.0000)	0.34 (<0.000)	0.20 (0.004)	0.17 (0.000)
	Management of referrals and/or specialist appointment waiting lists	0.20 (<0.000)	0.13 (0.000)	0.09 (0.000)	0.07 (0.011)
	Definition of access criteria, case prioritization, staff roles and responsibilities	0.05 (0.139)	-0.05 (0.181)	-0.09 (0.012)	-0.12 (0.001)
	Analysis of requests for support, identifying main demands	0.17 (<0.000)	-0.04 (0.327)	-0.10 (0.012)	-0.13 (0.000)
Block 3: Improving care quality
	Case conferences		0.67 (<0.000)	0.54 (<0.000)	0.50 (<0.000)
	Joint construction of singular therapy plans for complex cases		0.30 (<0.000)	0.22 (<0.000)	0.19 (<0.000)
	Analysis of concluded cases treated by the NASF		0.30 (<0.000)	0.23 (<0.000)	0.12 (0.001)
Block 4: Care delivery
	Shared appointments with professionals from the NASF and FH/PC teams			0.39 (<0.000)	0.37 (<0.000)
	Shared appointments with professionals from the NASF team			0.07 (0.033)	0.06 (0.0890)
	Health education activities			0.19 (0.000)	0.13 (0.013)
	Therapy groups			0.12 (0.003)	0.10 (0.000)
	Health surveillance			0.18 (0.000)	0.13 (0.009)
Block 5: Improving work processes
	Continuing education for FH/PC teams				0.16 (0.000)
	Discussions about FH/PC team work process				0.10 (0.005)
	Results monitoring				0.23 (<0.000)
	Adjusted R-squared	16.4%	20.2%	21.7%	22.2%
	VIF*	<10	<10	<10	<10

Intercept		Model 1 Beta (p)	Model 2 Beta (p)	Model 3 Beta (p)	Model 4 Beta (p)
Intercept		7.25 (<0.000)	7.02 (<0.000)	6.91 (<0.000)	6.94 (<0.000)
Block 1: Coordination with other points of care
	Actions/meetings with other health services (e.g. PSCC, polyclinics)	0.14 (<0.000)	0.10 (0.002)	0.09 (0.000)	0.08 (0.001)
	Actions/meetings with other sectors (e.g. SARC, SSARC, school)	0.25 (<0.000)	0.19 (<0.000)	0.13 (0.007)	0.11 (0.000)
	Participation in local health council meetings or other spaces of public participation	0.22 (<0.000)	0.16 (<0.000)	0.15 (<0.000)	0.13 (<0.000)
Block 2: Organization of demand
	Organization of demand for individual appointments	0.43 (<0.000)	0.33 (<0.000)	0.27 (<0.000)	0.25 (<0.000)
	Organization of demand for home appointments	0.45 (<0.000)	0.28 (<0.000)	0.18 (0.000)	0.17 (0.000)
	Management of referrals and/or specialist appointment waiting lists	0.21 (<0.000)	0.16 (<0.0000)	0.13 (0.000)	0.10 (0.000)
	Definition of access criteria, case prioritization, staff roles and responsibilities	0.04 (0.296)	-0.04 (0.225)	-0.08 (0.035)	-0.10 (0.009)
	Analysis of requests for support, identifying main demands	0.11 (0.004)	-0.05 (0.163)	-0.10 (0.011)	-0.13 (0.000)
Block 3: Improving care quality
	Case conferences		0.47 (<0.000)	0.38 (<0.000)	0.35 (<0.000)
	Joint construction of singular therapy plans for complex cases		0.28 (<0.000)	0.21 (<0.000)	0.19 (<0.000)
	Analysis of concluded cases treated by the NASF		0.23 (<0.000)	0.18 (<0.0000)	0.07 (0.067)
Block 4: Care delivery
	Shared appointments with professionals from the NASF and FH/PC teams			0.27 (<0.000)	0.25 (<0.000)
	Shared appointments with professionals from the NASF team			0.06 (0.073)	0.05 (0.114)
	Health education activities			0.07 (0.202)	0.03 (0.551)
	Therapy groups			0.11 (0.009)	0.09 (0.000)
	Health surveillance			0.16 (0.000)	0.13 (0.000)
Block 5: Improving work processes
	Continuing education for FH/PC teams				0.12 (0.000)
	Discussions about FH/PC team work process				0.02 (0.554)
	Results monitoring				0.26 (<0.000)
	Adjusted R-squared	13.6%	16.15%	16.99%	17.4%
	VIF*	<10	<10	<10	<10

[1] Collaborations

GEG Brito participated in the conception and design of the study, organization of data, and participation of the discussion of the study’s results; critical revision of its contents; approving the manuscript’s final version. FDS Forte participated in the conception and design of the study and participation of the discussion of the study’s results; critical revision of its contents; approving the manuscript’s final version. JCG Freire participated in the discussion of the study’s results; critical revision of its contents; approving the manuscript’s final version. LB Moreira participated in the discussion of the study’s results; critical revision of its contents; approving the manuscript’s final version. SO Paredes participated in the discussion of the study’s results; critical revision of its contents; approving the manuscript’s final version. SLA Silva participated in the conception and design of the study, organization of data, statistical analysis, and participation of the discussion of the study’s results; critical revision of its contents; approving the manuscript’s final version.

Brasil

Brasil

Coordination between Primary Care Teams and Family Health Support Units and influence on Primary Care delivery

Abstract