Evaluation of micro-level managementof older person carein primary healthcenters in a health region in the Federal District of Brazil

Sacco, Ruth da Conceição Costa e Silva; Cardoso, Paulo Ricardo dos Ramos; Escalda, Patrícia Maria Fonseca; Assis, Marcella Guimarães; Guimarães, Sílvia Maria Ferreira

doi:10.1590/1413-81232018246.08332019

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ARTICLE • Ciênc. saúde colet. 24 (6) • June 2019 • https://doi.org/10.1590/1413-81232018246.08332019 copy

Evaluation of micro-level managementof older person carein primary healthcenters in a health region in the Federal District of Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Primary health centers (PHCs) should consider the demographic and epidemiological profile of the health region to respond to population aging and structure service delivery around networks based on macro and micro-level management to ensure the provision of comprehensive services. A normative evaluation of micro-level management in four PHCs in a health region in the Federal District of Brazil was conducted to inform the development of recommendations for enhancing the delivery of comprehensive and integrated long-term care for older persons. A management evaluation matrix was used where management stages were classified as advanced, intermediate and incipient. The findings show that none of the PHCs were at the advanced stage, three were at the intermediate stage, and one at the incipient stage. The lowest scores were obtained for the subdimensions care model (which was shown to be predominantly traditional) and humanization (fragmentation of care). Lack of infrastructure and staff absenteeism were shown to be constraining factors, while effective communication with local administrators was as facilitating factor. Improvements need to be made in micro-level management to enhance the delivery of comprehensive and timely care to older persons in this health region.

Keywords
Elderly Health; Health Services; Health Care Delivery; Health Management; Health Evaluation

Dimensions	Subdimensions	Observed criteria	Operational concept
Management of health condition	Care model	Stratification of population risk.	Implies a shift from a healthcare model focused on the individual, cure, and rehabilitation towards a territorial-based approach with the identification of at risk individuals, focus on health promotion and protection, and early intervention to achieve better outcomes and lower costs.
		Use of clinical guidelines.
		Analysis of situation and risk surveillance.
		Healing and rehabilitation actions.
	Comprehensiveness of care	Existence of intersectoral actions.
	Comprehensiveness of care	Existence various points of healthcare.
Case management	Humanization	Elaboration and use of individualized treatment plans.	Dynamic and personalized relationship established between the professional responsible for the case and patient for the planning, monitoring, and evaluation of actions and services according to patient needs in order to promote quality humanized care.
	Humanization	Fragmentation of care.
	Coordination of care	Existence of referral and back referral flows.
		Adequate routine use of referral and back referral flows.
		Return and continuity of care of patients discharged from other levels of care.
	Planning, monitoring, and evaluation of actions and services	Situational health planning practices.
		Regular planning used as a management instrument.
		Timely provision of services to patients.
		Response to patients’ needs and expectations.
Clinical audit	Implicit auditing	Expert opinion to evaluate healthcare practices.	Critical and systematic appraisal of quality of healthcare, including aspects related to diagnosis and treatment, use of resources, and outcomes at all points of care, observing the use of established clinical protocols.
	Explicit auditing	Clinical guideline-based evaluation.
	Explicit auditing	Sentinel event-based evaluation.
Waiting lists	Rationalization of access	Organization of patients into waiting lists based on needs and risks.	Involves the establishment of rules and regulations for the use of services in some points of care, with needs and risk-based organization criteria. Aims to promote a balance between supply and demand.
Waiting lists	Rationalization of access	Transparency in the use of waiting lists.

Dimensions	Subdimensions	Maximum Score	Classification
Health Condition Management	Care model	25	Advanced: > 66.6%
Health Condition Management	Comprehensiveness of care	10
Case Management	Humanization	10
	Coordination of care	15
	Planning, monitoring, and evaluation of actions and services	15	Intermediate: > 33.3% and ≤ 66.6%
Clinical Audit	Implicit auditing	5	Intermediate: > 33.3% and ≤ 66.6%
Clinical Audit	Explicit auditing	10	Incipient: ≤ 33.3%
Waiting Lists	Rationalization of access	10	Incipient: ≤ 33.3%
Total		100

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborators

RCCS Sacco participated in project conception, data collection, analysis, and interpretation, and drafted and approved the final version of the text to be published. PRR Cardoso participated in results interpretation and drafting the text. PMF Escalda, MG Assis and SMF Guimarães contributed to data interpretation and the critical revision and approval of the version of the text to be published.