La longitudinalidad en la Atención Primaria a la Salud: comparación entre modelos asistenciales

Kessler, Marciane; Lima, Suzinara Beatriz Soares de; Weiller, Teresinha Heck; Lopes, Luís Felipe Dias; Ferraz, Lucimare; Thumé, Elaine

doi:10.1590/0034-7167-2017-0014

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RESEARCH • Rev. Bras. Enferm. 71 (3) • May-Jun 2018 • https://doi.org/10.1590/0034-7167-2017-0014 copiar

La longitudinalidad en la Atención Primaria a la Salud: comparación entre modelos asistenciales

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

evaluar el atributo lingitudinalidad en los diferentes modelos asistenciales de la Atención Primaria a la Salud y verificar su asociación con las características demográficas, socioeconómicas y de contexto de Atención a la Salud.

Método:

estudio transversal, realizado en 2015 con 1076 usuarios adultos de los servicios de atención primaria en los 32 municipios de la 4^a Coordinadora Regional de Salud del Estado del Rio Grande do Sul. Se utilizó el Primary Care Assessment Tool con definición de bajo (<6,6) o alto puntuación (≥6,6) para longitudinalidad. La asociación con variables independientes fue comprobada por medio de la Regresión de Poisson.

Resultados:

el atributo fue mejor evaluado en la Estrategia de Salud de la Familia y asociado a la edad, la región de salud de vivienda y modelo de atención.

Conclusión:

el estudio destaca la Estrategia de la Salud de la Familia como promotora del cuidado longitudinal, y así, se sugiere la ampliación de la cobertura de este modelo asistencial para la mejora de calidad en la Atención a la Salud.

Descriptores:
Atención Primaria a la Salud; Continuidad de la Asistencia al Paciente; Evaluación de los Servicios de Salud; Estudios Transversales; Enfermería

Variable	n (1067)	% (100.0)
Gender
Male	253	23.7
Female	814	76.3
Age Group^* * Variable that did not reach 100.0%; Variable Age Group and Formal Job= 8 losses; Variable Color/ethnicity, Education, Marital Situation, Income, Health Insurance and Transport= 4 losses; Variable Children= 3 losses.
18-38	485	45.8
39-59	401	37.9
60-91	173	16.3
Color/Ethnicity^* * Variable that did not reach 100.0%; Variable Age Group and Formal Job= 8 losses; Variable Color/ethnicity, Education, Marital Situation, Income, Health Insurance and Transport= 4 losses; Variable Children= 3 losses.
White	740	69.6
Brown/black/yellow/indigenous	323	30.4
Children^* * Variable that did not reach 100.0%; Variable Age Group and Formal Job= 8 losses; Variable Color/ethnicity, Education, Marital Situation, Income, Health Insurance and Transport= 4 losses; Variable Children= 3 losses.
Yes	907	85.2
No	157	14.8
Education^* * Variable that did not reach 100.0%; Variable Age Group and Formal Job= 8 losses; Variable Color/ethnicity, Education, Marital Situation, Income, Health Insurance and Transport= 4 losses; Variable Children= 3 losses.
≤ 8 years old	611	57.5
> 8 years old	452	42.5
Marital Situation^* * Variable that did not reach 100.0%; Variable Age Group and Formal Job= 8 losses; Variable Color/ethnicity, Education, Marital Situation, Income, Health Insurance and Transport= 4 losses; Variable Children= 3 losses.
With companion	661	62.2
Without companion	402	37.8
Formal Job^* * Variable that did not reach 100.0%; Variable Age Group and Formal Job= 8 losses; Variable Color/ethnicity, Education, Marital Situation, Income, Health Insurance and Transport= 4 losses; Variable Children= 3 losses.
Yes	286	27.0
No	773	73.0
Income^* * Variable that did not reach 100.0%; Variable Age Group and Formal Job= 8 losses; Variable Color/ethnicity, Education, Marital Situation, Income, Health Insurance and Transport= 4 losses; Variable Children= 3 losses.
≤ two salaries	817	76.9
> two salaries	246	23.1
Health insurance^* * Variable that did not reach 100.0%; Variable Age Group and Formal Job= 8 losses; Variable Color/ethnicity, Education, Marital Situation, Income, Health Insurance and Transport= 4 losses; Variable Children= 3 losses.
Yes	275	25.9
No	788	74.1
Transport^* * Variable that did not reach 100.0%; Variable Age Group and Formal Job= 8 losses; Variable Color/ethnicity, Education, Marital Situation, Income, Health Insurance and Transport= 4 losses; Variable Children= 3 losses.
On foot	633	59.6
Bicycle/car/public transport/school transport/own transport	430	40.4
Health Region
Verdes Campos	820	76.9
Entre Rios	247	23.1
Care model
Traditional	447	41.9
FHS^ Family Health Strategy	450	42.2
Mixed	170	15.9

Variables	Longitudinality
	Low score (< 6.6)		High score (≥ 6.6)		p ^* * Value of p: Chi-square Test.
	n	%	n	%
Gender					0.695
Male	131	24.2	122	23.2
Female	410	75.8	404	76.8
Age Group					<0.001
18-38	290	54.5	195	37.0
39-59	176	33.1	225	42.7
60-91	66	12.4	107	20.3
Color/Ethnicity					0.490
White	379	70.6	361	68.6
Brown/black/yellow/indigenous	158	29.4	165	31.4
Children					0.425
Yes	454	84.4	453	86.1
No	84	15.6	73	13.9
Education					<0.001
≤ 8 years old	274	51.0	337	64.1
> 8 years old	263	49.0	189	35.9
Marital Situation					0.370
With companion	341	63.5	320	60.8
Without companion	196	36.5	206	39.2
Formal Job					0.002
Yes	167	31.1	119	22.8
No	370	68.9	403	77.2
Income					0.101
≤ two salaries	403	74.8	414	79.0
> two salaries	136	25.2	110	21.0
Health insurance					0.088
Yes	127	23.6	148	28.2
No	411	76.4	377	71.8
Transport					0.514
On foot	325	60.5	308	58.6
Bicycle/car/public transport/school transport/ own transport	212	39.5	218	41.4
Health Region					<0.001
Verdes Campos	459	84.8	361	68.6
Entre Rios	82	15.2	165	31.4
Care model					<0.001
Traditional	265	49.2	182	34.5
FHS^ Family Health Strategy	175	32.1	275	52.4
Mixed	101	18.7	69	13.1

Variables	High score of Longitudinality (0-10)					p ^* * Value of p - Chi-square for heterogeneity;
Variables	PRcrude^# # PR crude - Crude Poisson Regression	CI 95%^† † CI 95% - Confidence interval of 95%;	p ^* * Value of p - Chi-square for heterogeneity;	PRadjusted^‡ ‡ PR adjusted - Adjusted Poisson Regression by: Age group, Education, Formal job, Income, Health Insurance, Health region and Health units; 1.00 - reference value.	CI 95%^† † CI 95% - Confidence interval of 95%;	p ^* * Value of p - Chi-square for heterogeneity;
Age (years)
60 to 91	1.10	1.05 - 1.16	< 0.001	1.06	1.01 - 1.11	0.010
18 to 59	1.00			1.00
Education
≤ 8 years old	1.09	1.05 - 1.14	< 0.001	1.05	1.00 - 1.11	0.057
> 8 years old	1.00			1.00
Formal Job
No	1.07	1.03 - 1.13	0.003	1.04	0.99 - 1.09	1.128
Yes	1.00			1.00
Income
≤ two salaries	1.04	0.99 - 1.09	1.040	1.01	0.96 - 1.06	0.854
> two salaries	1.00			1.00
Health insurance
Yes	1.04	1.00 -1.09	0.084	1.04	0.99 - 1.09	0.091
No	1.00			1.00
Health Region
Entre Rios	1.16	1.11 - 1.21	< 0.001	1.10	1.05 - 1.15	< 0.001
Verdes Campos	1.00			1.00
Care model
FHS^ Family Health Strategy	1.15	1.10 - 1.19	< 0.001	1.11	1.06 - 1.16	< 0.001
Traditional/Mixed	1.00			1.00

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[1] CORRESPONDING AUTHOR: Marciane Kessler E-mail: marciane.kessler@hotmail.com

Care model	Degree of Affiliation (0-10)
Care model	Standard score	Standard error	Median	Minimum	Maximum	p ^* * Value of p: Kruskal-Wallis Test and Dunn Test (a, b, c) - Statistically considerable difference (p<0.05).
Traditional	8.8^a	8.6-9.0	10.0	0.0	10.0	0.005
FHS^ Family Health Strategy	8.5^b	8.3-8.7	10.0	0.0	10.0
Mixed	8.4^c	8.0-8.7	10.0	0.0	10.0
Care model	Longitudinality score (0-10)
Care model	Standard score	Standard error	Median	Minimum	Maximum	p ^* * Value of p: Kruskal-Wallis Test and Dunn Test (a, b, c) - Statistically considerable difference (p<0.05).
Traditional	6.1^b	5.9-6.2	6.2	0.5	10.0	<0.001
FHS^ Family Health Strategy	6.9^a	6.7-7.1	7.1	0.7	10.0
Mixed	5.8^c	5.5-6.2	5.7	0.2	10.0