Attitudes towards interprofessional collaboration of Primary Care teams participating in the ‘More Doctors’ (Mais Médicos) program

ABSTRACT Objectives: to compare the attitudes regarding interprofessional collaboration of health professionals that make up the Family Health Strategy teams participating in the ‘More Doctors’ (Mais Médicos) program; and to identify factors associated with attitudes of interprofessional collaboration. Method: a descriptive, transversal and comparative study developed with 63 health professionals who responded to the Jefferson Scale of Attitudes Toward Interprofessional Collaboration. The data were statistically analyzed. Results: the sum of the scale items ranged from 88 to 139 points. The analysis of all the Family Health teams indicated statistically significant differences between the scores of the scale and the professional category and between the scores and the education level, suggesting that nurses and professionals with higher education are more inclined towards collaborative practice. The analysis according to the profile of the doctor - Brazilian, Cuban or foreign exchange doctor - found no statistical differences regarding the physicians’ scores, nor in the scores of the components of teams with different profiles. Conclusion: the profile did not suggest a statistically significant greater or lesser inclination of the doctors or teams toward interprofessional work. This study can support new studies which will contribute to the analysis of inter-professional collaboration and the impact of the Mais Médicos program.

In addition to the numerical conformation of the teams and the ESF expansion, it is expected that the context promoted by the PMM will have positive repercussions on the dynamics of the work process and in meeting the needs of the population. In this sense, health practices find an important resource to optimize care outcomes (1) in the principles of collaboration and interprofessionality.
Despite the multiprofessional conformation of the ESF teams, obstacles that obstruct collaborative practice are still perceived in the daily work; among them are the individualistic attitude of the professionals in the process of teamwork (8) , which stems from a process of uniprofessional academic training (9) . provision members of family health teams, whose group of professionals correspond to the study population.
The inclusion criterion adopted for the purpose of selecting the physicians were: having completed the first training cycle of the project -the Specialization Course in Family Health.
In turn, health professionals should work directly with the physician, and preferably (but not exclusively) as part of the minimum ESF team, with a minimum performance time in the ESF of one year.
The defined exclusion criteria were: professionals on vacations, on leave or removed from their functions during the data collection period.
In order to determine the sample, three ESF teams from each activity area (supervisory institution) were randomly included by draw, with one of each The adaptation followed the steps of translation, backtranslation, expert committee evaluation and pretest application. The instrument was subsequently submitted to construct validation and reliability with 128 PHC professionals (10) .

The original Jefferson Scale of Attitudes Toward
Interprofessional Collaboration (JeffSATIC) instrument was developed in 2014 (11) , and was tested and validated with 1,976 American and Australian students of different health professions.
JeffSATIC is structured into 20 items that must be answered using agreement/disagreement variables according to a seven-point Likert scale, in which the lowest level corresponds to Strongly disagree (1), and the highest to Strongly agree (7). The attitude toward collaboration is reflected by the total score on the scale which can range from 20 to 140, with higher scores indicating more positive attitudes.
A questionnaire was also applied to determine the respondent's profile, with variables related to their training and work history.
Data were statistically analyzed using SPSS version 21. A significance of 5% was assumed for the hypothesis tests.
Eight of the 20 items on the scale are inversely scored, and therefore such items were recoded for the analysis using the inversion of the points in an equivalent way, as recommended by the authors (10)(11) .
The internal consistency of the instrument was tested by Cronbach's Alpha test, considering a value greater than 0.7 as a good level of consistency.  (Table 2).
As Table 3 shows, the comparison of the scores between the different professional groups resulted in differences with statistical significance (p=0.001), with higher scores for nurses. The post hoc analysis to identify pairs that differed revealed statistically significant differences in the scores between nurses and community agents (p=0.001).
A statistically higher difference was identified among professionals with a higher level (p<0.001), while the score of professionals with specialization did not differ (p=0.383).
The nationality and legal status of higher education institutions where doctors graduated from did not attribute significant differences in relation to the scores obtained with the responses from these professionals (p=0.662, p=1, in this order), as indicated in Table 4.  Freire Filho JR, Costa MV, Magnago C, Forster AC.  (12) . In this understanding, the professional relations built under the historical bias of the hierarchy can affect the attitudes of the health workers in relation to collaborative practice.
In this study, we found that nurses' attitudes were more positive than those of other professionals. This result is consistent with previous findings from studies that applied similar scales to those used in this research in order to establish comparisons between physicians and nurses (13)(14)(15)(16)(17) .
The involvement of the nursing professional is vital for advancing PHC, and consequently of the SUS and the expansion of access to primary care based on scientific and safe evidence (18) . Thus, both nurses and physicians need to strengthen collaborative relationships and work side-by-side with the goal of providing effective care to the population (19) .
Despite the highlight of the group of nurses, the mean score of the different professional groups was high (> 112), which shows that all categories have attitudes in favor of interprofessional collaboration, as found in another study (20) .
In this sample, higher education acted as an intervening variable for the scale result, indicating greater availability of undergraduates towards collaboration. A positive relationship between years of professional practice and interprofessional collaboration was also found, which was similar to a study conducted with American physicians and nurses (21) .
Regarding the training in health education, the literature points out that there is still resistance to overcoming training processes that legitimize a healthcare model based on the work fragmentation.
Thus, professionals continue to be trained from a uniprofessional perspective to work in a team, a contradiction that has implications for the development and quality of health actions offered (22) .
In this sense, the development of collaborative skills is still a challenge for the hegemonic health training model, since it focuses on the development of specific skills, strengthening what the literature has called tribalism of the professions (23)(24) .
One of the strongest characteristics and which justifies collaboration as a differentiating factor for reorganizing health practices is the user centrality in the production of health services.
It is this centrality that demands other principles

Conclusion
The results indicated that a Brazilian, Cuban or foreign exchange profile did not imply in statistical