Longitudinal link of the Family Health Strategy at the frontline of the Covid-19 pandemic

Frota, Amanda Cavalcante; Barreto, Ivana Cristina de Holanda Cunha; Carvalho, André Luís Bonifácio de; Ouverney, Assis Luiz Mafort; Andrade, Luiz Odorico Monteiro de; Machado, Nádia Maria da Silva

doi:10.1590/0103-11042022E109

person Amanda Cavalcante Frota

schoolUniversidade Federal do Ceará (UFC) - Fortaleza (CE), Brasil.

0000-0003-3944-2263

person Ivana Cristina de Holanda Cunha Barreto

schoolFundação Oswaldo Cruz (Fiocruz) - Eusébio (CE), Brasil.

0000-0001-8447-3654

person André Luís Bonifácio de Carvalho

schoolUniversidade Federal da Paraíba (UFPB) - João Pessoa (PB), Brasil.

0000-0003-0328-6588

person Assis Luiz Mafort Ouverney

schoolFundação Oswaldo Cruz (Fiocruz), Centro de Estudos Estratégicos (CEE) - Rio de Janeiro (RJ), Brasil.schoolFundação Oswaldo Cruz (Fiocruz), Escola Nacional de Saúde Pública Sergio Arouca (Ensp), Departamento de Ciências Sociais (DCS) - Rio de Janeiro (RJ), Brasil.

0000-0002-8581-3777

person Luiz Odorico Monteiro de Andrade

schoolFundação Oswaldo Cruz (Fiocruz) - Eusébio (CE), Brasil.

0000-0002-3335-0619

person Nádia Maria da Silva Machado

schoolUniversidade de Brasília (UnB) - Brasília (DF), Brasil.

0000-0001-9334-9305

Conflict of interests: non-existent

Collaborators

Frota AC (0000-0003-3944-2263)^* and Barreto ICHC (0000-0001-8447-3654)^* contributed substantially to the design, planning, analysis, and interpretation of data, elaboration, and critical review of the preliminary version and participated in the approval of the final version of the manuscript. Carvalho ALB (0000-0003-0328-6588)^* contributed substantially to the planning, analysis, and interpretation of data, elaboration, and critical review of the preliminary version and participated in the approval of the final version of the manuscript. Ouverney ALM (0000-0002-8581-3777)^*, Andrade LOM (0000-0002-3335-0619)^* and Machado NMS (0000-0001-9334-9305)^* contributed substantially to the planning, analysis, and interpretation of data.

*

Orcid (Open Researcher and Contributor ID).

Sociodemographic. professional. and health responsibility profile	Total (n=962)		Ceará (n=583)		Paraíba (n=379)
	N	%	N	%	N	%
Participating municipalities	154	100	91	59.09	63	40.91
Participating professionals	962	100	583	60.60	379	39.40
Sex (n=962)
Female	781	81.19	459	78.73	322	84.96
Male	180	18.71	123	21.10	57	15.04
Preferred not to respond	1	0.10	1	0.17	0	0
Age group (n=962)
18-39 years	595	61.85	384	65.87	211	55.67
40-59 years	344	35.76	190	32.59	154	40.63
60 years and over	23	2.39	9	1.54	14	3.69
Employment type (n=962)
Statutory	469	48.75	283	48.54	186	49.08
Temporary contract	349	36.28	208	35.68	141	37.2
Outsourced	18	1.87	17	2.92	1	0.26
Other work relationships	126	13.10	75	12.86	51	13.46
Profession (n=962)
Community Health Worker	279	29	155	26.59	124	32.72
Nurse	256	26.61	161	27.62	95	25.07
Doctor	130	13.51	81	13.89	49	12.93
Dentist	81	8.42	57	9.78	24	6.33
NASF professional	122	12.68	79	13.55	43	11.35
Nursing technician	69	7.17	38	6.52	31	8.18
Oral Health technician/assistant	25	2.60	12	2.06	13	3.43
Seniority in the team (n=895)
≤ 1 year	157	17.54	83	15.23	74	21.14
≤ 1 Recruited due to Covid-19	16	1.79	11	2.02	5	1.43
>1 ≤ 3 years	199	22.23	138	25.32	61	17.43
>3 ≤ 5 years	145	16.20	99	18.17	46	13.14
>5 ≤ 10 years	116	12.96	78	14.31	38	10.86
>10 years	262	29.27	136	24.95	126	36.00
Current team territory covered (n=962)
Urban	564	58.63	332	56.95	232	61.21
Rural	277	28.79	179	30.70	98	25.86
Both	121	12.58	72	12.35	49	12.93
Number of users attaching to the current team (n=893)
≤ 2.500	196	21.95	123	22.65	73	20.86
> 2.500 ≤ 3.000	204	22.84	120	22.10	84	24.00
> 3.000 ≤ 4.000	175	19.60	85	15.65	90	25.71
> 4.000 ≤ 6.000	103	11.53	69	12.71	34	9.71
> 6.000 ≤ 36.000	70	7.84	48	8.84	22	6.29
Not clearly defined	36	4.03	28	5.16	8	2.29
Did not respond	109	12.21	70	12.89	39	11.14
Number of EqSF per UBS (n=790)
1 EqSF	463	58.61	283	58.59	180	58.63
2 EqSF	145	18.35	100	20.70	45	14.66
3 EqSF	61	7.72	43	8.90	18	5.86
4 EqSF and over	121	15.32	57	11.80	64	20.85

Work situation and user access to UBS/ESF during the pandemic period	Total		Ceará		Paraíba
	N	%	N	%	N	%
Current work situation in the ESF (n=871)
Yes. face-to-face	806	92.54	488	91.39	318	94.36
Yes. remotely	41	4.71	30	5.62	11	3.26
No. reassigned to another service	24	2.76	16	3.00	8	2.37
Situation of the work process regarding the routine activities of the ESF (n=786)
Performing routine activities. systematically. as before	405	51.53	265	54.64	140	46.51
Performing routine activities only on demand	65	8.27	43	8.87	22	7.31
Performing only activities related to Covid-19	11	1.40	9	1.86	2	0.66
Prioritizing activities related to Covid-19 and performing routine activities (on demand)	247	31.42	129	26.60	118	39.20
Other (specify)	58	7.38	39	8.04	19	6.31
Users in the territory where EqSF operates have UBS as their first care reference for Covid-19 (n=733)
Yes	637	86.90	395	86.81	242	87.05
No	75	10.23	45	9.89	30	10.79
Did not respond	21	2.86	15	3.30	6	2.16
New users joined the service (n=733)
Yes	537	73.26	327	71.87	210	75.54
No	150	20.46	97	21.32	53	19.06
Did not respond	46	6.28	31	6.81	15	5.40
New SUS Cards were registered (n=733)
Yes	498	67.94	283	62.20	215	77.34
No	96	13.10	70	15.38	26	9.35
Did not respond	139	18.96	102	22.42	37	13.31
Users not registered with the SUS Card are attended to at their UBS (n=733)
Yes. all were attended to *	488	66.58	291	63.96	197	70.86
Yes. all were attended to. and SUS Card was prepared **	163	22.24	114	25.05	49	17.63
Not attended to and oriented ** *	43	5.87	27	5.93	16	5.76
Did not respond	39	5.32	23	5.05	16	5.76

New flows and routines at UBS and ESF in the Covid-19 pandemic	Total (n=733)
	Yes		No		Did not respond
	N	%	N	%	N	%
Covid-19 case in the covered municipality (n=782)	782	99.62	3	0.38	0	0
Exclusive flows for respiratory symptoms	592	80.76	92	12.55	49	6.68
Wing in the UBS or a reserved room for those with respiratory symptoms to wait for care	516	70.40	192	26.19	25	3.41
Wing in the UBS or room reserved for the exclusive care of respiratory symptoms	494	67.39	209	28.51	30	4.09
Exclusive wing for respiratory symptoms outside the UBS (Ex.: Stand. Tent. or Canvas)	173	23.60	534	72.85	26	3.55
Posters fixed at the UBS indicating the use of a mask or hand hygiene by all users	681	92.91	44	6	8	1.09
Escalation of the UBS cleaning routine	637	86.90	77	10.50	19	2.59
Change in the garbage collection routine of UBS spaces and offices	453	61.80	184	25.10	96	13.10
Home delivery of medicines	258	35.20	371	50.61	104	14.19
Change in the frequency of medication prescription	533	72.71	104	14.19	96	13.10
Change in the frequency of drug dispensing	415	56.62	192	26.19	126	17.19
Ceará (n=455)
Covid-19 case in the covered municipality (n=483)	483	99.79	1	0.21	0	0
Exclusive flows for respiratory symptoms	368	80.88	59	12.97	28	6.15
Wing in the UBS or a reserved room for those with respiratory symptoms to wait for care	312	68.57	127	27.91	16	3.52
Wing in the UBS or room reserved for the exclusive care of respiratory symptoms	308	67.69	127	27.91	20	4.40
Exclusive wing for respiratory symptoms outside the UBS (Ex.: Stand. Tent. or Canvas)	113	24.84	325	71.43	17	3.74
Posters fixed at the UBS indicating the use of a mask or hand hygiene by all users	419	92.09	33	7.25	3	0.66
Escalation of the UBS cleaning routine	400	87.91	43	9.45	12	2.64
Change in the garbage collection routine of UBS spaces and offices	285	62.64	104	22.86	66	14.51
Home delivery of medicines	186	40.88	205	45.05	64	14.07
Change in the frequency of medication prescription	350	76.92	43	9.45	62	13.63
Change in the frequency of drug dispensing	294	64.62	89	19.56	72	15.82
Paraíba (n=278)
Covid-19 case in the covered municipality (n=299)	299	99.34	2	0.66	0	0
Exclusive flows for respiratory symptoms	224	80.58	33	11.87	21	7.55
Wing in the UBS or a reserved room for those with respiratory symptoms to wait for care	204	73.38	65	23.38	9	3.24
Wing in the UBS or room reserved for the exclusive care of respiratory symptoms	186	66.91	82	29.50	10	3.60
Exclusive wing for respiratory symptoms outside the UBS (Ex.: Stand. Tent. or Canvas)	60	21.58	209	75.18	9	3.24
Posters fixed at the UBS indicating the use of a mask or hand hygiene by all users	262	94.24	11	3.96	5	1.80
Escalation of the UBS cleaning routine	237	85.25	34	12.23	7	2.52
Change in the garbage collection routine of UBS spaces and offices	168	60.43	80	28.78	30	10.79
Home delivery of medicines	72	25.90	166	59.71	40	14.39
Change in the frequency of medication prescription	183	65.83	61	21.94	34	12.23
Change in the frequency of drug dispensing	121	43.53	103	37.05	54	19.42

PPE. UBS Hygiene Routine and Suspected/Symptomatic Diagnostic/Care Supplies	Sufficient		Insufficient		Unavailable		Did not respond
	N	%	N	%	N	%	N	%
Ceará (n=427)
Personal Protective Equipment for professionals
Surgical mask for professionals	280	65.57	100	23.42	29	6.79	18	4.22
N95 mask for professionals	229	53.63	142	33.26	38	8.90	18	4.22
Procedure gloves for professionals	333	77.99	62	14.52	12	2.81	20	4.68
Goggles for professionals	227	53.16	75	17.56	97	22.72	28	6.56
Face shield for professionals	283	66.28	82	19.20	44	10.30	18	4.22
Disposable/waterproof apron for professionals	248	58.08	123	28.81	33	7.73	23	5.39
Hygiene routine in the PHC Unit
Soap for professional hand hygiene	339	79.39	54	12.65	19	4.45	15	3.51
Routine for cleaning and disinfecting frequently touched objects and surfaces	288	67.45	96	22.48	14	3.28	29	6.79
Intensified garbage collection routine from UBS spaces and offices	267	62.53	89	20.84	20	4.68	51	11.94
Supplies for the diagnosis and care of suspected/symptomatic cases
Oxygen	92	21.55	52	12.18	202	47.31	81	18.97
Infrared thermometer	179	41.92	54	12.65	150	35.13	44	10.30
Oximeter	241	56.44	72	16.86	52	12.18	62	14.52
Communication infrastructure (n=535)
	Yes. good		Yes. fair		Yes. poor		No
Internet	191	35.70	231	43.18	39	7.29	74	13.83
	Yes						No
Telephone	139	25.98					396	74.02
Paraíba (n=258)
Personal Protective Equipment for professionals
Surgical mask for professionals	180	69.77	66	25.58	7	2.71	5	1.94
N95 mask for professionals	137	53.10	58	22.48	56	21.71	7	2.71
Procedure gloves for professionals	212	82.17	36	13.95	3	1.16	7	2.71
Goggles for professionals	146	56.59	42	16.28	54	20.93	16	6.20
Face shield for professionals	200	77.52	34	13.18	17	6.59	7	2.71
Disposable/waterproof apron for professionals	159	61.63	79	30.62	12	4.65	8	3.10
Hygiene routine in the PHC Unit
Soap for professional hand hygiene	209	81.01	26	10.08	14	5.43	9	3.49
Routine for cleaning and disinfecting frequently touched objects and surfaces	176	68.22	64	24.81	9	3.49	9	3.49
Intensified garbage collection routine from UBS spaces and offices	174	67.44	49	18.99	9	3.49	26	10.08
Supplies for the diagnosis and care of suspected/symptomatic cases
Oxygen	59	22.87	14	5.43	151	58.53	34	13.18
Infrared thermometer	109	42.25	25	9.69	102	39.53	22	8.53
Oximeter	162	62.79	31	12.02	38	14.73	27	10.47
Communication infrastructure (n=343)
	Yes. good		Yes. fair		Yes. poor		No
Internet	162	47.23	103	30.03	18	5.25	60	17.49
	Yes						No
Telephone	180	52.48					163	47.52

Actions and Routine Services at the ESF	Maintained		Partially maintained		Suspended		Non-ESF routine		Did not respond
Actions and Routine Services at the ESF	N	%	N	%	N	%	N	%	N	%
Ceará (n=485)
Prenatal care	453	93.40	23	4.74	4	0.82	0	0	5	1.03
Drug dispensing	453	93.40	19	3.92	2	0.41	4	0.82	7	1.44
Immunization	427	88.04	41	8.45	8	1.65	0	0	9	1.86
Individual procedures (removal of stitches. dressing. and administration of medication)	379	78.14	83	17.11	11	2.27	5	1.03	7	1.44
Rapid testing for Sexually Transmitted Infections - STIs (syphilis. HIV and HV)	312	64.33	114	23.51	28	5.77	9	1.86	22	4.54
Care to walk-in demand (non-Covid-19 demand)	294	60.62	153	31.55	28	5.77	1	0.21	9	1.86
Care to people with hypertension and diabetes	279	57.53	166	34.23	29	5.98	4	0.82	7	1.44
Surveillance of infectious diseases in the territory (active search. registration. follow-up of tuberculosis. Hansen's disease. and others)	277	57.11	129	26.60	45	9.28	9	1.86	25	5.15
Follow-up of people with mental health problems	264	54.43	154	31.75	23	4.74	21	4.33	23	4.74
Follow-up of people with other chronic diseases	260	53.61	187	38.56	27	5.57	4	0.82	7	1.44
Continuing care for older adults	235	48.45	200	41.24	42	8.66	4	0.82	4	0.82
Sexual and reproductive planning	232	47.84	157	32.37	57	11.75	13	2.68	26	5.36
Collection of laboratory tests	207	42.68	121	24.95	34	7.01	95	19.59	28	5.77
Team meeting to evaluate and plan the work process	206	42.47	182	37.53	69	14.23	17	3.51	11	2.27
Prevention of breast and cervical cancer	204	42.06	124	25.57	125	25.77	12	2.47	20	4.12
Childcare	198	40.82	135	27.84	135	27.84	5	1.03	12	2.47
Mental health promotion	192	39.59	169	34.85	66	13.61	32	6.60	26	5.36
Home visits	152	31.34	186	38.35	137	28.25	6	1.24	4	0.82
Home delivery of medicines	149	30.72	71	14.64	42	8.66	166	34.23	57	11.75
Oral health	135	27.84	200	41.24	113	23.30	26	5.36	11	2.27
Individual educational actions for general health promotion	131	27.01	153	31.55	169	34.85	14	2.89	18	3.71
Intersectoral activities	63	12.99	153	31.55	165	34.02	39	8.04	65	13.40
Integrative and Complementary Health Practices (Pics)	62	12.78	114	23.51	91	18.76	120	24.74	98	20.21
Community participation activities (health promotion)	56	11.55	128	26.39	269	55.46	21	4.33	11	2.27
Therapeutic groups	37	7.63	67	13.81	288	59.38	65	13.40	28	5.77
Paraíba (n=304)
Prenatal care	268	88.16	28	9.21	1	0.33	2	0.66	5	1.64
Drug dispensing	258	84.87	24	7.89	8	2.63	7	2.30	7	2.30
Immunization	253	83.22	36	11.84	5	1.64	3	0.99	7	2.30
Individual procedures (removal of stitches. dressing. and administration of medication)	211	69.41	21	6.91	6	1.97	47	15.46	19	6.25
Rapid testing for Sexually Transmitted Infections - STIs (syphilis. HIV and HV)	203	66.78	72	23.68	12	3.95	3	0.99	14	4.61
Care to walk-in demand (non-Covid-19 demand)	183	60.20	109	35.86	3	0.99	2	0.66	7	2.30
Care to people with hypertension and diabetes	190	62.50	82	26.97	10	3.29	8	2.63	14	4.61
Surveillance of infectious diseases in the territory (active search. registration. follow-up of tuberculosis. Hansen's disease. and others)	170	55.92	112	36.84	12	3.95	7	2.30	3	0.99
Follow-up of people with mental health problems	170	55.92	87	28.62	24	7.89	4	1.32	19	6.25
Follow-up of people with other chronic diseases	167	54.93	116	38.16	8	2.63	5	1.64	8	2.63
Continuing care for older adults	152	50	105	34.54	22	7.24	9	2.96	16	5.26
Sexual and reproductive planning	151	49.67	107	35.20	31	10.20	5	1.64	10	3.29
Collection of laboratory tests	150	49.34	126	41.45	17	5.59	6	1.97	5	1.64
Team meeting to evaluate and plan the work process	146	48.03	112	36.84	36	11.84	6	1.97	4	1.32
Prevention of breast and cervical cancer	127	41.78	60	19.74	18	5.92	81	26.64	18	5.92
Childcare	123	40.46	113	37.17	34	11.18	22	7.24	12	3.95
Mental health promotion	117	38.49	115	37.83	59	19.41	6	1.97	7	2.30
Home visits	102	33.55	147	48.36	49	16.12	3	0.99	3	0.99
Home delivery of medicines	88	28.95	151	49.67	50	16.45	10	3.29	5	1.64
Oral health	85	27.96	119	39.14	82	26.97	9	2.96	9	2.96
Individual educational actions for general health promotion	49	16.12	71	23.36	168	55.26	4	1.32	12	3.95
Intersectoral activities	47	15.46	45	14.80	25	8.22	152	50	35	11.51
Integrative and Complementary Health Practices (Pics)	41	13.49	93	30.59	109	35.86	23	7.57	38	12.50
Community participation activities (health promotion)	34	11.18	74	24.34	75	24.67	67	22.04	54	17.76
Therapeutic groups	23	7.57	57	18.75	174	57.24	29	9.54	21	6.91

[1] Source: Own elaboration.

[TFN4] ^*
Yes, all are attended to even without a SUS Card.

[TFN5] ^**
Yes, all are attended to, but SUS Card was prepared when treated.

[TFN6] ^***
Without the SUS Card and without the possibility of using it at the time of care; they are instructed to return with the documentation so that they are attended to.

Longitudinal link of the Family Health Strategy at the frontline of the Covid-19 pandemic

ABSTRACT