Organizational processes in the Family Health Strategy: an analysis conducted by nurses

Arantes, Luciano José; Shimizu, Helena Eri; Merchán-Hamann, Edgar

doi:10.1590/1982-0194201600039

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Acta Paulista de Enfermagem

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Sumário

Original Article • Acta Paul Enferm. 29 (3) • May-Jun 2016 • https://doi.org/10.1590/1982-0194201600039 copy

Organizational processes in the Family Health Strategy: an analysis conducted by nurses

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To analyze the organizational processes of Family Health teams after implementing the Plan Director for Primary Health Care.

Methods

This cross-sectional study was conducted in the city of Unai, State of Minas Gerais, Brazil. A Likert questionnaire was used for data collection and the Kruskal-Wallis test was used for analysis, with a 5 % significance level.

Results

Better results were identified for the dimensions of maternal and child health, management contract and information systems. Unsatisfactory results were found in the dimensions: principles of primary health care, diagnosis, local programming, welcoming approach, risk classification, family approach, and relationship with the community, health care networks, monitoring, family health medical charts and diagnostic support. A statistically significant difference was identified in the dimensions principles of primary healthcare, local programming, monitoring, women’s and child health.

Conclusion

Further investment is needed in team organization, particularly regarding organizational processes related to management.

Health management; Primary health care; Family health strategy; Health services evaluation; Process assessment (Health care); Health policy

Dimensions	Themes addressed
PHC principles	Knowledge and structuring in professional practice.
Diagnosis	Annual (re)enrollment of the population, classification of families according to risk, use of distribution maps of disease, and risk situations in the territory.
Local programming	Implementation of guidelines and protocols, risk stratification (hypertension, diabetes, pregnant women, children, adolescents, adults, elderly, and oral health), structuring and execution of programmed actions.
Welcoming and risk classification	Using principles of welcoming, Manchester Protocol implementation, and organizing the schedule for spontaneous and scheduled care demands.
Family health medical charts	Use of medical charts classified according to risk, implementation of the electronic version, confidentiality of information and assessment records.
Family approach	Application of genogram instruments and lifecycle families.
Relationship with the community	Team participation in the Local Council and district health meetings; interaction, dissemination of actions and outcomes to the community; knowledge and professional relationship with the best-known people in the community.
Health care networks	Knowledge of reference protocols for secondary and tertiary care, access to laboratory tests and imaging, regulatory system and users transport in the network, agreement with other points of care.
Diagnostic support	Implementation of clinical laboratory protocols, planning the amount of testing by the teams, and organization of the procedural flow before and after the examinations.
Management contract	Professional knowledge of municipal goals established in the contract; pact of local indicators and targets; monitoring the goals related to prenatal care, vaccination and cytopathology testing in women 25-59 years of age; and contracting with the teams for municipal coordination.
Information systems	Frequency of insertion and use of data in action planning.
Monitoring	Knowledge of the goals established for APS municipality, preparation of monitoring proposal of goals, organizational processes to achieve the goals, achievement of monitoring as planned.
Women’s health	Actions taken to guarantee sexual and reproductive rights, prenatal, postpartum, prevention and control of breast cancer and cervical cancer, and menopause.
Children’s health	Actions in the first week of life for child, growth and development, vaccinations, and healthy eating.

Dimensions	Number of items analyzed	Scores		p-value*
Dimensions	Number of items analyzed	Median	Mean	p-value*
FHC principles	05	1	1.4666	0.015
Local diagnostic	04	1.5	1.6111	Not calculated
Local programming	12	1	1.4722	0.000
Welcoming and Risk classification	05	1	1.5333	0.375
Family health medical charts	05	0	0.8	0.165
Family approach	02	1	1	Not calculated
Relationship with the community	03	1	1.1111	Not calculated
Health care network	07	1	0. 8730	0.107
Diagnostic support	03	0	0.3333	Not calculated
Management contract	06	2	2	0.107
Information system	02	2	2.0555	Not calculated
Monitoring	05	1	1.1777	0.000
Total	59	1	1.31	0.000

Dimensions	Number of items analyzed	Scores		p-value*
Dimensions	Number of items analyzed	Median	Mean	p-value*
Women´s health	40	2	2.025	0.000
Child´s health	30	3	2.4111	0.000
Total	70	2	2.19	0.000

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author. Helena Eri Shimizu. Campus Universitário Darcy Ribeiro, 70910-900, Asa Norte, Brasília, DF, Brazil. shimizu@unb.br