Primary care experiences in 25 years of Journal Ciência &amp; Saúde Coletiva: a review of the scientific literature

Pinto, Luiz Felipe; Hartz, Zulmira Maria de Araújo

doi:10.1590/1413-812320202512.24882020

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

REVIEW • Ciênc. Saúde Colet. 25 (12) • Dec 2020 • https://doi.org/10.1590/1413-812320202512.24882020 copy

Primary care experiences in 25 years of Journal Ciência & Saúde Coletiva: a review of the scientific literature

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The term “basic care” is restricted to a few countries like Brazil. Since the 1978 Alma-Ata Conference, “primary health care” (PHC) has been used to designate care at the first level. The paper summarizes the experiences of evaluation in primary health care, based on the review of the set of manuscripts published by Journal Ciência & Saúde Coletiva. A bibliographic search was made in the SciELO database in the 1996-2020 period. Several descriptors were selected in the spectrum of evaluation and basic care/primary care. The reviewed studies suggest the existence of two analytical periods over the 25 years of the Journal. The first, characterized by the 1996-2010 studies, had the studies of structure/process/results by Donabedian as its predominant theory. The second, from 2011-2020, was Billings’ theories on Ambulatory Care Sensitive Conditions (ACSC) and Starfield’s PHC attributes. The main dimensions presented in the studies refer to evaluations with a quantitative approach and are induced by the policies and public consultations of the Ministry of Health, and instruments referenced by it.

Key words:
Health assessment; Primary Health Care; Brazil

Key words searched (free translation into English, with the removal of same-meaning word strings)	N° of studies
	Pre-selected (N)	Eliminated by the abstract (e)	Review by general inclusion criteria (n = N - e)
01. Community health worker, community workers, community health workers/Family Health Program	44	40	4
02. Basic care, Basic health care, Primary health care	55	42	13
03. Primary health care	7	4	3
04. Basic health services/primary health care	4	2	2
05. Basic health services	4	4	0
06. Primary health care and payment for performance	1	0	1
07. Primary health care and research in health services	1	0	1
08. Primary health care and hospitalizations for conditions sensitive to basic/primary care	4	0	4
09. Primary care assessment	4	0	4
10. Performance assessment or assessment of the performance of basic health services	1	0	1
11. Assessment and community health workers/Assessment and Family Health and Program	7	5	2
12. Assessment and primary care	25	12	13
13. Assessment and primary health care/assessment/assessment and primary care	4	0	4
14. Assessment and Family Health/Health Assessment and Family Health	16	7	9
15. Assessment of the quality of care/health care and primary care	4	0	4
Total	181	116	65

n	Authors (year)	Study Location	Object/unit of analysis	Sample/census	Data collection period
01. Normative assessment (several references)
1	Tomasi et al. (2011)	Some states in the Northeast and South regions of Brazil	Care performed in health units	n=26,019 attendances	2008
2	Cardoso et al. (2015)	Municipalities in the northeast of Minas Gerais	Municipalities	n=63 municipalities	2011
3	Neto et al. (2016)	Curitiba (Paraná), Rio de Janeiro (Rio de Janeiro), and Lisbon (Portugal)	Municipalities	n=3 (case series)	2015
4	Salazar et al. (2017)	Municipality of Rio de Janeiro, and Brazil	Family Health Teams	n1=324 (Rio) teams; n2=17,200 (Brazil)	2012
5	Monteiro et al. (2017)	ACeS Amadora, ACeS Almada-Seixal (ARSLVT, Portugal)	Men and Women	n=176,293 people	2016
6	Monteiro et al. (2017)	ACeS Oeste Norte x Regional Administration of Lisbon and Vale do Tejo (ARSLVT), Portugal	Men and Women	n=76,293 people	2016
7	Soranz et al. (2017)	Municipality of Rio de Janeiro, Rio de Janeiro	Men and Women	n ~3 million people	2016
8	Santos and Hugo (2018)	Brazil	Oral Health Teams in the Family Health Strategy	n=18,114 Oral Health teams	2013-2014
9	Monteiro (2020)	Portugal	Men and Women	n=10,220,858 people	2019
10	Pinto and Santos (2020)	Planning Area of the municipality of Rio de Janeiro	Adults 18 years and over	N = 115,280 people	2014-2015
02. Political-institutional analysis
11	Biscaia and Heleno (2017)	Family Health Units of Marginal, Cascais, Portugal	Family Health Units	case study	2016
12	Reis et al. (2019)	Brazil	Establishment of the Primary Health Care Secretariat in the Ministry of Health	case study	2019
03. Qualitative exploratory analysis (Minayo, 2003)
13	Nascimento and Nascimento (2005)	Municipality of Jequié, Bahia	Nurses	n=14 nurses	1999-2002
14	Galavote et al. (2011)	Municipality of Vitória, Espírito Santo	Community health workers	n=14 Community health workers	2005-2006
15	Pinheiro et al. (2012)	Municipality of Florianópolis, Santa Catarina	Nurses	n=14 nurses	2010
16	Engstrom et al. (2020)	Municipality of Rio de Janeiro, Rio de Janeiro	Students	n=42 graduates	2016
04. Theory of assessment and implementation of programs (Hartz, 1997; Contandriopoulos et al., 1997)
17	Bodstein (2002)	Brazil	SUS decentralization process and primary care	case study	2001
18	Albuquerque et al. (2007)	Municipality of Recife, Pernambuco	PHC facilities (n1) and family health facilities (n2)	n1=42; n2=84	2002
19	Rocha and Sá (2011)	Portugal	Family Health Units (USF)	n=11 USF (case series)	2009
05. Matus Government Triangle (Matus, 1972)
20	Sampaio et al. (2011)	State Health Secretariat of a Northeastern state	State Health Secretariat	case study	2006
06. Theory of Assessment of Impact in Public Policies (Draibe, 2004)
21	Roncalli and Lima (2008)	Some municipalities in the Northeast Region with a population greater than 100 thousand inhabitants	Children under five years	n=2,144 children	2005
07. Theory of the complexity of health systems: the four existing rationales
22	Contandriopoulos (2006)	Brazil	Evaluative research, normative assessment, decision-making	case study	2006
08. Assessment Theory and use of the logical model (Hartz, 1997)
23	Felisberto (2006)	Brazil	Institutionalization of health assessment and primary care	case study	2006
24	Costa et al. (2011)	Municipality of Recife, Pernambuco	Family Health Teams	n=72	2010
09. Descriptive assessment of the local situation (Testa, 1992)
25	Gomes et al. (2009)	Municipality of Paula Cândido, Minas Gerais	Families not covered by the ESF (1992) and covered by the ESF (2003)	n1 = n2 = 127 families	1992/ 2003
10. Theory of structure/process/outcome assessment (Donabedian, 1990)
26	Costa and Pinto (2002)	All Brazilian municipalities	Municipalities by population size	n=5,354 municipalities	2002
27	Machado et al. (2004)	Municipalities and health regions of Minas Gerais	Municipalities and regions of Minas Gerais	N ~ 800 municipalities	2003
28	Facchini et al. (2006)	Municipalities of Alagoas, Paraíba, Pernambuco, Piauí, Rio Grande do Norte, Rio Grande do Sul, and Santa Catarina	Municipal health counselors (n1), municipal health secretaries (n2), primary care coordinators (n3)	n1=41, n2=29, n3=32	2005
29	Pereira et al. (2006)	Municipalities of Amapá, Maranhão, Pará e Tocantins	Municipalities with more than 100 thousand inhabitants	n=16 municipalities	2006
30	Caldeira et al. (2010)	Municipality of Montes Claros, Minas Gerais	Children under two years	n=1,200 families, 595 mothers	2006
31	Costa et al. (2011)	Municipality of Teixeiras, Minas Gerais	Children under two years	n=161 mothers	2006
32	Serapioni and Silva (2011)	Regions of the State of Ceará	Family Health Teams, health professionals, managers, health counselors, academics, users	case study + n1=340 users	2010
33	Portela and Ribeiro (2011)	Brazilian municipalities with more than 100 thousand inhabitants	Municipalities	n=185 municipalities	2007
34	Mendes et al. (2012)	Municipality of Recife, Pernambuco	Users (n1), doctors (n2), and nurses (n3)	n1=1,180, n2=61, n3=56	2009
35	Bulgareli et al. (2014)	Municipality of Marília, São Paulo	PHC facilities (n1) and Family Health facilities (n2)	n1=6 UBS, n2=11 USF	2007-2009
11. Theory of Clinical Management in Primary Health Care (Wagner, 2012)
36	Janett and Yeracaris (2020)	United States	Use of electronic medical records in primary health care	case study	2019
12. Theory on access and use of health services (Andersen, 1995)
37	Bousquat et al. (2012)	Municipality of Santo André, São Paulo	Men and Women	n=175 people	2011
13. Epidemiological Theory, aggregate-ecological studies and population-based studies (Medronho et al., 2009)
38	d'Ávila Viana et al. (2006)	All municipalities of the State of São Paulo	Municipalities	n=62 municipalities	2005
39	Szwarcwald et al. (2006)	Some municipalities of the State of Rio de Janeiro with more than 100 thousand inhabitants	Adults 18 years and over and mothers of children under two years	n=1,970 people	2005
40	Ribeiro et al. (2010)	Municipality of Teresópolis, Rio de Janeiro	Children under five years	n=594 responsible for the children	2005
41	Busato et al. (2011)	Municipality of Curitiba, Paraná	Dental surgeons	n=191 dentists	2006
14. Theory of the attributes of Primary Health Care (PHC) (Starfield, 2002)
42	Elias et al. (2006)	All the municipalities of the State of São Paulo	Users (n1), health professionals (n2), and managers (n3)	n1=1,117, n2=600(?), n3=343 (?)	2005
43	Ibañez et al. (2006)	Municipalities of São Paulo with more than 100 thousand inhabitants	Users (n1) and health professionals (n2)	n1=2,923; n2=167 health professionals	2005
44	Alves Leão and Caldeira (2011)	Municipality of Montes Claros, Minas Gerais	Children under two years	n=350 mothers	2009
45	Reis et al. (2013)	Municipality of São Luís, Maranhão	Users (n1), health professionals (n2), and managers (n3)	n1=882, n2=80, n3=30	2010-2011
46	Alencar et al. (2014)	Municipality of São Luís, Maranhão	Users (n1), health professionals (n2), and managers (n3)	n1=883, n2=80, n3=32	2010-2011
47	Marques et al. (2014)	Municipality of São Francisco, Minas Gerais	Children under five years in a quilombola community	n=76 families	2011
48	Araújo et al. (2014)	Municipality of Macaíba, Rio Grande do Norte	Older adults	n=100	2012
49	Mesquita Filho et al. (2014)	Municipality of Pouso Alegre, Minas Gerais	Children under two years	n=419 children caregivers	2009
50	Quaresma and Stein (2015)	Municipality of Palmas, Tocantins	Children and adolescents 12-18 years	n=469 children and adolescents	2013
51	Harzheim et al. (2016)	Municipality of do Rio de Janeiro, Rio de Janeiro	Adults ≥ 18 years, and responsible for children < 12 years	n1=3,530 and n2=3,145	2014
52	Pinto et al. (2017)	District of Rocinha, Municipality of Rio de Janeiro, Rio de Janeiro	Adults ≥ 18 years, and responsible for children < 12 years	n1=433 and n2=369	2014
53	Sellera et al. (2020)	Brazil	Institutionalization of health assessment and primary care	case study	2019
15. Theory of Billings (1990), on Ambulatory Care Sensitive Conditions (ACSC)
54	Barbara Rehem and Egry (2011)	Municipalities of the State of São Paulo	Men and Women	n ~ 400 thousand hospitalizations/year	2000-2007
55	Pitilin et al. (2015)	Municipalities of Guarapuava, Paraná	Women	n=429 hospitalizations	2013
56	Avelino et al. (2015)	Municipality of Alfenas, Minas Gerais	Men and Women	n=2,200 hospitalizations	2008-2012
57	Costa et al. (2016)	Municipality of Porto Alegre, Rio Grande do Sul	Men and Women	total of hospitalizations not specified	1998-2012
58	Gonçalves et al. (2016)	Municipalities of the Northeast	Men and Women	n=181,152 hospitalizations	2012-2015
59	Magalhães and Morais Neto (2017)	Health Districts of the Municipality of Goiânia, Goiás.	Men and Women	n=502,908 hospitalizations	2008-2013
60	Morimoto and Costa (2017)	Municipality of São Leopoldo, Rio Grande do Sul.	Men and Women	n=10 thousand hospitalizations/year	2003-2012
61	Pinto and Giovanella (2018)	Brazil (capitals and inland regions), other selected capitals	Men and Women	n=187 million hospitalizations	2001-2016
62	Pinto Junior et al. (2018)	Bahia	Children under five years	n=810,831 hospitalizations	2000-2012
63	Pinto et al. (2019)	Brazil, Brasília, São Paulo, Rio de Janeiro, Belo Horizonte, Porto Alegre, Curitiba, and Florianópolis.	Men and Women	n ~ 20 million hospitalizations	2009-2018
64	Lôbo et al. (2019)	Municipalities of the State of São Paulo	Children under one year	n=851,713 hospitalizations	2008-2014
65	Rocha et al. (2020)	Brazil and Portugal	Men and Women	n1=11.6 million (Brazil); n2=1 million (Portugal)	2019

Predominant thematic classification	Up to 2010		2011-2020		Total
Predominant thematic classification	n° of papers	%	n° of papers	%	n° of papers	%
01. Epidemiological studies (with clinical and management indicators, which may include ACSCs)	1	5.6	17	36.2	18	27.7
02. Evaluative research with users/health professionals/managers (many using the PCATool instrument)	3	16.7	12	25.5	15	23.1
03. Evaluative research with the comparison of care models (ESF x traditional model; oral health)	4	22.2	4	8.5	8	12.3
04. Evaluative research on specific actions/programs or procedures performed in PHC	3	16.7	5	10.6	8	12.3
05. Conceptual or institutional discussion	1	5.6	2	4.3	3	4.6
06. Evaluative research with case studies	0	0.0	4	8.5	4	6.2
07. Assessment of the PAB implementation, the Family Health, Oral Health teams (including economic/financial assessment)	5	27.8	1	2.1	6	9.2
08. Exploratory research on PHC work processes	1	5.6	2	4.3	3	4.6
Total	18	100.0	47	100.0	65	100.0

Predominant theory in the papers	Up to 2010		2011-2020		Total
Predominant theory in the papers	n° of papers	%	n° of papers	%	n° of papers	%
01. Normative assessment (several references cited in Chart 1)	0	0.0	10	20.8	10	15.4
02. Political-institutional analysis¹²12 Reis JG, Harzheim E, Nachif MCA, Freitas JC, D'Ávila O, Hauser L, Martins C, Pedebos LA, Pinto LF. Criação da Secretaria de Atenção Primária à Saúde e suas implicações para o SUS. Cien Saude Colet 2019; 24(9):3457-3462.^,²⁴24 Biscaia AR, Heleno LCV. A Reforma dos Cuidados de Saúde Primários em Portugal: portuguesa, moderna e inovadora. Cien Saude Colet 2017; 22(3):701-712.	0	0.0	2	4.2	2	3.1
03. Qualitative exploratory analysis25	1	5.9	3	6.3	4	6.2
04. Theory of assessment and implementation of programs26,27	2	11.8	1	2.1	3	4.6
05. Matus Government Triangle²⁸28 Matus C. Estrategia y plan. Santiago de Chile: Editorial Universitaria; 1972.	0	0.0	1	2.1	1	1.5
06. Theory of Assessment of Impact in Public Policies²⁹29 Draibe SM. Avaliação de implementação: esboço de uma metodologia de trabalho em políticas públicas. In: Barreira MCR, Carvalho MCB, organizadores. Tendências e perspectivas na avaliação de políticas e programas sociais. São Paulo: IEE/PUC; 2004. p. 15-42.	1	5.9	0	0.0	1	1.5
07. Theory of the complexity of health systems: the four existing rationales³⁰30 Contandriopoulos AP. Avaliando a institucionalização da avaliação. Cien Saude Colet 2006; 11(3):705-711.	1	5.9	0	0.0	1	1.5
08. Assessment Theory and use of logical model²⁶26 Hartz ZMA. Avaliação em saúde: dos modelos conceituais à prática na análise da implantação de programas. Rio de Janeiro: Editora Fiocruz; 1997	1	5.9	1	2.1	2	3.1
09. Descriptive assessment of the local situation³¹31 Testa M. O diagnóstico de saúde. In: Rivera FJU, organizador. Planejamento e programação em saúde: um enfoque estratégico. 2ª ed. São Paulo: Editora Cortez; 1992.	1	5.9	0	0.0	1	1.5
10. Theory of structure/process/outcome assessment¹⁴14 Donabedian A. The seven pillars of quality. Arch Pathol Lab Med 1990; 114(11):1115-1118.	5	29.4	5	10.4	10	15.4
11. Theory of Clinical Management in Primary Health Care³²32 Wagner ECK. Guiding Transformation: How Medical Practices Can Become Patient Centered Medical Homes. New York: The Commonwealth Fund; 2012.	0	0.0	1	2.1	1	1.5
12. Theory on access and use of health services³³33 Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav 1995; 36(1):1-10.	0	0.0	1	2.1	1	1.5
13. Theory of Billings15, on Ambulatory Care Sensitive Conditions (ACSC)	0	0.0	12	25.0	12	18.5
14. Theory of the attributes of Primary Health Care (PHC)¹⁶16 Starfield B. Atenção primária: equilíbrio entre necessidades de saúde, serviços e tecnologia. Brasília: Unesco, MS; 2002.	2	11.8	10	20.8	12	18.5
15. Epidemiological Theory, aggregate-ecological studies, and population-based studies³⁴34 Medronho RA, Bloch KV, Luiz RR, Werneck GL, editores. Epidemiologia. 2ª ed. São Paulo: Editora Atheneu; 2009.	3	17.6	1	2.1	4	6.2
Total	17	100.0	48	100.0	65	100.0

ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Collaborations

LF Pinto developed research on assessment and primary health care, generating as part of this, the elaboration of the paper, as part of his post-doctoral internship at the Institute of Hygiene and Tropical Medicine (IHMT), of the Universidade Nova de Lisboa, Portugal. ZMA Hartz critically reviewed the text and approved it.