Analysis of the attributes of primary health care using the electronic medical records in the city of Rio de Janeiro

Soranz, Daniel; Pinto, Luiz Felipe; Camacho, Luiz Antonio Bastos

doi:10.1590/1413-81232017223.33142016

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ARTICLE • Ciênc. saúde colet. 22 (3) • Mar 2017 • https://doi.org/10.1590/1413-81232017223.33142016 copy

Analysis of the attributes of primary health care using the electronic medical records in the city of Rio de Janeiro

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Epidemiology plays a strategic role at this stage of the policy cycle, contributing to goal setting, resource allocation and use of information systems. In 2009, the Municipal Health Secretariat of Rio de Janeiro initiated a reform of the health care model under the main influence the Primary Health Care concept. This study evaluates the trend of selected pay-for-performance indicators that measure the health care process in the city’s PHC. This a study on repeated panels, from the administrative and clinical records of electronic medical records in the period from 2012 to 2016. We selected seven indicators that analyzed longitudinal performance within the established goal, among those that represent access, longitudinality, coordination of care - APS attributes, as well as other characteristics of the services, such as care performance and economic efficiency. This study demonstrated that management decentralization to levels closer to the user is potentially successful for the recording of clinical data under an adequate monitoring of indicators, regular clinical audits and feedback to health professionals, along with data and indicators monitoring.

Pay-for-performance; Primary Health Care; Process indicators

Code	Action	Indicator	Calculation formula	Goal	Remarks
A1	Access/ Longitudinality	Proportion of consultations performed by own family doctor	(N) Nº of medical consultations performed on patients of the team by team doctor ______________ X 100 (D) Nº of medical consultations performed on patients of the team at the facility	70 to 90%
A2	Access	Proportion of spontaneous (*) vs. scheduled demand (doctors, nurses and dentists)	(N) Nº consultations not previously scheduled (spontaneous demand) by doctors, nurses and dentists of the team ______________ X 100 (D) Nº total consultations performed (doctors, nurses and dentists) by the team	Minimum 40%	(*) Reception of unplanned demand or referrals from other facilities. Spontaneous demand is a consultation that is carried out on the same day, without previous scheduling. Collective care services, groups or activities other than consultation are excluded.
A5	Access	Rate of service portfolio items implemented	(N) Nº service portfolio actions implemented by family and oral health team ______________ X 100 (D) Total service portfolio actions	Minimum 80%
D2	Care performance	Proportion of diabetics with at least 2 consultations recorded in the last 12 months	(N) Nº diabetics covered by the team with at least consultations recorded in the last 12 months ______________ X 100 (D) Total Nº of diabetics registered in the area covered by the team	Minimum 70%	For the calculation of the indicator, consider as denominator (D) only diabetics who had a diagnosis validated by the team doctor. In order to follow-up, show in new column next to (D) the number of diabetics in the team area (by the PHC register (card B) + those validated by the doctor).
D3	Care performance	Percentage of hypertensive patients with a blood pressure record in the last 6 months	(N) Nº of hypertensive patients covered by the team with blood pressure record in the last 6 months ______________ X 100 (D) Total Nº of hypertensive patients registered in the area covered by the team	Minimum 70%
E1	Efficiency	Average cost of prescription drugs per user	(N) Sum of the amount of prescriptions by the doctor of each team in the last 3 months (REMUME and non-REMUME) ______________ (D) Nº of total users attended by doctors of each team in the last 3 months (with prescription + without prescription)	Maximum R$ 51.78	* Consider as denominator (D) all users attended by the doctor of each team (patients in the area and attended out of the area by the doctor) regardless of whether medication was prescribed or not. * Show new column next to (D) with the number of patients attended who had prescribed medication. * Should allow details of patients, the medication prescribed, the cost of the prescription and the amount of prescription drugs delivered to the facility’s pharmacy. * All medical records must make available the option of non-REMUME medication prescription.
E2	Coordination – integration of care (PCATool)	Proportion of patients referred vs. number of patients attended	(N) Nº of patients attended by the doctor of each team (patients in the area and out of the area) in the last 3 months referred to some service / specialty ______________ x 100 (D) Total Nº of patients by the doctor of each team (patients in the area and out of the area) in the last 3 months	Maximum 20%	* Consider as denominator (D) all users attended by the doctor of each team (patients in the area and attended out of the area by the doctor) regardless of whether medication was prescribed or not.

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

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[1] Conflict of interest

D Soranz participated as manager of the PHC Reform in the period 2009-2016. LF Pinto supported the design and actions of the Reform.

Collaborations

D Soranz participated in paper design and writing. LF Pinto collected data and developed the statistical part, as well as contributing to the analysis of the results. LAB Camacho reviewed the article critically and contributed to data analysis and paper final version.