Construction of a logical theoretical model to assess disability care in Primary Health Care services

Zarili, Thais Fernanda Tortorelli; Castanheira, Elen Rose Lodeiro

doi:10.1590/1413-812320242911.11562023

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THEMATIC ARTICLE • Ciênc. saúde coletiva 30 (suppl 1) • 2025 • https://doi.org/10.1590/1413-812320242911.11562023EN linkcopy

Construction of a logical theoretical model to assess disability care in Primary Health Care services

Authorship SCIMAGO INSTITUTIONS RANKINGS

The aim is to propose a theoretical-logical evaluation model for the Attention to Disability dimension in Primary Health Care services. A model was created with 128 indicators divided into five domains: Structure (EST), Prenatal Care (APN), Child Health Care (ASC), Prevention of Disabilities Related to Chronic Conditions (PICC) and Care for People with Disability and the Caregiver (APcDC). Based on the frequency of responses from the application of the Assessment and Monitoring of Primary Care Services (QualiAB) questionnaire in 2739 PHC services in the São Paulo’ state, between 2017 and 2018, the existing correlations between the evaluative domains and the dimension by Spearman's correlation coefficient and the level of reliability of responses by Cronbach's alpha (α). The α for the evaluative dimension was 0.956, for the EST domain 0.687, for APN 0.845, ASC 0.872, PICC 0.919 and APcDC 0.916. Significant correlations were found between the evaluative dimension and the domains, and between them, with the exception of the EST domain. The proposed evaluation methodology covers the analysis of the conditions of the physical structure, human resources and work process.

Keywords:
Health Evaluation; Primary Health Care; Health Services; Disabled persons; Models theoretical

Indicators	(%)
“Prenatal Care” Domain
Early identification for the start of prenatal care	79.8
Average proportion of pregnant women who start prenatal care in their first pregnancy trimester	74.1
Recording of prenatal care in medical records, Pregnancy Card and Perinatal Form	92.1
Health visits during prenatal care and in the last month of pregnancy	83.9
Identification of high-risk pregnant women	93.6
Referral of high-risk pregnant women to a reference service and maintenance of follow-up at the basic health unit	61.7
Special care for pregnant women aged 10 to 19	37.5
Laboratory tests requested in the first trimester of pregnancy to identify complications that may cause prematurity, developmental changes or fetal death	10.8
Laboratory tests requested in the second and/or third trimester of pregnancy to identify complications that may cause prematurity, developmental changes or fetal death	3.0
Electrocardiogram performed at the unit	47.3
DTaP vaccine (diphtheria, tetanus and acellular pertussis) administered	77.3
Benzathine penicillin (Benzetacil) administered at the unit	71.8
Prevention of vertical transmission of syphilis	76.5
Prevention of vertical transmission of HIV	77.1
Treatment of syphilis for pregnant women and their partners with benzathine penicillin at the basic health unit	74.3
Guidance for partner(s) to come for evaluation and counseling in cases suggestive of sexually transmitted diseases	83.9
Prevention of anemia and changes in nutritional status during pregnancy	75.4
Indication of the use of medications with lesser effects on the fetus during pregnancy	81.2
Assessment of the risks of smoking and the use of alcoholic beverages and other drugs during pregnancy	86.6
Assessment of working conditions for pregnant women	58.4
Assessment of birth complications in immediate postpartum care	79.6
Guidance on breastfeeding and iron supplementation in immediate postpartum care	62.8
Guidance for pregnant women on breastfeeding and support for women who will not be able to breastfeed	89.3
Training and/or ongoing education for professionals at the basic health unit on women’s health carried out in the last year	71.7
“Child Health Care” Domain
Birth conditions of the newborn and guidelines on basic care in the immediate postpartum period	87.1
Guidelines for newborn care (vaccination, exams, others) in the immediate postpartum period	89.0
Scheduling the newborn’s first health appointment at the unit	70.3
Guidance on newborn heel prick, ear and eye tests	87.5
Application of the BCG vaccine	56.0
Application of the Polio vaccine/oral polio vaccine/OPV and Inactivated Polio vaccine/inactivated polio vaccine/IPV	76.6
Administration of the Pentavalent vaccine (DTP + Hib + HB)	78.4
Application of the DTP vaccine (Triple Bacterial)	78.1
Application of the Triple Viral vaccine (Measles, Mumps and Rubella - MMR)	78.3
Application of the Tetra Viral vaccine (Measles, Mumps, Rubella and Chickenpox)	76.5
Application of the Meningococcal C vaccine	77.5
Application of the 10-valent Pneumococcal vaccine	75.9
Vaccination in institutions for children such as schools and daycare centers	66.9
Scheduled calendar of health visits for children up to 2 years old, in addition to occasional unscheduled appointments	52.7
Parents’ groups	20.2
Evaluation of children’s growth and neuropsychomotor development of the child	81.0
Evaluation and nutritional child guidance (breastfeeding, introduction of foods, others)	92.0
Identification of child development disorders (genetic, biological, socio-familial)	75.5
Guidelines for preventing domestic accidents to protect children’s health	57.2
Evaluation of visual acuity in institutions for children such as schools and daycare centers	38.9
Evaluation of hearing acuity in institutions for children such as schools and daycare centers	16.3
Guidelines for neuropsychomotor stimuli in institutions for children such as schools and daycare centers	13.8
Actions for social inclusion and combating prejudice in institutions for children such as schools and daycare centers	13.9
Actions for preventing domestic accidents in institutions for children such as schools and daycare centers	21.7
Absence of cases of congenital syphilis in the last three years	47.4
Use of a care protocol for detecting violence against children and adolescents	28.9
Identification of physical and psychological symptoms/complaints to detect violence against children and adolescents	76.7
Raising awareness and training staff to identify cases of violence against children and adolescents	34.5
Monitoring of child labor (under 16 years of age) as an alert situation - sentinel event	8.8
Meetings with CRAS on child health care	39.1
Referral to a milk bank or access to modified milk if necessary (HIV, others)	55.0
Training and/or ongoing education on Child Health carried out in the previous year	55.0
Domain “Prevention of Disabilities in Chronic Diseases and Injuries”
Dressing of acute and chronic ulcers	94.7
Activities in conjunction with the epidemiological and/or health surveillance team in the community in cases of diseases or conditions requiring compulsory notification	73.8
Registration of patients with chronic non-communicable diseases differentiated risk	43.7
Guidelines for preventing work-related accidents and diseases	33.8
Compulsory notification of work-related conditions.	44.2
Active search for patients with chronic non-communicable diseases who are not adhering to treatment	68.8
Eye fundus examination for patients with type II diabetes mellitus	63.3
Control, assessment and guidance on foot care for patients with type II diabetes mellitus	67.2
Eye fundus examination for patients with high blood pressure	62.3
Actions for men’s health with a focus on cardiovascular risk	65.1
Evaluation of the mental health of older adults (depressive conditions, dementia and others)	69.0
Evaluation of the functional capacity of the elderly (Activities of Daily Living and Instrumental Activities)	51.1
Actions for preventing falls in older adults	64.0
Encouragement and guidance on physical activity and physical exercise for older adults	72.2
Investigation of family and social support for older adults	56.3
Guidance on the Rights of the Elderly	41.5
Diagnosis of new cases of leprosy	52.7
Monitoring of leprosy cases	34.3
Control of the number of leprosy cases under monitoring	41.7
Dispensing of leprosy medication	78.9
Supervised treatment at the Unit or at home for leprosy	20.6
Active search for intra-household contacts in leprosy cases	34.0
Active search for those who have missed leprosy treatment	54.5
Educational actions in the family and community about leprosy	64.5
Active search in cases of disease or condition requiring compulsory notification with indication of control of contacts and/or the environment	88.0
Mandatory notification of leprosy cases	69.3
Investigation and control of comorbidities associated with alcohol dependence	39.4
Investigation and control of comorbidities associated with drug abuse	37.9
Training and/or continuing education on mental health carried out during the previous year	48.8
Training and/or continuing education on older adults health carried out in the previous year	40.9
Team training on diseases or conditions requiring compulsory notification	63.2
Team training to care for leprosy cases	45.2

Indicators	(%)
“Structure” Domain
Structural access to the service for people with disabilities	77.0
Bathrooms adapted for patients with disabilities (PwD)	67.6
Dressing room	89.5
Vaccination room	81.2
Vaccination performance	80.6
Room for educational activities and groups	51.3
Dental office and dental equipment	77.8
Wheelchairs	92.7
Equipment for urgent and emergency care, such as emergency cart and oxygen cylinder	40.7
Access to an ambulance for patient transportation, when necessary	87.5
Vehicle for use by the Unit	37.8
Access to information systems for database feeding	86.7
Presence of a family doctor or general practitioner and nurse on the health team	85.4
Presence of a dentist on the health team	65.2
Presence of a dentist’s assistant or dental hygiene technician on the health team	63.7
Presence of a nursing assistant OR nursing technician on the health team	98.0
Technical support provided by a NASF-AB and/or multidisciplinary team	69.0
“Care for People with Disabilities and Caregivers” Domain
Recording of home care actions in medical records for bedridden individuals	79.0
Diagnosis and referral of individuals with disabilities to other levels of care	80.2
Home procedures (such as vaccination, changing of indwelling urinary catheters, dressings, etc.) for bedridden individuals	84.2
Changing of indwelling urinary catheters	77.2
Dental care, when possible at the Unit for individuals with disabilities	58.0
Regular home visits with the support of a multidisciplinary team for individuals with disabilities	51.2
Regular home visits with a doctor and/or nurse for individuals with disabilities	69.2
Home dental care for bedridden individuals and provision of dental care for bedridden patients	24.5
Oral hygiene guidelines for bedridden individuals	64.8
Guidance on the social rights of individuals with disabilities	45.9
Monitoring and attention to the use of alcohol and other drugs by individuals with disabilities	33.4
Actions for the sexual and reproductive health of people with disabilities	35.9
Surveillance and attention in cases of violence against people with disabilities	41.4
Detection, support and monitoring for situations of violence against people with disabilities	35.8
Coordination with the health network and institutions (schools, special schools, among others) in relation to people with disabilities	43.0
Discussion of specific cases with the health network (CRAS, Health Council, CREAS, others) on care for bedridden patients	59.8
Assessment and monitoring of the health of caregivers of older adults and/or bedridden people (stress and others)	39.2
Support group for caregivers of elderly and/or bedridden patients	7.8
Actions for older adults caregivers and/or bedridden patients with a focus on general guidelines on daily care needs	79.0
Actions for older adults caregivers and/or bedridden people with a focus on guidelines on preventing and identifying situations of violence	52.2
Guidance for caregivers of patients with disabilities	77.9
Technical support for the activities of caregivers of older adults and/or bedridden patients, if necessary	59.6
Training of the team on care for patients with disabilities	36.5

DOMAIN	Structure		Pre-natal		Child Health		Prevention of Disability		PwD Care		Dimension
DOMAIN	r	p	r	p	r	p	r	p	r	p	r	p
Structure	-	-	.338	<0.001	.365	<0.001	.315	<0.001	.344	<0.001	.541	<0.001
Prenatal			-	-	.688	<0.001	.553	<0.001	.539	<0.001	.759	<0.001
Child Health					-	-	.588	<0.001	.585	<0.001	.817	<0.001
Prevention of Disability							-	-	.818	<0.001	.887	<0.001
PwD Care									-	-	.875	<0.001
Dimension											-	-

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[TFN4n] Source: QualiAB System, 2018.