Evaluación de atributos de la atención primaria a la salud: niños y adolescentes viviendo con VIH

Antunes, Bibiana Sales; Padoin, Stela Maris de Mello; Paula, Cristiane Cardoso de

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Brasil

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RESEARCH • Esc. Anna Nery 22 (2) • 2018 • https://doi.org/10.1590/2177-9465-EAN-2017-0233 copiar

Evaluación de atributos de la atención primaria a la salud: niños y adolescentes viviendo con VIH

Autoría SCIMAGO INSTITUTIONS RANKINGS

Resumen

Objetivos:

Evaluar los atributos derivados de la Atención Primaria a la salud (APS) con enfoque en niños y adolescentes que viven con VIH, en la perspectiva de los profesionales de salud, comparando las unidades de modelo tradicional (UBS) y la Estrategia de Salud de la Familia (ESF).

Método:

Estudio transversal. Participaron 524 profesionales de 25 municipios de Rio Grande do Sul, Brasil. Se utilizó el instrumento PCATool-Brasil, entre marzo y agosto de 2014.

Resultados:

La puntuación derivada de APS atribuido a ESF (7,8) fue mayor que la atribuida a UBS (6,8). Los puntajes más altos contribuyeron a la visita domiciliaria, la calificación profesional y el vínculo laboral, este último actuando independientemente de los demás.

Conclusión:

La evaluación de atributos derivados demuestra la interacción con los usuarios y la comunidad y el potencial de APS para atender a estos niños y adolescentes, siendo que la visita al domicilio califica la práctica.

Palabras clave:
Atención Primaria a la Salud; Investigación de Servicios de Salud; VIH; Salud del Niño; Salud del Adolescente; Profesionales de la Salud

Derived attributes	Primary Heaalth Care Unit ^* * Mann-Whitney Test; PHU (n = 243)		Family Health Strategy ^* * Mann-Whitney Test; FHS (n = 249)		p-value^* * Mann-Whitney Test;
Derived attributes	Average (DP)	Minimum-Maximum	Average (DP)	Minimum-Maximum	p-value^* * Mann-Whitney Test;
Family Guidance	7.9 (2.2)	0-10	8.4 (1.5)	3.3-10	0.039
Community Guidance	5.6 (2.2)	0-10	7.2 (1.5)	2.2-10	<0.001
Derived Score	6.8 (1.7)	0.6-10	7.8 (1.2)	0.4-10	<0.001

	Primary Health Care Unit			Family Health Strategy
	High Score (≥ 6.6) n (%)	Low Score (< 6.6) n (%)	p-value^* * Person’s Chi-Square Test.	High Score (≥ 6.6) n (%)	Low Score (< 6.6) n (%)	p-value^* * Person’s Chi-Square Test.
Family Guidance (N=524)	n = 270			n = 254
G1 - Do you ask the patients what are their ideas and opinions on planning the treatment and care of teh patient and family member?			0.490			0.983
High Score	118 (43.7)	15 (5.6)		91 (35.8)	14 (5.5)
Low Score	125 (46.3)	12 (4.4)		129 (50.8)	20 (7.9)
G2 - Do you ask about illnesses and health issues that may occur in patient’s families?			0.798			0.724
High Score	159 (58.9)	17 (6.3)		142 (55.9)	23 (9.1)
Low Score	84 (31.1)	10 (3.7)		78 (30. 7)	11 (4.3)
G3 - Are you willing and capable to asses patient’s family members to discuss a health or family issue?			0.934			0.838
High Score	147 (54.1)	16 (5.9)		159 (62.6)	24 (9.4)
Low Score	97 (35.9)	11 (4.1)		61 (24.0)	10 (3.9)
Family Guidance General Score	243 (90.0)	27 (10.0)	<0.001	220 (86.6)	34 (13.4)	<0.001
Community Guidance (N=492)	N=248			N=244
H1 - Do you or anybody from your service do home visits?			0.433			0.714
High score	60 (24.2)	47 (18.9)		140 (57.4)	93 (38.1)
Low Score	72 (29.0)	69 (27.8)		6 (2.5)	5 (2.0)
H2 - Do you believe that your health serice have adequate knowledge of the health issues in the community they asses?			0.823			0.157
High score	46 (18.5)	42 (16.9)		64 (26.2)	52 (21.3)
Low Score	86 (34.7)	74 (29.8)		82 (33.6)	46 (18.8)
H3 - Do your health service listen to the community’s opinion and ideas on how to improve health services?			0.159			0.116
High score	40 (16.1)	45(18.10		73 (29.9)	59 (24.2)
Low score	92 (37.1)	71 (28.60)		73 (29.9)	39 (16.0)
H4 - Do you do research with patients to see if services are satisfying (assessing) people’s needs?			0.336			0.691
High score	16 (6.4)	19 (7.7)		34 (13.9)	25 (10.2)
Low score	116 (46.8)	97 (39.1)		112 (45.9)	73 (29.9)
H5 - Do you research in the community to identify health issues you should know?			0.597			0.363
High score	14 (5.6)	10 (4.0)		30 (12.3)	25 (10.2)
Low score	118 (47.6)	106 (42.7)		116 (47.5)	73 (29.9)
H6 - Presence of Users in Local Health Council (Board of Directors, User Council)			0.327			0.839
High Score	44 (17.7)	32 (12.9)		60 (24.6)	39 (16.0)
Low Score	88 (35.5)	84 (33.9)		86 (35.2)	59 (24.2)
Community Guidance Score	132 (53.2)	116 (46.8)	0.309	146 (59.8)	98 (40.2)	0.002

Variables	High Score
Variables	RPb^* * RPb: Gross Poisson Regression;	IC95%^† † IC 95%: Confidence gap of 95%; Minimum-Maximum	p-value	RPa^‡ ‡ RPa: Poisson regression adjusted by: Age, Conjugal Situation, Employment Bond, Length of Service, Formation, Completion of Undergraduation, Gradute Studies, and Graduate studies Completion.	IC95%^† † IC 95%: Confidence gap of 95%; Minimum-Maximum	p-value
Employment relationship
Statutory	0.881	0.808-0.960	0.004	0.869	0.815-0.925	< 0.001
Clerk	0.937	0.856-1.025	0.156	0.891	0.826-0.962	0.003
Outsourced	ref			ref
Time of service
≤3 years	1.013	0.9670-1.0610	0.5790	1.0160	0.9520-1.0830	0.6380
>3 years	ref			ref
Training
General pratictioner	0.990	0.909-1.077	0.807	0.972	0.885-1.068	0.558
Nurse	0.907	0.83-0.992	0.033	0.920	0.818-1.034	0.163
Odontologist	0.956	0.872-1.047	0.331	0.958	0.849-1.080	0.481
Gynecologist	0.943	0.84-1.058	0.317	0.935	0.832-1.050	0.257
Pediatrician	ref			ref
Undergraduation
≤15 years	0.980	0.936-1.026	0.386	1.015	0.940-1.097	0.698
>15 years	ref			ref
Graduate Studies
Specialization	1.081	0.929-1.258	0.314	1.080	0.926-1.260	0.329
None	1.154	0.991-1.344	0.660	0.981	0.629-1.531	0.932
Resídency	1.130	0.967-1.320	0.123	1.099	0.930-1.298	0.267
Master’s	ref			ref
Graduate Studies
≤6 years	0.973	0.920-1.029	0.333	0.979	0.906-1.057	0.585
>6 years	ref			ref

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[1] Corresponding author: Cristiane Cardoso de Paula. E-mail: cris_depaula1@hotmail.com