OBJECTIVE: To investigate access to basic actions among children attended at emergency departments, reconstructing their trajectories to contact with the service for the event in question, characterizing links with basic care and the appropriateness of morbidity to the organizational profile of the service attended. METHODS: Cross-sectional study, carried out in November 2002 and from February to May 2003 at five public pediatric emergency services, of a sample of 383 children under five years old, resident in Recife, calculated for an estimated 20% of appropriate morbidity, 5% error and 10% loss. Using standard instruments applied by eight purposely-trained interviewers. RESULTS: During their trajectories to reach the contact in question, 38.5% of the children had sought other services, primarily: emergency (48.3%), family health team (19.7%) and health centers (17%), with 18.4% having experienced difficulties with primary care. 39.4% only used emergency and at some point 54.4% had resorted to this type of service. Approximately 88% are registered with a unit: 34.5% with the family health team (56.8% of these didn't use the service and 25.6% had sought them), 42% at health centers (59.1% of those didn't use the service and 18.2% had resorted to them). Only 18.9% preferred a basic unit when their child was ill, and therefore for the contact in question, the majority had been brought to their preferred service (like/confide in our professionals, geographic accessibility, and quality of care). Just 36.5% of the demand was defined as appropriate. CONCLUSIONS: Despite of difficulties with the basic network in guaranteeing access and resolution, a substantial part of this spontaneous demand came from the enormous legitimacy of the emergency services as seen by the population.
Accessibility; primary care; reference and counter-reference system; healthcare evaluation
