Assessment of access to first contact in the perspective of professionals

an evaluative and cross-sectional study, carried out from February to March 2017. The sample consisted of 163 health professionals, of both genders, who worked in the basic care of the Municipality of Juazeiro do Norte, Ceará. Access to first contact was evaluated by the Primary Care Assessment Tool (PCATool). The 6.60 mark was used as the cut-off point for the evaluated attribute.

Results:

access to first contact reached a score of 3.3, denoting a low degree of orientation for Primary Health Care. Nurses were the ones who evaluated the attribute more negatively (p=3.2).

Conclusions:

access to first contact obtained a low score, pointing to the fragility of the Family Health Strategy as a gateway to the Brazilian Unified Health System (Sistema Único de Saúde).

Descriptors:
Health Evaluation; Access to Health Services; Primary Health Care; Family Health Strategy; Health Personnel

Assessment items – Access to first contact
A1 – Is your health service open on a Saturday or Sunday?
A2 - Is your health service open at least on certain days of the week, until 8:00 p.m.?
A3 – When your health service is open and some patient falls ill, does someone at your service see you on the same day?
A4 – When your health service is open, can patients get quick counseling over the phone when they think it’s necessary?
A5 – When your health care service is closed, is there a phone number that patients can call when they get sick?
A6 − When your health service is closed on Saturdays and Sundays and some of your patients become ill, does someone from your service see you on the same day?
A7 – When your health service is closed at night and some patient becomes ill, does someone at your service see you that night?
A8 – Is it easy for a patient to be able to set a time for a health check-up (routine visit) at their health service?
A9 – On average, do patients have to wait more than 30 minutes to be seen by the physician or nurse (not counting the screening or the host)?

Variables	Dentist		Nurse		Physician		p value
Variables	n	%	n	%	n	%	p value
Postgraduate
Yes	34	24.5	62	44.6	43	30.9	<0.001
No	4	26.7	0	0.0	11	73.3
In progress	2	22.2	1	11.1	6	66.7
Type of postgraduate course (n=139)
Specialization	31	28.0	55	49.5	25	22.5	<0.001
Residency	-	-	-	-	12	100.0
Master	3	20.0	7	46.7	5	33.3
Doctorate	-	-	-	-	1	100
Years working (mean ± Standard Deviation)	11.0 - 3.5		11.6 - 5.5		10.2 - 6.9		0.367³ 3 Kruskal-Wallis Test.
Years at FHS (mean ± Standard Deviation)	7.6 - 3.4		6.6 - 4.3		5.4 - 4.9		0.008 ³ 3 Kruskal-Wallis Test.
Age (mean ± Standard Deviation)	42.2 ± 8.6		39.8 ± 7.9		42.4 ± 13.5		0.460³ 3 Kruskal-Wallis Test.
Age group
24 to 29	2	11.8	5	29.4	10	58.8	<0.001² 2 Fisher’s Exact Test;
30 to 39	19	30.6	29	46.8	14	22.6
40 to 49	6	14.6	17	41.5	18	43.9
50 to 59	9	47.4	7	36.8	3	15.8
60 or over	1	9.1	1	9.1	9	81.8
Gender
Male	19	33.3	6	10.6	32	56.1	<0.001¹ Note: 1Chi-Square Test;
Female	20	19.6	55	53.9	27	26.5	<0.001¹ Note: 1Chi-Square Test;
Marital status
Married	33	27.5	43	35.8	44	36.7	0.225¹ Note: 1Chi-Square Test;
Not married	6	15.0	19	47.5	15	37.5	0.225¹ Note: 1Chi-Square Test;
Zone
Urban	35	24.2	55	37.9	55	37.9	0.698² 2 Fisher’s Exact Test;
Rural	5	27.8	8	44.4	5	27.8	0.698² 2 Fisher’s Exact Test;

	Access to first contact
Items^* Note: *A1 – Is your health service open on a Saturday or Sunday? A2 – Is your health service open at least on certain days of the week, until 8:00 p.m.? A3 – When your health service is open and some patient falls ill, does someone at your service see you on the same day? A4 – When your health service is open, can patients get quick counseling over the phone when they think it’s necessary? A5 – When your health care service is closed, is there a phone number that patients can call when they get sick? A6 - When your health service is closed on Saturdays and Sundays and some of your patients become ill, does someone from your service see you on the same day? A7 - When your health service is closed at night and some patient becomes ill, does someone at your service see you that night? A8 – Is it easy for a patient to be able to set a time for a health check-up (routine visit) at their health service? A9 – On average, do patients have to wait more than 30 minutes to be seen by the physician or nurse (not counting the screening or the host)?	Certainly yes		Probably yes		Probably not		Certainly not		I do not know/ I do not remember		Score of the attributed
	N	%	N	%	N	%	N	%	N	%
A1	-	-	-	-	11	6.8	152	93.2	-	-	3.3
A2	-	-	-	-	9	5.5	154	95.4	-	-
A3	97	59.5	57	35.0	2	1.2	5	3.1	2	1.2
A4	9	5.5	28	17.2	43	26.4	71	43.5	12	7.4
A5	5	3.1	8	4.9	29	17.8	111	68.1	10	6.1
A6	4	2.5	9	5.5	30	18.4	118	72.4	2	1.2
A7	3	1.8	7	4.3	36	22.1	114	70.0	3	1.8
A8	84	51.5	64	39.3	12	7.4	3	1.8	-	-
A9	16	9.8	83	50.9	35	21.5	18	11.0	11	6.8

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[1] Corresponding author: Glaucia Margarida Bezerra Bispo. E-mail: glauciambbispo@hotmail.com