Evaluación del acceso de primer contacto en la perspectiva de los profesionales

el estudio de evaluación e transversal, realizado en el período de febrero a marzo de 2017. La muestra fue compuesta por 163 profesionales de salud, de ambos sexos, que trabajaban en la atención básica del Municipio de Juazeiro do Norte, Ceará. El acceso de primer contacto fue evaluado por el instrumento Primary Care Assessment Tool (PCATool). Se empleó la marca de 6,60 como punto de corte para el atributo evaluado.

Resultados:

el acceso de primer contacto alcanzó una puntuación de 3,3, denotando un bajo grado de orientación para la Atención Primaria de Salud. Los profesionales enfermeros fueron los que evaluaron de modo más negativo el atributo (p=3,2).

Conclusiones:

el acceso de primer contacto obtuvo bajo puntaje, apuntando a la fragilidad de la Estrategia Salud de la Familia como puerta de entrada del Sistema Único de Salud (Sistema Único de Saúde).

Descriptores:
Evaluación en Salud; Acceso a los Servicios de Salud; Atención Primaria de Salud; Estrategia Salud de la Familia; Personal de Salud

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