Addressing chronic noncommunicable diseases in primary health care in Goiás, Brazil: a descriptive study, 2012 and 2014

Oliveira, Júlio Henrique de; Souza, Marta Rovery de; Morais Neto, Otaliba Libânio de

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Epidemiologia e Serviços de Saúde

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Original article • Epidemiol. Serv. Saúde 29 (5) • Nov 2020 • https://doi.org/10.1590/S1679-49742020000500016 copy

Addressing chronic noncommunicable diseases in primary health care in Goiás, Brazil: a descriptive study, 2012 and 2014¹ 1 Article derived from the Ph.D. thesis entitled ‘Evaluation of chronic noncommunicable disease care actions in primary health care services in Goiás, Brazil’, defended by Júlio Henrique de Oliveira at the Federal University of Goiás Tropical Medicine and Public Health Postgraduate Program in 2019.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To compare primary health care (PHC) actions taken to care for chronic non-communicable diseases (NCDs) in the state of Goiás, Brazil, between 2012 and 2014.

Methods:

This was a descriptive study using secondary data from the National Program for Improving Primary Care Access and Quality (PMAQ-AB). The proportions of teams performing actions to address NCDs were compared between PMAQ-AB cycles I and II using the McNemar test for paired samples.

Results:

Seventeen of the 20 variables studied showed a proportional increase between the two cycles: from 16.0% to 32.1% of teams that practiced all care management actions, from 21.5% to 35.2% of those that practiced all health promotion actions and from 22.2% to 39.8% of teams that practiced all activities at school.

Conclusion:

PHC actions to address NCDs in Goiás were strengthened between the two PMAQ-AB cycles.

Keywords:
Primary Health Care; Chronic Disease; Health Evaluation; Epidemiology, Descriptive

Dimension	Variable	Content of the variable
Care management	Attending to spontaneous demand	Proportion of teams attending to spontaneous demand.
	Assessment of risk and vulnerability at initial care	Proportion of teams carrying out assessment of risk and vulnerability at initial care for service users.
	Training for assessment and classification of risk and vulnerability	Proportion of teams carrying patient embracement and trained to assess and classify their risk and vulnerability.
	Repeat prescription without having to have an appointment	Proportion of teams issuing repeat prescriptions for patients under continuous care/programs such as hypertension and diabetes, without having to have an appointment.
	Time slots allotted for receiving and showing test results	Proportion of teams that allot time slots in the appointment book or at a convenient time for health professionals so that patients can receive and be shown their test results.
	Time slots allotted for post-consultation queries	Proportion of teams that allot time slots in the appointment book or at a convenient time for health professionals so that patients can make post-consultation queries or show how their situation has progressed.
	All care management actions	Proportion of teams carrying out all care management actions.
Health promotion	Support with self-care of chronic diseases	Proportion of teams carrying out health education and health promotion actions in group activities with the aim of supporting self-care of chronic diseases.
	Actions aimed at women	Proportion of teams carrying out health education and health promotion actions aimed at women (cervical and breast cancer).
	Actions aimed at men	Proportion of teams carrying out health education and health promotion actions aimed at men.
	Actions aimed at the elderly	Proportion of teams carrying out health education and health promotion actions aimed at the elderly.
	Actions aimed at healthy eating	Proportion of teams carrying out health education and health promotion actions aimed at healthy eating.
	Encouragement of bodily practices and physical activity	Proportion of teams that encourage and arrange bodily practices or physical activity at the primary health care center and/or in its catchment area.
	All health promotion actions	Proportion of teams carrying out all health promotion actions.
Activity at schools	Carries out activity at schools	Proportion of teams carrying out activities at schools.
	Early detection of arterial hypertension	Proportion of teams carrying out early detection of arterial hypertension.
	Nutritional assessment	Proportion of teams carrying out nutritional assessment.
	Food security and healthy eating promotion actions	Proportion of teams carrying out food security and healthy eating promotion actions.
	Promotion of bodily practices and physical activity at schools	Proportion of teams promoting bodily practices and physical activity at schools.
	All activity actions at schools	Proportion of teams carrying out all activity actions at schools.

Care management: Actions	n=648% (95%CI^a)
	Cycle		p-valor^b
	I	II	p-valor^b
Attending to spontaneous demand	65,6 (61,9;69,1)	96,9 (95,3;98,0)	<0,001
Assessment of risk and vulnerability at initial care	55,7 (51,9;59,5)	90,4 (87,9;92,5)	<0,001
Training for assessment and classification of risk and vulnerability	33,0 (29,5;36,7)	62,2 (58,4;65,8)	<0,001
Repeat prescription without having to have an appointment	73,1 (69,6;76,4)	84,9 (81,9;87,4)	<0,001
Reserving time slots to receive and show test results	50,3 (46,5;54,2)	66,8 (63,1;70,3)	<0,001
Reserving time slots for post-consultation queries	47,8 (44,0;51,7)	60,8 (57,0;64,5)	<0,001
All care management actions	16,0 (13,4;19,1)	32,1 (28,6;35,8)	<0,001

Health promotion: Actions	n=648% (95%CI^a)
	Cycle		p-valor^b
	I	II	p-valor^b
Support with self-care of chronic diseases	55,1 (51,2;58,9)	68,5 (64,9;72,0)	<0,001
Actions aimed at women	78,7(75,4;83,7)	80,9 (77,7;83,7)	0,35
Actions aimed at men	36,7 (33,1;40,5)	61,7 (57,9;65,4)	<0,001
Actions aimed at the elderly	77,9 (75,6;80,1)	81,2 (78,0;84,0)	0,17
Actions aimed at healthy eating	73,9 (70,4;77,2)	77,6 (74,3;80,7)	0,12
Bodily practices and/or physical activity	67,6 (63,9;71,1)	78,4 (75,1;81,4)	<0,001
All health promotion actions	21,5 (18,5;24,8)	35,2 (31,6;38,9)	<0,001

Activity at schools: Actions	n=648 % (95%CI^a)
	Cycle		p-valor^b
	I	II	p-valor^b
Carries out activity at schools	77,2 (73,8;80,2)	88,9 (86,2;91,1)	<0,001
Early detection of arterial hypertension	37,7 (34,0;41,5)	59,6 (55,7;63,3)	<0,001
Nutritional assessment	47,5 (43,7;51,4)	74,7 (71,2;77,9)	<0,001
Food security and healthy eating promotion actions	55,1 (51,2;58,9)	75,8 (72,3;78,9)	<0,001
Promotion of bodily practices and physical activity at schools	35,3 (31,8;39,1)	54,0 (50,2;57,8)	<0,001
All activity actions at schools	22,2 (19,2;25,6)	39,8 (36,1;43,6)	<0,001
Todas as ações de promoção da saúde	21,5 (18,5;24,8)	35,2 (31,6;38,9)	<0,001

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[1] Correspondence: Júlio Henrique de Oliveira - Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Pública, Rua 235, S/N, Sala 409, Setor Universitário, Goiânia, GO, Brazil. Postcode: 74605-050. E-mail: juliohenrique21@gmail.com