Innovations in the national household random sampling in Brazilian National Health Survey: results from Starfield and Shi's adult primary care assessment tool (PCAT).

BACKGROUND: Several middle and upper income countries carry out household surveys that seek to trace the profile of access and use of health services. Probably one of the most ambitious examples is Brazil, with its National Health Survey (PNS-2019). We evaluated PNS-2019, presenting in an unprecedented way, one of its innovations, which refer to Starfield and Shi's adult Primary Care Assessment Tool (PCAT). METHODS: Based on a cross-sectional study, we evaluated Module H of the PNS-2019, which interviewed a probabilistic sample of about 10,000 adults in 2019 in all 27 Brazilian states. According to the PCAT methodology, an average score equal to or above 6.6 indicates a greater orientation and quality of the evaluated primary care services. RESULTS: Brazilian overall PCAT score [5, 9] reveals the need to improve primary health care services across the country. There were no statistically significant differences in the scores by sex (men and women, 5.9), and race (whites 5.9 [5.7; 6.0] and brown / black 5.9 [5.8; 6.0]). On the other hand, there was a difference in terms of age. The elderly evaluated the services in a more positive way (score = 6.1 [6.0; 6.2]), when compared to those aged 40-59 years (5.9 [5.7; 6.0]) and 18 to 39 years (5.6 [5.5; 5.8]). First results of PNS-2019 show that the population that most needs primary care services in SUS is the one with the best perception and the most positive evaluation of the actions and procedures offered in health facilities. DISCUSSION: During 2019, Brazil undertook important structural reforms in PHC based on a new financing model with the aim of inducing an improvement in efficiency and strengthening its attributes. It is essential that countries with universal health coverage (UHC) guarantee access to their population and, especially, the most vulnerable, seek better efficiency of these services and regularly assess PHC based on the population's perception, through an independent methodology that monitor the quality of services and the strength of PHC, generating value for public resources applied to health services.

RESUMO: INTRODUçãO: Vários países de renda média e alta realizam pesquisas domiciliares que procuram traçar o perfil de acesso e uso dos serviços de saúde. Provavelmente um dos exemplos mais ambiciosos é o Brasil, com sua PNS. Avaliamos esse inquérito e apresentamos, de forma inédita uma de suas inovações, que se refere ao uso do instrumento Primary Care Assessment Tool (PCAT). MéTODOS: Com base em um estudo transversal, avaliamos o Módulo H da PNS-2019, que entrevistou uma amostra probabilística de cerca de 10.000 adultos em 2019 em todos os 27 estados brasileiros. De acordo com a metodologia do PCAT, um escore médio igual ou acima de 6,6 indica uma maior orientação e qualidade dos serviços de atenção primária avaliados. RESULTADOS: O escore médio geral do PCAT no Brasil foi de 5,9, revelando a necessidade de melhoria dos serviços de atenção primária à saúde em todo o país. Não houve diferenças estatisticamente significantes nos escores por sexo (homens e mulheres, 5,9) e raça (brancos 5,9 [5,7; 6,0] e pardos / pretos 5,9 [5,8; 6,0]). Por outro lado, houve diferença em termos de idade. Os idosos avaliaram os serviços de forma mais positiva (escore = 6,1 [6,0; 6,2]), quando comparados aos de 40­59 anos (5,9 [5,7; 6,0]) e 18 a 39 anos (5,6 [5,5; 5,8]). Os primeiros resultados da PNS-2019 mostram que a população que mais necessita dos serviços de atenção básica no SUS é aquela que tem melhor percepção e avaliação mais positiva das ações e procedimentos oferecidos nas unidades de saúde. DISCUSSãO: Durante o ano de 2019, o Brasil fez reformas estruturais importantes na APS a partir de um novo modelo de financiamento, com o objetivo de induzir uma melhoria da eficiência e fortalecer seus atributos. É fundamental que países com sistemas de saúde de cobertura universal, garantam acesso a sua população e, em especial, aos mais vulneráveis; busquem melhor eficiência desses serviços e avaliem regularmente a APS a partir da percepção da população, por meio de uma metodologia independente que monitore a qualidade dos serviços e a força da APS, gerando valor aos recursos públicos aplicados nos serviços de saúde.

Reasons for encounter in primary health care in Brazil.

BACKGROUND: Primary health care (PHC) delivery in Brazil has improved in the last decades. However, it remains unknown whether the Family Health Strategy teams are meeting the health needs of the population. OBJECTIVES: To describe the reasons for encounter (RFEs) in PHC in Brazil and to examine variations in RFEs according to sex, age and geographic region. METHODS: This descriptive study is part of a national cross-sectional study conducted in 2016. The sample was stratified by the number of PHC physicians per geographic region. Physicians who had been working for at least 1 year in the same PHC unit were included. For every participating physician, 12 patients aged ≥18 years who had attended at least two encounters were included. Patients were asked about their RFEs, which were classified according to the International Classification of Primary Care. RESULTS: In 6160 encounters, a total of 8046 RFEs were coded. Seven reasons accounted for 50% of all RFEs. There was a high frequency of codes related to test results, medication renewal and preventive medicine. RFEs did not vary significantly by sex or geographic region, but they did by age group (P < 0.001). The rates of prescriptions, requests for investigations and referrals to specialized care were 71.1%, 42.8%, and 21.3%, respectively. CONCLUSION: This novel study opened the 'black box' of RFEs in PHC in Brazil. These findings can contribute to redefining the scope of PHC services and reorienting work practices in order to improve the quality of PHC in Brazil.

Following the legacy of professors Barbara Starfield and Leiyu Shi in Brazil as health policy: the National Health Survey (PNS), led by the Brazilian National Institute of Geography and Statistics (IBGE) and the Primary Care Assessment Tool (PCAT).

We present to the scientific community the pioneering of Brazilian National Institute of Geography and Statistics (IBGE, the Brazilian Census Bureau) in partnership with the Ministry of Health, the largest fieldwork ever conducted in a single country in the world, using the PCAT in a national household sample survey, visiting more than 100,000 households and 40% of the country's municipalities. In Brazil, PCAT is being consolidated as an instrument to support public policy for the evaluation of primary health care. We believe that it represents a virtuous example of dialogue between scientific community and health management, following the legacy of Professors Barbara Starfield and Leiyu Shi.

[Primary health care performance in Brazil and association with the More Doctors physician recruitment programCalidad de la atención primaria de salud en Brasil y relación con el Programa Más Médicos]. / Qualidade da atenção primária à saúde no Brasil e associação com o Programa Mais Médicos.

OBJECTIVE: To assess the performance of primary health care (PHC) in Brazil and its association with the More Doctors Program (Programa Mais Médicos, PMM). METHOD: This nationwide cross-sectional study used the Primary Care Assessment Tool validated for Brazilian Portuguese (PCATool-Brasil) to determine the achievement of PHC according to user experience associated with three physician categories: Brazilian physicians participating in the PMM, Cuban physicians participating in the PMM, and Brazilian physicians not linked to the PMM. The following PHC scores were calculated: overall PCA score, accessibility (first contact), and longitudinality. The association between PHC scores, physician category, and other user and physician characteristics was investigated using multilevel analysis. RESULTS: The overall PCA score for Brazil was 6.78, and the longitudinality score was 7.43. There was no difference in these scores among the three physician categories. The overall accessibility score was 4.24. A small but significant difference (P < 0.001) in accessibility score was detected among physician categories: 4.43 for Cuban physicians participating in the PMM (CI: 4.32-4.54), 4.08 for Brazilian physicians participating in the PMM(CI: 3.98-4.18), and 4.20 for Brazilian physicians not linked to the PMM (CI: 4.09-4.32). Age, socioeconomic level, presence of chronic diseases, and home visits by physicians positively influenced the overall PCA score on multilevel analysis. CONCLUSIONS: The type of physician did not influence the primary care orientation (overall score) of the healthcare system in Brazil. PMM was associated with higher accessibility sores in more socioeconomically vulnerable areas. Multilevel analysis showed that PCH may be strengthened by the reinforcement of essential physician roles (such as home visits) and by improving access for socioeconomically vulnerable, younger populations or those without chronic diseases.

OBJETIVO: Evaluar la calidad de la atención primaria de salud (APS) en Brasil y su relación con el Programa Más Médicos (PMM). MÉTODOS: Estudio transversal de alcance nacional em el que se utilizó la herramienta PCATool-Brasil para evaluar la calidad de la APS a partir de la experiencia de los usuarios vinculados a tres categorías de médicos: médicos brasileños del PMM, médicos cubanos del PMM y médicos brasileños no vinculados al PMM. Se calcularon los siguientes puntajes: Puntaje general de APS, Puntaje de acceso y Puntaje de longitudinalidad. Se investigaron mediante análisis multinivel la asociación entre el Puntaje general obtenido, la categoría del médico y otras características de los usuarios y los profesionales. RESULTADOS: El Puntaje general de APS para Brasil fue 6,78, y el Puntaje de longitudinalidad, 7,43. No hubo diferencia entre estos puntajes para las tres categorías de médicos. El Puntaje de acceso para Brasil fue de 4,24 y mostró una diferencia pequeña, pero significativa (p <0,001) entre las categorías de médicos: médicos cubanos del PMM 4,43 (IC: 4,32-4,54), médicos brasileños del PMM 4,08 (IC: 3,98-4,18) y médicos brasileños no vinculados al PMM 4,20 (IC: 4,09-4,32). En el análisis multinivel, la edad, el estrato socioeconómico, la presencia de enfermedades crónicas y el hecho de que el médico realizara visitas domiciliarias influyeron positivamente em el Puntaje general. CONCLUSIONES: El tipo de médico no influyó en el grado de orientación a los atributos de la APS (Puntaje general) en Brasil. El PMM se asoció com mayores Puntajes de acceso en las regiones de mayor vulnerabilidad socioeconómica. Con el análisis multinivel se identificó que el fortalecimiento de la APS también puede ser alcanzado reforzando los roles fundamentales de los médicos que trabajan en la APS (como las visitas domiciliarias) y mejorando el acceso de las poblaciones de mayor vulnerabilidad socioeconómica y de las personas más jóvenes o sin enfermedades crónicas.

Primary health care quality and hospitalizations for ambulatory care sensitive conditions in the public health system in Porto Alegre, Brazil.

PURPOSE: To investigate the relation of hospitalization for ambulatory care sensitive conditions (ACSC) with the quality of public primary care health services in Porto Alegre, Brazil. METHODS: Cohort study constructed by probabilistic record linkage performed from August 2006 to December 2011 in a population ≥18 years of age that attended public primary care health services. The Primary Care Assessment Tool (PCATool-Brazil) was used for evaluation of primary care services. RESULTS: Of 1200 subjects followed, 84 were hospitalized for primary care sensitive conditions. The main causes of ACSC hospital admissions were cardiovascular (40.5%) and respiratory (16.2%) diseases. The PCATool average score was 5.3, a level considerably below that considered to represent quality care. After adjustment through Cox proportional hazard modelling for covariates, >60 years of age [hazard ratio (HR): 1.13; P = 0.001), lesser education (HR: 0.66; P = 0.02), ethnicity other than white (HR: 1.77; P = 0.01) and physical inactivity (HR: 1.65; P = 0.04) predicted hospitalization, but higher quality of primary health care did not. CONCLUSION: Better quality of health care services, in a setting of overwhelmingly low quality services not adapted to the care of chronic conditions, did not influence the rate of avoidable hospitalizations, while social and demographic characteristics, especially non-white ethnicity and lesser schooling, indicate that social inequities play a predominant role in health outcomes.

Telehealth in Rio Grande do Sul, Brazil: Bridging the Gaps.

INTRODUCTION: In 1988, Brazil adopted a universal healthcare model in which access is mediated by the primary care level. However, difficulties have emerged in the coordination of care between the primary and specialized levels. Telehealth was thus proposed as a means to overcome this challenge. This article describes initiatives developed by a large Brazilian program, TelessaúdeRS/UFRGS, in the fields of teleconsultation, telediagnosis, tele-education, and information technology development to support the public healthcare system. MATERIALS AND METHODS: TelessaúdeRS/UFRGS was established in 2010 to develop a telehealth platform and a support system for primary care teams with a special focus on optimizing the flow between primary and specialized levels of care. To define priorities, TelessaúdeRS analyzes the health needs of the Brazilian population and the most common inquiries it receives from primary care health professionals. This information is then combined with the best available scientific evidence for development of services. RESULTS: Since 2010, over 50,000 clinical consultations have been provided. More than 15,000 healthcare professionals have benefited from teleconsultations and from telediagnosis and tele-education activities. All services were provided using information technology solutions developed by the Telessaúde team, including smartphone apps and a Web-based National Telehealth Platform. CONCLUSIONS: The case of TelessaúdeRS/UFRGS shows that even in the presence of structural limitations, telemedicine is potentially useful to improve the quality of care and streamline the flow between different levels of care.

Health and health care of mothers and children in a suburban area of Luanda, Angola.

Population health data available in Angola are often insufficient to guide the planning of health interventions. To address this gap, the goal of the present study was to investigate the health of mothers and infants in a suburban municipality in Luanda (Cacuaco), in order to provide a baseline for future comparisons. This was a prevalence study investigating infants younger than 2 years of age and their mothers. Mothers were interviewed, and children's height and weight were measured. Of 749 mothers interviewed, 98.5% (95% CI 98.2-99.1%) had at least one prenatal visit and 51.7% (95% CI 47.4-56.3%) had a health card. Most mothers with a health card had their first prenatal visit before the 20th week of pregnancy, and had at least four prenatal visits; 81.1% (95% CI 78.3-84.1%) of mothers also had their child's health card. Prevalence of exclusive breastfeeding at 6 months was 19% (95% CI 16.2-23.1%). Prevalence of low height-for-age and low BMI-for-age were 32 and 6%, respectively. Mothers with higher education levels were more likely to have had their first prenatal visit earlier, to have had more prenatal visits, to have given birth at a health facility, and to have her own and her child's health cards. Results showed a high prevalence of prenatal care and a low frequency of acute malnutrition. Maternal education level, among factors studied, was the predominant correlate of more positive health behaviors. These findings suggest important progress of mother and child health in Cacuaco, and may serve as a baseline for the planning of health interventions.

[Validity and reliability of the Argentine version of the PCAT-AE for the evaluation of primary health care]. / Validez y fiabilidad de la versión argentina del PCAT-AE para evaluar la atención primaria de salud.

OBJECTIVE: To determine the validity and reliability of the version of the Primary Care Assessment Tool for adult users, adapted for Argentina (known as AR-PCAT-AE). METHODS: Two cross-sectional pilot studies were conducted among people over age 17, largely through self-administered questionnaires. Items that were equivalent to the original version of the PCAT and 13 others proposed for the instruments were analyzed. The factorial validity and reliability of the scores for each dimension were studied. The validity indicators were: factors that had three or more items with a factorial load of > 0.35, item-total correlation > 0.30, and interpretation of the solution according to the theoretical model. RESULTS: The factorial analysis yielded nine factors that explained 57.4% of the variability. Considering the pre-established criteria for validity, two items were excluded from the dimensions of continuity and comprehensiveness and six were added to comprehensiveness and cultural competency. In the dimensions, the percentage of questions with an item-total correlation of greater than 0.30 ranged from 67% to 100% and the Chronbach's (alpha) coefficient of internal consistency ranged from 0.44 to 0.90. CONCLUSIONS: The validity and reliability of the AR-PCAT-AE questionnaire are adequate, maintaining high equivalence with the original version. The process presented could be adopted in other contexts to advance the evaluation of primary health care functions with quality tools.

Brazilian Survey on Preventive Actions for the Population With Access to Primary Healthcare: Inefficient Spending in a Country in Economic Crisis.

BACKGROUND: Cancer ranks second as a cause of death in Brazil. Although preventive practices are part of the daily routine of primary healthcare (PHC) teams, organized screening programs are lacking. This study aimed to evaluate the adequacy of preventive interventions in the main cancer types, as defined by the Brazilian government. METHODS: We analyzed cross-sectional data from a larger project conducted in 2016 with PHC service users and physicians from all over Brazil, interviewed by trained research staff. The sample was stratified by the number of PHC physicians per geographic region, who were eligible for inclusion if they had been working in the same PHC unit for at least one year. Twelve adult patients with at least two encounters were included per participating physician. Only the data from service users were analyzed in this study. We evaluated the questions about preventive practices and calculated the following indicators: coverage, focus, screening errors, and screening ratio. National guidelines and international evidence were used as a comparison parameter. RESULTS: The study population consisted of 6160 service users. The data indicate that the recommendations for cervical, breast, and prostate cancer screening and for treatment of tobacco dependence are not adequately followed. Coverage for breast and cervical cancer screening presented an overutilization bias, with rates 50% and 9% above the expected, respectively. The screening focus was also inadequate: 24%, 47%, and 54% of the screening tests for the three cancer types were performed in individuals outside the recommended age range. 31% of smokers were not approached for treatment. CONCLUSION: These findings indicate that the Brazilian population has been subjected to inadequate and potentially iatrogenic interventions in PHC. New policies based on stricter criteria of adequacy and increased use of the concept of quaternary prevention may improve the effectiveness and equity of the health system.

Validation of the Brazilian version of Primary Care Assessment Tool (PCAT) for Oral Health - PCATool Brazil Oral Health for Professionals.

This study verified the internal consistency and reliability of an instrument to evaluate dental services in Primary Health Care (PHC). In order to verify the factor validity, a factor analysis with principal component extraction and varimax orthogonal rotation method was used. Factors with three or more items with factor loadings greater than 0,35 were selected. This instrument's reliability was verified using internal consistency (total item correlation >0,30 and Cronbach alpha = or >0,70)). 562 dentists participated in the study. In the factor analysis, ten factors were kept, which explain 40,95% of the total variation. Regarding the internal consistency, only 3 items presented insufficient correlation. Also on internal consistency, using Cronbach's alpha, the following values of the coefficients were identified: Access (0.55), Continuity (0,74), Care Coordination (0,55), Coordination - Information System (0.21), Comprehensiveness of Services Available (0,91), Comprehensiveness of Services Provided (0,79), Family Orientation (0.66), Community Orientation (0,87), Cultural Competence (0,81). For the success ratio of the scale, all results were higher than 88%, less the "Information Systems" component (21%).

Primary Care Assessment Tool: regional differences based on the National Health Survey from Instituto Brasileiro de Geografia e Estatística. / Primary Care Asssement Tool: diferenças regionais a partir da Pesquisa Nacional de Saúde do Instituto Brasileiro de Geografia e Estatística.

In 2019, unprecedentedly among the official statistical institutes worldwide, the IBGE included a particular module on evaluating primary health care in its central population-based population survey, the National Health Survey (PNS-2019). The survey considered the reduced version of the Primary Care Assessment Tool (PCAT), developed and disseminated by Starfield and Shi, to assess the existence and extent of the structure and process characteristics of PHC services. It is the most significant probabilistic sample using this instrument ever conducted in a single country in the world that interviewed users aged 18 or over (n=9,677). The results of the Brazilian overall PCAT scores (5.9 [5.8; 5.9]) point to significant regional and intraregional contrasts, with the South of the country standing out with the best evaluations of primary care services (overall score = 6.3 [6.2; 6.5]) and the North with the worse (overall score = 5,5 [5,3; 5,7]). There were also statistically significant and more favorable differences between residents of households registered by family health teams, among older adults, and those using health services the most (adults with reported morbidities).

Em 2019, o Instituto Brasileiro de Geografia e Estatística (IBGE) de forma inédita entre os institutos oficiais de estatística em todo o mundo, incluiu um módulo especial sobre avaliação da atenção primária à saúde em seu principal inquérito populacional de base domiciliar, a Pesquisa Nacional de Saúde (PNS). O inquérito considerou a versão reduzida do instrumento Primary Care Assessment Tool (PCAT), desenvolvida e disseminada por Starfield e Shi para avaliar a existência e extensão das características de estrutura e processos dos serviços de atenção primária em saúde. Trata-se da maior amostra probabilística com o uso desse instrumento já realizada em um único país do mundo que entrevistou usuários com 18 anos ou mais (n = 9.677). Os resultados dos escores gerais do PCAT do Brasil (5,9 [5,8; 5,9]) apontam grandes contrastes regionais e intraregionais, com a região Sul do país destacando-se com as melhores avaliações dos serviços de atenção primária (escore geral = 6,3 [6,2; 6,5]) e a região norte, por outro lado, com as menores (escore geral = 5,5 [5,3; 5,7]). Foram também observadas diferenças estatisticamente significantes e mais favoráveis entre os moradores de domicílios cadastrados pelas equipes de saúde da família, entre os mais idosos e entre que mais utilizam os serviços de saúde (adultos com morbidades referidas).

Ophthalmic image acquired by ophthalmologists and by allied health personnel as part of a telemedicine strategy: a comparative study of image quality.

OBJECTIVES: This study evaluates the quality of ophthalmic images acquired by a nurse technician trained in teleophthalmology as compared with images acquired by an ophthalmologist, in order to provide a better understanding of the workforce necessary to operate remote care programs. METHODS: A cross-sectional study was performed on 2044 images obtained from 118 participants of the TeleOftalmo project, in Brazil. Fundus and slit-lamp photography were performed on site by an ophthalmologist and by a nurse technician under the supervision of a remote ophthalmologist. Image quality was then evaluated by masked ophthalmologists. Proportion of suitable images in each group was compared. RESULTS: The proportion of concordant classification regarding quality was 94.8%, with a corrected kappa agreement of 0.94. When analyzing each type of photo separately, there was no significant difference in the proportion of suitable images between on-site ophthalmologist and nurse technician with remote ophthalmologist assistance for the following: slit-lamp views of the anterior segment and anterior chamber periphery, and fundus photographs centered on the macula and on the optic disc (P = 0.825, P = 0.997, P = 0.194, and P = 0.449, respectively). For slit-lamp views of the lens, the proportion of suitable images was higher among those obtained by an ophthalmologist (99.6%) than by a technician (93.8%, P < 0.01). CONCLUSIONS: Ophthalmic photographs acquired by a trained technician consistently achieved >90% adequacy for remote reading. Compared with ophthalmologist-acquired photos, the proportion of images deemed suitable achieved a high overall agreement. These findings provide favorable evidence of the adequacy of teleophthalmological imaging by nurse technicians.

Progression rate of neurological deficits in a 10-year cohort of SCA3 patients.

Spinocerebellar ataxia 3 is an untreatable CAG repeat expansion disorder whose natural history is not completely understood. Our aims were to describe the progression of neurological manifestations in a long-term cohort of spinocerebellar ataxia 3, and to verify if CAG expanded repeat, gender, and age at onset were associated with the rate of progression. Patients entered the study between 1998 and 2005 and were seen until 2007. On each visit, the validated NESSCA scale, an inventory of 18 neurological manifestations, was applied. Scores observed in each year of disease duration produced a Growth Curve, which was analyzed through the random coefficients model. Scores obtained in some individual items were described through multi-state Markov models. One hundred fifty-six patients (78 families) were recruited; 28 were lost, and 23 died. Mean (sd) ages at onset and at baseline were 32.8 (10.6) and 40.7 (12.8) years; median (range) expanded CAGn was 74 (67-85). Three hundred fifteen NESSCA evaluations were performed, comprising disease durations from zero to 34 years. The 105 patients who completed the study were seen over 5 (sd = 2.4) years at intervals of 2.5 (sd = 1.5) years. The trajectory of NESSCA obtained for the overall group increased by 1.26 points per year. This slope increased by 0.15 points per each additional CAG in the expanded repeat (p < 0.0002) and decreased by 0.03 points per each additional year of age at onset (p = 0.005). NESSCA worsened steadily, producing linear trajectories, which were faster among patients with longer expanded repeats (>74) and with lower ages at onset (<34 years).

Impact of teleconsultations on the conduct of oral health teams in the Telehealth Brazil Networks Programme.

Telehealth has been applied in the Unified Health System (SUS) as a tool for qualifying professionals and improving the healthcare provided to the population served by the system. The aim of the present study was to evaluate the impact of teleconsultations on the qualifications of the clinical approach of the oral health teams involved in primary health care (PHC) in the state of Rio Grande do Sul under the Telehealth Brazil Networks Programme. The sample population of the study was composed of 285 dentists and 132 oral health assistants belonging to the Family Health Teams. A chi-square test was used to investigate possible associations between the absolute number of teleconsultations performed and several independent variables, namely, gender, age, dental specialty, time since graduation, time working in the Family Health Strategy (FHS), employment status, type of training institution, familiarity with information technology, and work satisfaction at the health facility. The level of significance was p < 0.05. Use of the oral health teleconsultation service led to a reduction of more than 45% in the number of referrals to other levels of care. However, no significant association was found between the number of teleconsultations and the independent variables analysed. The use of teleconsultations proved to be a powerful tool for professional training, for increasing the effectiveness of PHC, and for improving the oral healthcare provided.

Measuring the quality of primary care in national health surveys: Lessons from Brazil.

BACKGROUND: South Africa started to lead the cross-culturally validation and use of the Primary Care Assessment Tool (PCAT) in Africa, when Professor Bresick filled a gap, as this continent was until then the only one that had never used it in evaluation of primary health care facilities until 2015. AIM: The authors aim to demonstrate that after the consolidation of Bresick's team to an African version of PCAT, it had been adapted to household survey in Brazil. METHODS: In this letter, authors reflect on how Brazil had adapted PCAT to a national random household survey with Brazilian National Institute of Geography and Statistics (IBGE) - the Brazilian Census Bureau. RESULTS: In the the beginning of 2019, Brazilian Ministry of Health brought back the PCAT as the official national primary health care assessment tool. Brazilian National Institute of Geography and Statistics (IBGE) included a new module (set of questions) in its National Health Survey (PNS-2019) and collected more than 100 000 households interviews in about 40% of the country's municipalities. This module had 25 questions of the Brazilian validated version of the adult reduced PCAT. CONCLUSION: We believe that IBGE innovation with the Ministry of Health can encourage South Africa to establish a similar partnership with its National Institute of Statistics (Statistics South Africa) for the country to establish a baseline for future planning of primary health care, for decision-making based on scientific evidence.

Validity and reliability of the Brazilian Primary Care Assessment Tool: Oral Health of Adults.

OBJECTIVE: To test the factorial validity and reliability of the Primary Care Assessment Tool adapted to Oral Health, adult patient version, an instrument used to verify the presence and extent of attributes in Primary Health Care services. METHODS: Population-based cross-sectional study using conglomerate random sample carried out in Primary Health Care Dental services in Porto Alegre between 2011 and 2013. We interviewed 407 adult patients who used Primary Health Care Dental services. Construct validity was tested through factorial validity and reliability of the Primary Care Assessment Tool, that comprises 81 items distributed throughout Primary Health Care attributes. Equamax orthogonal rotation method was used in the factorial analysis; and, in order to assess reliability of each component, we used the item-total correlation and the ratio of success of the scale. RESULTS: In the factorial analysis, 10 factors were retained, explaining 53.3% of the total variation. This result demonstrates the multidimensional structure of the instrument. The reliability assessment showed Cronbach's alpha values ranging from 0.39 to 0.89. For the success of the scale most of the results (eight of nine attributes) were greater than 85%. CONCLUSIONS: The instrument is valid for the assessment of oral health services in Primary Health Care from the perspective of adult patients, as well as for monitoring and evaluation of oral health services in Primary Health Care attributes and comparative studies.

Presence and extension of the attributes of primary health care in public dental services in Porto Alegre, Rio Grande do Sul State, Brazil.

The objective was to compare the presence and extension of primary health care (PHC) in oral health services using the PHC attributes according to three different types of PHC organizational arrangements: Family Health Strategy (FHS), Community Health Service (CHS) and Traditional Primary Care (TPC). This is a cross-sectional study carried out between 2011-2013, following a cluster random sampling strategy. Adult users were interviewed from 15 health services of that 6 were managed by the CHS, 4 by the FHS and 5 by the TPC and which had the same oral health team for at least two years. The final sample was 407 users interviewed using the Primary Care Assessment Tool - Oral Health of Adults evaluation instrument and a sociodemographic questionnaire. PHC scores were calculated and transformed on a scale ranging from 0 to 10. For high scores, the cut-off point > 5.5 was used. Most of the interviewees were females, for the three types of services. The performance of CHS and FHS was higher than those of TPC in almost all attributes (p < 0.05). The extent of PHC attributes in services was poor (overall highest score was 5.75 in CHS). The CHS was the only service witch half of the users (83; 49.1%) rated oral health services as having a high overall score for PHC. It is concluded that there were differences among the organizational arrangements of PHC oral health services, however, there is much to be improved in the orientation of dental care services for PHC. More studies are necessary to evaluate the differences in PHC services considering oral health.