Professional Doctorate in Primary Care (DPAPS): a legacy for the Rio de Janeiro SUS. / Doutorado Profissional em Atenção Primária em Saúde (DPAPS): o início de um legado para o SUS carioca.

Since 2009, the Municipal Health Secretariat of Rio de Janeiro (SMS-RJ) has encouraged the creation of a Master's degree in primary health care at the National Health School/Fiocruz (ENSP/Fiocruz). In the following decade, this proposal became one of the main lines of the institution's professional stricto sensu postgraduate program, which culminated in CAPES approving the first professional doctorate class in the history of Fiocruz-RJ offered in 2024. The class comprises primary health care (PHC) students from Rio's SUS and Fiocruz employees in science, technology and innovation. Regarding the profile of the PHC students, the highlights were women (61.5%), a degree in medicine (53.8%), a mean of 15 years since graduating, 10 years working in PHC, graduates of a medical or multiprofessional residency course (69.2%) and a Master's degree in primary care from ENSP/Fiocruz or UFRJ (84.6%). The SMS-RJ thus leaves a legacy for Brazilian Public Health as a leader in the promotion of Fiocruz-RJ stricto sensu professional training programs, innovating in the end-of-course work, reviving the presence of doctors in the classes and bringing the contributions of the Portuguese SNS, a source of inspiration for the PHC reform undertaken in Rio de Janeiro, to the Rio de Janeiro SUS debate.

Desde 2009, a Secretaria Municipal de Saúde do Rio de Janeiro (SMS-RJ) fomentou a criação do mestrado em atenção primária à saúde na Escola Nacional de Saúde Pública/Fiocruz (ENSP/Fiocruz). Essa proposta, na década seguinte, se tornou uma das principais linhas do programa de pós-graduação stricto sensu profissional da instituição, culminando com a aprovação pela CAPES da primeira turma de doutorado profissional na história da Fiocruz-RJ ofertada em 2024. A turma é formada por alunos da atenção primária à saúde (APS) do SUS carioca e por servidores da Fiocruz na área de ciência, tecnologia & inovação. No que se refere ao perfil dos alunos da APS destacam-se as mulheres (61,5%), a graduação em medicina (53,8%), o tempo médio de 15 anos de formado, 10 anos de atuação na APS, egressos de curso de residência médica ou multiprofissional (69,2%) e do mestrado em atenção primária da ENSP/Fiocruz ou UFRJ (84,6%). A SMS-RJ deixa assim, um legado para a Saúde Pública brasileira como protagonista no fomento aos programas de formação profissional stricto sensu da Fiocruz-RJ, inovando nos trabalhos de final de curso, resgatando a presença dos médicos nas turmas e trazendo para o debate do SUS carioca, as contribuições do SNS português, fonte de inspiração para a reforma da APS empreendida no Rio de Janeiro.

Factors associated with COVID-19 vaccination among pregnant women in Rio De Janeiro City, Brazil.

COVID-19 vaccination during pregnancy is safe and effective in reducing the risk of complications. However, the uptake is still below targets worldwide. This study aimed to explore the factors associated with COVID-19 vaccination uptake among pregnant women since data on this topic is scarce in low-to-middle-income countries. A retrospective cohort study included linked data on COVID-19 vaccination and pregnant women who delivered a singleton live birth from August 1, 2021, to July 31, 2022, in Rio de Janeiro City, Brazil. Multiple logistic regression was performed to identify factors associated with vaccination during pregnancy, applying a hierarchical model and describing odds ratio with 95% confidence intervals. Of 65,304 pregnant women included in the study, 53.0% (95% CI, 52-53%) received at least one dose of COVID-19 vaccine during pregnancy. Higher uptake was observed among women aged older than 34 (aOR 1.21, 95%CI 1.15-1.28), black (aOR 1.10, 1.04-1.16), or parda/brown skin colour (aOR 1.05, 1.01-1.09), with less than eight years of education (aOR 1.09, 1.02-1.17), living without a partner (aOR 2.24, 2.16-2.34), more than six antenatal care appointments (aOR 1.92, 1.75-2.09), and having a previous child loss (OR 1.06, 1.02-1.11). These results highlight the need for targeted educational campaigns, trustful communication, and accessibility strategies for specific populations to improve vaccination uptake during pregnancy.

Safety of BNT162b2 and CoronaVac during pregnancy on birth outcomes and neonatal mortality: a cohort study from Brazil.

BACKGROUND: COVID-19 vaccines have been shown to protect pregnant individuals against mild and severe COVID-19 outcomes. However, limited safety data are available for inactivated (CoronaVac) and mRNA (BNT162b2) vaccines during pregnancy regarding their effect on birth outcomes and neonatal mortality, especially in low- and middle-income countries. METHODS: We conducted a retrospective population-based cohort study in Rio de Janeiro, Brazil, with 17 513 singleton live births conceived between 15 May 2021 and 23 October 2021. The primary exposure was maternal vaccination with CoronaVac or mRNA BNT162b2 vaccines and sub-analyses were performed by the gestational trimester of the first dose and the number of doses given during pregnancy. The outcomes were pre-term birth (PTB), small for gestational age (SGA), low birthweight (LBW), low Apgar 5 and neonatal death. We used the Cox model to estimate the hazard ratio (HR) with a 95% CI and applied the inverse probability of treatment weights to generate adjusted HRs. RESULTS: We found no significant increase in the risk of PTB (HR: 0.98; 95% CI 0.88, 1.10), SGA (HR: 1.09; 95% CI 0.96, 1.27), LBW (HR: 1.00; 95% CI 0.88, 1.14), low Apgar 5 (HR: 0.81; 95% CI 0.55, 1.22) or neonatal death (HR: 0.88; 95% CI 0.56, 1.48) in women vaccinated with CoronaVac or BNT162b2 vaccines. These findings were consistent across sub-analyses stratified by the gestational trimester of the first dose and the number of doses given during pregnancy. We found mild yet consistent protection against PTB in women who received different vaccine platforms during the third trimester of pregnancy (any vaccines, HR: 0.78; 95% CI 0.63, 0.98; BNT162b2, HR: 0.75; 95% CI 0.59, 0.99). CONCLUSIONS: This study provides evidence that COVID-19 vaccination in all trimesters of pregnancy, irrespective of the vaccine type, is safe and does not increase the risk of adverse birth outcomes or neonatal deaths.

Excess mortality from all causes during the COVID-19 pandemic in the city of Rio de Janeiro, Brazil.

OBJECTIVE: To evaluate excess mortality in the city of Rio de Janeiro, Brazil, due to the COVID-19 pandemic (March 2020 to January 2022). METHODS: Ecological study using secondary data from the Brazilian Mortality Information System, having the city of Rio de Janeiro as the unit of analysis. Excess mortality was estimated by the difference between the mean number of all expected deaths and the mean number of observed deaths, considering the 2015-2019 period. The quantile regression method was adjusted. The total value of cases above that expected by the historical series was estimated. Among all deaths, cases of COVID-19 and Influenza as underlying causes of death were selected. The ratio between excess mortality and deaths due to COVID-19 was calculated. RESULTS: We identified an excess of 31,920 deaths by the mean (increase of 26.8%). The regression pointed to 31,363 excess deaths. We found 33,401 deaths from COVID-19 and 176 deaths from Influenza. The ratio between the verified excess mortality and deaths due to COVID-19 was 0.96 by the mean and 0.95 by the regression. CONCLUSION: The study pointed to large excess deaths during the COVID-19 pandemic in the city of Rio de Janeiro distributed in waves, including the period of the Influenza outbreak.

Excess mortality from all causes during the COVID-19 pandemic in the city of Rio de Janeiro, Brazil / Excesso de mortalidade por todas as causas na pandemia de COVID-19 no município do Rio de Janeiro (RJ)

ABSTRACT Objective: To evaluate excess mortality in the city of Rio de Janeiro, Brazil, due to the COVID-19 pandemic (March 2020 to January 2022). Methods: Ecological study using secondary data from the Brazilian Mortality Information System, having the city of Rio de Janeiro as the unit of analysis. Excess mortality was estimated by the difference between the mean number of all expected deaths and the mean number of observed deaths, considering the 2015-2019 period. The quantile regression method was adjusted. The total value of cases above that expected by the historical series was estimated. Among all deaths, cases of COVID-19 and Influenza as underlying causes of death were selected. The ratio between excess mortality and deaths due to COVID-19 was calculated. Results: We identified an excess of 31,920 deaths by the mean (increase of 26.8%). The regression pointed to 31,363 excess deaths. We found 33,401 deaths from COVID-19 and 176 deaths from Influenza. The ratio between the verified excess mortality and deaths due to COVID-19 was 0.96 by the mean and 0.95 by the regression. Conclusion: The study pointed to large excess deaths during the COVID-19 pandemic in the city of Rio de Janeiro distributed in waves, including the period of the Influenza outbreak.

RESUMO Objetivo: Analisar o excesso de óbitos no município do Rio de Janeiro (MRJ), RJ, durante a pandemia de COVID-19 (março de 2020 a janeiro de 2022). Métodos: Foi realizado um estudo ecológico com dados secundários do Sistema de Informação sobre Mortalidade cuja unidade de análise foi o MRJ. O excesso de mortalidade foi calculado pela diferença entre a média de óbitos esperados e a média dos óbitos observados levando-se em conta o período de 2015 a 2019. Foi ajustado um método de regressão quantílica. Calculou-se o valor total dos casos acima do esperado pela série histórica. Foram selecionados os óbitos por causa básica COVID-19 e Influenza. Também foi calculada a razão entre o excesso de óbitos e os óbitos atribuídos à COVID-19. Resultados: Foi identificado excesso de 31.920 óbitos pela média (26,8% de incremento). Pela regressão quantílica, encontrou-se excesso de 31.363 óbitos. Ocorreram 33.401 óbitos por COVID-19 e 176 por Influenza. A razão entre o excesso de óbitos encontrado e os óbitos atribuídos à COVID-19 foi de 0,96 pela média e 0,95 pela regressão quantílica. Conclusão: O estudo apontou grande excesso de óbitos durante a pandemia de COVID-19 no MRJ, distribuído em ondas, incluindo-se o período do surto de Influenza.

Seroepidemiology of SARS-CoV-2 on a partially vaccinated island in Brazil: Determinants of infection and vaccine response.

Background: A vaccination campaign targeted adults in response to the pandemic in the City of Rio de Janeiro. Objective: We aimed to evaluate the seroprevalence of SARS-CoV-2 antibodies and identify factors associated with seropositivity on vaccinated and unvaccinated residents. Methods: We performed a seroepidemiologic survey in all residents of Paquetá Island, a neighborhood of Rio de Janeiro city, during the COVID-19 vaccine roll-out. Serological tests were performed from June 16 to June 19, 2021, and adjusted seropositivity rates were estimated by age and epidemiological variables. Logistic regression models were used to estimate adjusted ORs for risk factors to SARS-CoV-2 seropositivity in non-vaccinated individuals, and potential determinants of the magnitude of antibody responses in the seropositive population. Results: We included in the study 3,016 residents of Paquetá (83.5% of the island population). The crude seroprevalence of COVID-19 antibodies in our sample was 53.6% (95% CI = 51.0, 56.3). The risk factors for SARS-CoV-2 seropositivity in non-vaccinated individuals were history of confirmed previous COVID-19 infection (OR = 4.74; 95% CI = 3.3, 7.0), being a household contact of a case (OR = 1.93; 95% CI = 1.5, 2.6) and in-person learning (OR = 2.01; 95% CI = 1.4, 3.0). Potential determinants of the magnitude of antibody responses among the seropositive were hybrid immunity, the type of vaccine received, and time since the last vaccine dose. Being vaccinated with Pfizer or AstraZeneca (Beta = 2.2; 95% CI = 1.8, 2.6) determined higher antibody titers than those observed with CoronaVac (Beta = 1.2; 95% CI = 0.9, 1.5). Conclusions: Our study highlights the impact of vaccination on COVID-19 collective immunity even in a highly affected population, showing the difference in antibody titers achieved with different vaccines and how they wane with time, reinforcing how these factors should be considered when estimating effectiveness of a vaccination program at any given time. We also found that hybrid immunity was superior to both infection-induced and vaccine-induced immunity alone, and online learning protected students from COVID-19 exposure.

Vaccine effectiveness of ChAdOx1 nCoV-19 against COVID-19 in a socially vulnerable community in Rio de Janeiro, Brazil: a test-negative design study.

OBJECTIVES: To estimate vaccine effectiveness after the first and second dose of ChAdOx1 nCoV-19 against symptomatic COVID-19 and infection in a socially vulnerable community in Brazil when Gamma and Delta were the predominant variants circulating. METHODS: We conducted a test-negative study in the community Complexo da Maré, the largest group of slums (n = 16) in Rio de Janeiro, Brazil, from January 17, 2021 to November 27, 2021. We selected RT-qPCR positive and negative tests from a broad community testing program. The primary outcome was symptomatic COVID-19 (positive RT-qPCR test with at least one symptom) and the secondary outcome was infection (any positive RT-qPCR test). Vaccine effectiveness was estimated as 1 - OR, which was obtained from adjusted logistic regression models. RESULTS: We included 10 077 RT-qPCR tests (6,394, 64% from symptomatic and 3,683, 36% from asymptomatic individuals). The mean age was 40 (SD: 14) years, and the median time between vaccination and RT-qPCR testing among vaccinated was 41 (25-75 percentile: 21-62) days for the first dose and 36 (25-75 percentile: 17-59) days for the second dose. Adjusted vaccine effectiveness against symptomatic COVID-19 was 31.6% (95% CI, 12.0-46.8) 21 days after the first dose and 65.1% (95% CI, 40.9-79.4) 14 days after the second dose. Adjusted vaccine effectiveness against COVID-19 infection was 31.0% (95% CI, 12.7-45.5) 21 days after the first dose and 59.0% (95% CI, 33.1-74.8) 14 days after the second dose. DISCUSSION: ChAdOx1 nCoV-19 was effective in reducing symptomatic COVID-19 in a socially vulnerable community in Brazil when Gamma and Delta were the predominant variants circulating.

[COVID-19 emergency operations center: experience of the Rio de Janeiro municipality, BrazilCentro de operaciones de emergencia en respuesta a la COVID-19: la experiencia del municipio de Rio de Janeiro]. / Centro de operações de emergência na COVID-19: a experiência do município do Rio de Janeiro.

The present report describes the implementation of an emergency operations center to coordinate the response to the COVID-19 pandemic in the municipality of Rio de Janeiro, Brazil. Following the public health emergency management framework proposed by the World Health Organization (WHO), this temporary center (COE COVID-19 RIO) started operating in January 2021. The report is organized along five themes: legal framework; structure, planning, and procedures; institutional articulation; health information for decision-making; and risk communication. Major advances obtained with the initiative include improvements in governance for the management of COVID-19, increase in the synergy among sectors and institutions, improved information sharing in relation to COVID-19 prevention and control measures, innovation in epidemiologic analyses, and gains in transparency and decision-making opportunities. In conclusion, even if conceived at an advanced stage of the pandemic in the municipality of Rio de Janeiro, the COE COVID-19 RIO has played a relevant role in shaping the city's responses to the pandemic. Also, despite its temporary character, the experience will leave a lasting legacy for the management of future public health emergencies in the municipality of Rio de Janeiro.

En el presente artículo se describe la experiencia al establecerse un centro de operaciones de emergencia (COE) para coordinar la respuesta a la pandemia de COVID-19 en el municipio de Rio de Janeiro (Brasil). Siguiendo el modelo de gestión de emergencias de salud pública promovido por la Organización Mundial de la Salud (OMS), este centro temporal se activó en enero del 2021. El informe se estructuró con base en cinco ejes temáticos: marco legal; estructura, planes y procedimientos; articulaciones institucionales; información en materia de salud para sustentar las decisiones; y comunicación sobre riesgos. Entre los principales avances relacionados con esta iniciativa cabe destacar los adelantos en cuanto a la gobernanza para organizar la forma de enfrentar la COVID-19, el aumento de la sinergia entre los sectores y las instituciones correspondientes, un mayor intercambio de información sobre las medidas de prevención y control de la enfermedad, innovación en los análisis epidemiológicos, mayor transparencia en la toma de decisiones y decisiones tomadas de manera más oportuna. Se llegó a la conclusión de que este COE, a pesar de que había sido establecido en una fase avanzada de la pandemia en la ciudad, tuvo un papel importante en la estructuración de la respuesta. Sin embargo, a pesar de su carácter temporal, la experiencia demostró ser un importante legado para enfrentar futuras emergencias de salud pública en el municipio de Rio de Janeiro.

Centro de operações de emergência na COVID-19: a experiência do município do Rio de Janeiro / COVID-19 emergency operations center: experience of the Rio de Janeiro municipality, Brazil / Centro de operaciones de emergencia en respuesta a la COVID-19: la experiencia del municipio de Rio de Janeiro

RESUMO O presente artigo descreve a experiência de implantação de um centro de operações de emergência (COE) para coordenação da resposta à pandemia de COVID-19 no município do Rio de Janeiro, Brasil. Seguindo o modelo de gestão de emergências em saúde pública preconizado pela Organização Mundial da Saúde (OMS), este centro de caráter temporário (COE COVID-19 RIO) foi ativado em janeiro de 2021. O relato foi estruturado com base em cinco eixos temáticos: arcabouço legal; estrutura, planos e procedimentos; articulações institucionais; informações em saúde para apoio decisório; e comunicação de risco. Entre os avanços importantes relacionados ao estabelecimento desta iniciativa, destacaram-se ganhos em governança para a organização do enfrentamento à COVID-19, aumento da sinergia entre setores e instituições, maior compartilhamento de informações em relação às medidas de prevenção e controle da doença, inovação nas análises epidemiológicas e ganhos na transparência e oportunidade na tomada de decisões. Concluiu-se que, mesmo sendo concebido em estágio avançado da pandemia na cidade, o COE COVID-19 RIO teve papel relevante na estruturação da resposta. Ainda, apesar do caráter temporário do COE, a experiência mostrou-se como importante legado para a condução de futuras emergências em saúde pública no município do Rio de Janeiro.

ABSTRACT The present report describes the implementation of an emergency operations center to coordinate the response to the COVID-19 pandemic in the municipality of Rio de Janeiro, Brazil. Following the public health emergency management framework proposed by the World Health Organization (WHO), this temporary center (COE COVID-19 RIO) started operating in January 2021. The report is organized along five themes: legal framework; structure, planning, and procedures; institutional articulation; health information for decision-making; and risk communication. Major advances obtained with the initiative include improvements in governance for the management of COVID-19, increase in the synergy among sectors and institutions, improved information sharing in relation to COVID-19 prevention and control measures, innovation in epidemiologic analyses, and gains in transparency and decision-making opportunities. In conclusion, even if conceived at an advanced stage of the pandemic in the municipality of Rio de Janeiro, the COE COVID-19 RIO has played a relevant role in shaping the city's responses to the pandemic. Also, despite its temporary character, the experience will leave a lasting legacy for the management of future public health emergencies in the municipality of Rio de Janeiro.

RESUMEN En el presente artículo se describe la experiencia al establecerse un centro de operaciones de emergencia (COE) para coordinar la respuesta a la pandemia de COVID-19 en el municipio de Rio de Janeiro (Brasil). Siguiendo el modelo de gestión de emergencias de salud pública promovido por la Organización Mundial de la Salud (OMS), este centro temporal se activó en enero del 2021. El informe se estructuró con base en cinco ejes temáticos: marco legal; estructura, planes y procedimientos; articulaciones institucionales; información en materia de salud para sustentar las decisiones; y comunicación sobre riesgos. Entre los principales avances relacionados con esta iniciativa cabe destacar los adelantos en cuanto a la gobernanza para organizar la forma de enfrentar la COVID-19, el aumento de la sinergia entre los sectores y las instituciones correspondientes, un mayor intercambio de información sobre las medidas de prevención y control de la enfermedad, innovación en los análisis epidemiológicos, mayor transparencia en la toma de decisiones y decisiones tomadas de manera más oportuna. Se llegó a la conclusión de que este COE, a pesar de que había sido establecido en una fase avanzada de la pandemia en la ciudad, tuvo un papel importante en la estructuración de la respuesta. Sin embargo, a pesar de su carácter temporal, la experiencia demostró ser un importante legado para enfrentar futuras emergencias de salud pública en el municipio de Rio de Janeiro.

Laboratory for innovation in Primary Health Care: implementation and results. / Laboratório de inovação na Atenção Primária à Saúde: implementação e desdobramentos.

This article presents and problematizes innovation actions aimed at improving the quality of Primary Health Care (PHC), describing an experience that can be adapted to different contexts, considering diverse sociodemographic, economic, cultural and epidemiological realities. We conducted an exploratory study using documentary sources referring to the implementation of the Campo Grande Laboratory for Innovation in Primary Health Care (INOVAAPS). The project proposes the reorientation of the care model adopted in the municipality's public primary care services, redefining work processes and improving the quality of practice. We identified product, process and organizational innovations that have the potential to transform and tailor health care practices to the population's health needs. It is concluded that the proposals implemented by the project focus on the consolidation and expansion of access to primary care, recruitment and training of adequately qualified health professionals, adoption of resolutive technologies, regulatory improvement, and strengthening the mediating role of primary health care.

O objetivo do estudo foi apresentar e problematizar as ações de inovação para a qualificação da Atenção Primária à Saúde (APS), evidenciando experiência que pode ser adaptada e implementada em diversos contextos, considerando as diferentes realidades sociodemográficas, econômicas, culturais e epidemiológicas. Trata-se de um estudo exploratório realizado a partir de fontes documentais sobre a implementação do Laboratório de Inovação na Atenção Primária à Saúde (INOVAAPS) no município de Campo Grande-MS, que propõe a reorientação do modelo assistencial, com ressignificação dos processos de trabalho na APS, qualificando as práticas. Foram identificadas ações inovadoras organizacionais, processuais e de produto que são potentes para a transformação e readequação de práticas do fazer em saúde. Concluiu-se que as propostas já executadas estão pautadas na expansão, consolidação e ampliação de acesso à APS, à provisão e formação profissionais adequadas, à alocação de tecnologias resolutivas, ao aprimoramento da regulação e à efetivação do papel mediador da APS.

Applicability and potentiality in the use of Business Intelligence tools in Primary Health Care. / Aplicabilidade e potencialidades no uso de ferramentas de Business Intelligence na Atenção Primária em Saúde.

Data management tools, called Business Intelligence (BI), can be important to provide complete and customizable information for the demands of health management. The objective of the article is to present the evaluation of the applicability and potential of a BI tool in the planning of management actions of Primary Health Care. Exploratory study, with a quantitative approach, using the dimensions of efficiency and optimization as attributes of quality. A Family Clinic was selected in the city of Rio de Janeiro. Data from the territory, from the Bolsa Família Program register and some "Care Lines" were inserted in the BI, in order to explore the possibilities of combining and generating indicators. In this article, we present the use of Form A and the pregnant woman's Care Line. As a result, greater range of detailed indicators compared to a common tab, and optimization in obtaining lists and perform monitoring tasks by the teams and the manager. Regarding efficiency, its low cost and easy handling reduces the costs of creation and necessary professionals. As a conclusion, the BI tool enables greater organization and planning, facilitating the Family Health Clinic management, mainly for the monitoring of indicators and evaluation processes.

As ferramentas de gestão de dados, denominadas Business Intelligence (BI), podem ser importantes para fornecer informações completas e personalizáveis para as demandas da gestão em saúde. O objetivo é apresentar a avaliação da aplicabilidade e potencialidade do uso de uma ferramenta de BI no planejamento das ações de gestão da Atenção Primária em Saúde. Estudo exploratório, de abordagem quantitativa, tendo as dimensões de eficiência e otimização como atributos da qualidade. Seleção de uma Clínica da Família, da cidade do Rio de Janeiro, sendo inseridos no BI dados do território, do cadastro do Programa Bolsa Família e de linhas de cuidado, para explorar as possibilidades de combinação e de geração de indicadores. Neste artigo, apresentamos a Ficha A e a Linha de cuidado da gestante. Como resultados a ampliação de indicadores detalhados em relação à um tabulador comum e otimização na obtenção de listas e do monitoramento por parte das equipes e do gestor. Quanto à eficiência, seu baixo custo e fácil manuseio reduz custos de criação e de profissionais necessários. Conclui-se que a ferramenta viabiliza uma maior organização e planejamento, facilitando a gestão da Clínica da Família, sobretudo no monitoramento dos indicadores e processos avaliativos.

Laboratório de inovação na Atenção Primária à Saúde: implementação e desdobramentos / Laboratory for innovation in Primary Health Care: implementation and results

Resumo O objetivo do estudo foi apresentar e problematizar as ações de inovação para a qualificação da Atenção Primária à Saúde (APS), evidenciando experiência que pode ser adaptada e implementada em diversos contextos, considerando as diferentes realidades sociodemográficas, econômicas, culturais e epidemiológicas. Trata-se de um estudo exploratório realizado a partir de fontes documentais sobre a implementação do Laboratório de Inovação na Atenção Primária à Saúde (INOVAAPS) no município de Campo Grande-MS, que propõe a reorientação do modelo assistencial, com ressignificação dos processos de trabalho na APS, qualificando as práticas. Foram identificadas ações inovadoras organizacionais, processuais e de produto que são potentes para a transformação e readequação de práticas do fazer em saúde. Concluiu-se que as propostas já executadas estão pautadas na expansão, consolidação e ampliação de acesso à APS, à provisão e formação profissionais adequadas, à alocação de tecnologias resolutivas, ao aprimoramento da regulação e à efetivação do papel mediador da APS.

Abstract This article presents and problematizes innovation actions aimed at improving the quality of Primary Health Care (PHC), describing an experience that can be adapted to different contexts, considering diverse sociodemographic, economic, cultural and epidemiological realities. We conducted an exploratory study using documentary sources referring to the implementation of the Campo Grande Laboratory for Innovation in Primary Health Care (INOVAAPS). The project proposes the reorientation of the care model adopted in the municipality's public primary care services, redefining work processes and improving the quality of practice. We identified product, process and organizational innovations that have the potential to transform and tailor health care practices to the population's health needs. It is concluded that the proposals implemented by the project focus on the consolidation and expansion of access to primary care, recruitment and training of adequately qualified health professionals, adoption of resolutive technologies, regulatory improvement, and strengthening the mediating role of primary health care.

Aplicabilidade e potencialidades no uso de ferramentas de Business Intelligence na Atenção Primária em Saúde / Applicability and potentiality in the use of Business Intelligence tools in Primary Health Care

Resumo As ferramentas de gestão de dados, denominadas Business Intelligence (BI), podem ser importantes para fornecer informações completas e personalizáveis para as demandas da gestão em saúde. O objetivo é apresentar a avaliação da aplicabilidade e potencialidade do uso de uma ferramenta de BI no planejamento das ações de gestão da Atenção Primária em Saúde. Estudo exploratório, de abordagem quantitativa, tendo as dimensões de eficiência e otimização como atributos da qualidade. Seleção de uma Clínica da Família, da cidade do Rio de Janeiro, sendo inseridos no BI dados do território, do cadastro do Programa Bolsa Família e de linhas de cuidado, para explorar as possibilidades de combinação e de geração de indicadores. Neste artigo, apresentamos a Ficha A e a Linha de cuidado da gestante. Como resultados a ampliação de indicadores detalhados em relação à um tabulador comum e otimização na obtenção de listas e do monitoramento por parte das equipes e do gestor. Quanto à eficiência, seu baixo custo e fácil manuseio reduz custos de criação e de profissionais necessários. Conclui-se que a ferramenta viabiliza uma maior organização e planejamento, facilitando a gestão da Clínica da Família, sobretudo no monitoramento dos indicadores e processos avaliativos.

Abstract Data management tools, called Business Intelligence (BI), can be important to provide complete and customizable information for the demands of health management. The objective of the article is to present the evaluation of the applicability and potential of a BI tool in the planning of management actions of Primary Health Care. Exploratory study, with a quantitative approach, using the dimensions of efficiency and optimization as attributes of quality. A Family Clinic was selected in the city of Rio de Janeiro. Data from the territory, from the Bolsa Família Program register and some "Care Lines" were inserted in the BI, in order to explore the possibilities of combining and generating indicators. In this article, we present the use of Form A and the pregnant woman's Care Line. As a result, greater range of detailed indicators compared to a common tab, and optimization in obtaining lists and perform monitoring tasks by the teams and the manager. Regarding efficiency, its low cost and easy handling reduces the costs of creation and necessary professionals. As a conclusion, the BI tool enables greater organization and planning, facilitating the Family Health Clinic management, mainly for the monitoring of indicators and evaluation processes.

National Primary Care Policy 2017: analysis of teams composition and national coverage of Family Health. / Política Nacional de Atenção Básica de 2017: análise da composição das equipes e cobertura nacional da Saúde da Família.

The Family Health Strategy is the main form of organization of the Brazilian health system. However, the third edition of the National Primary Health Care Policy (PNAB) recognized other types of teams financially. A time series study was conducted from 2007 to 2019 using data from the National Register of Health Facilities (CNES) of jobs, teams and national coverage of Family Health to analyze the effects of the 2017 National Primary Health Care Policy (PNAB) on team composition. We observed the concentration of doctors in the Southeast and Northeast and variation of this professional category before the events of the "Mais Médicos" (More Doctors) Program. The number of nurses increased 5% and Community Health Workers (ACS) dropped 0.3% in the country. Despite the authorization and funding for the implementation of "Primary Care" teams (eAB), they correspond to less than 1% of the total teams. It is noteworthy that the municipal managers' preferred mode is the traditional Family Health Teams, equivalent to 75% of the total and growing. While the questionings and expectations generated by the 2017 PNAB in the context of Primary Health Care, we can conclude that, regarding the teams and their compositions, no significant change was identified two years into its coming into force.

A Estratégia Saúde da Família é a principal forma de organização do sistema de saúde brasileiro. Contudo, a terceira edição da Política Nacional de Atenção Básica (PNAB) passou a reconhecer financeiramente outros tipos de equipes. Para analisar os efeitos da PNAB de 2017 na composição das equipes, foi realizado um estudo de série temporal de 2007 a 2019 utilizando dados do Cadastro Nacional de Estabelecimentos de Saúde (CNES) de postos de trabalho e de equipes e a cobertura nacional da Saúde da Família. Observou-se a concentração de médicos nas regiões Sudeste e Nordeste e oscilação dessa categoria profissional ante os acontecimentos do Programa Mais Médicos. Houve acréscimo de 5% de enfermeiros e redução de 0,3% dos ACS no país. A despeito da autorização e financiamento para implantação de equipes de "Atenção Básica" (eAB), elas correspondem a menos de 1% do total de equipes. Vale ressaltar que a modalidade preferencial dos gestores municipais se mantem pela Equipes de Saúde da Família, correspondendo a 75% do total de equipes e em crescimento. Apesar dos questionamentos e expectativas gerados pela PNAB de 2017 no contexto da Atenção Primária à Saúde, conclui-se que, em relação às equipes e suas composições, não houve mudança significativa após dois anos de sua vigência.

Política Nacional de Atenção Básica de 2017: análise da composição das equipes e cobertura nacional da Saúde da Família / National Primary Care Policy 2017: analysis of teams composition and national coverage of Family Health

Resumo A Estratégia Saúde da Família é a principal forma de organização do sistema de saúde brasileiro. Contudo, a terceira edição da Política Nacional de Atenção Básica (PNAB) passou a reconhecer financeiramente outros tipos de equipes. Para analisar os efeitos da PNAB de 2017 na composição das equipes, foi realizado um estudo de série temporal de 2007 a 2019 utilizando dados do Cadastro Nacional de Estabelecimentos de Saúde (CNES) de postos de trabalho e de equipes e a cobertura nacional da Saúde da Família. Observou-se a concentração de médicos nas regiões Sudeste e Nordeste e oscilação dessa categoria profissional ante os acontecimentos do Programa Mais Médicos. Houve acréscimo de 5% de enfermeiros e redução de 0,3% dos ACS no país. A despeito da autorização e financiamento para implantação de equipes de "Atenção Básica" (eAB), elas correspondem a menos de 1% do total de equipes. Vale ressaltar que a modalidade preferencial dos gestores municipais se mantem pela Equipes de Saúde da Família, correspondendo a 75% do total de equipes e em crescimento. Apesar dos questionamentos e expectativas gerados pela PNAB de 2017 no contexto da Atenção Primária à Saúde, conclui-se que, em relação às equipes e suas composições, não houve mudança significativa após dois anos de sua vigência.

Abstract The Family Health Strategy is the main form of organization of the Brazilian health system. However, the third edition of the National Primary Health Care Policy (PNAB) recognized other types of teams financially. A time series study was conducted from 2007 to 2019 using data from the National Register of Health Facilities (CNES) of jobs, teams and national coverage of Family Health to analyze the effects of the 2017 National Primary Health Care Policy (PNAB) on team composition. We observed the concentration of doctors in the Southeast and Northeast and variation of this professional category before the events of the "Mais Médicos" (More Doctors) Program. The number of nurses increased 5% and Community Health Workers (ACS) dropped 0.3% in the country. Despite the authorization and funding for the implementation of "Primary Care" teams (eAB), they correspond to less than 1% of the total teams. It is noteworthy that the municipal managers' preferred mode is the traditional Family Health Teams, equivalent to 75% of the total and growing. While the questionings and expectations generated by the 2017 PNAB in the context of Primary Health Care, we can conclude that, regarding the teams and their compositions, no significant change was identified two years into its coming into force.