Characteristics of house calls in Brazil: analysis of PMAQ-AB external evaluation cycles / Características da visita domiciliar no Brasil: análise de ciclos de avaliação externa do PMAQ-AB

ABSTRACT Objective: To analyze characteristics of the home visit (HV) in Brazil, 2012 and 2017. Methods: Ecological study, with panel data whose units of analysis were the Primary Health Care teams in Brazil, participants of the 1st and 3rd cycles of the Program to Improve Access and Quality of Primary Care of the Unified Health System. Descriptive, inferential and spatial analyzes (alpha=5%) were performed. Results: There was an increase in the proportion of teams that carried out home visits at a frequency defined based on risk and vulnerability analysis and actively searched for people with respiratory symptoms and women with delayed and altered cytopathological examination. In the heat maps, the Northeast, Southeast and South regions had a higher concentration of teams that carried out the HV and carried out an active search. Conclusion: The maintenance and qualification of HVs must be a priority in Brazil, since there are few countries in the world with such capillarity of health services, reaching the homes of millions of people.

RESUMO Objetivo: Analisar características da visita domiciliar (VD) no Brasil em 2012 e 2017. Métodos: Estudo ecológico com dados em painel cujas unidades de análise foram as equipes de saúde da Atenção Primária à Saúde no Brasil, participantes do 1º e 3º ciclos do Programa de Melhoria do Acesso e Qualidade da Atenção Básica do Sistema Único de Saúde. Foram realizadas análises descritivas, inferenciais e espaciais (alpha=5%). Resultados: Houve aumento na proporção de equipes que realizavam visita domiciliar com periodicidade definida a partir da análise de risco e vulnerabilidade e na de busca ativa de pessoas com sintomáticos respiratórios e de mulheres com exame citopatológico atrasado e alterado. Nordeste, Sudeste e Sul foram as regiões com maior concentração de equipes que realizavam a VD e faziam busca ativa. Conclusão: A manutenção e qualificação das VD deve ser uma prioridade no Brasil, uma vez que poucos são os países no mundo com tamanha capilaridade dos serviços de saúde, alcançando os domicílios de milhões de pessoas.

Advances and weaknesses of the work process of the oral cancer care network in Brazil: A latent class transition analysis.

OBJECTIVE: To analyse the provision of oral cancer (OC) care services in the Dental Specialties Centers (Centros de Especialidades Odontológicas-CEO) in Brazil and identify changes over two cycles of external evaluation of the Program for the Improvement of Access and Quality-PMAQ, in 2014 and 2018. METHOD: This is a nationwide panel ecological study, including 916 CEO. Data from interviews with managers and dentists of the CEO were used, including variables related to training on OC, clinical protocols, biopsies, referral for diagnosis and treatment, and registration of users with OC. We carried out Latent Transition Analysis (LTA) to identify patterns (latent status LS) of service adequacy and work processes' changes between the two assessment cycles. We tested models with three, four, and five LS, selecting the one with the best conceptual interpretability and good model fit parameters. Data from the LS were plotted on choropleth and hotspots maps in Brazil allowing us to identify areas with the better or worse provision of specialized OC services. RESULTS: The model with four LS was chosen. The four LS were named: 1.'Most indicators inadequate for OC care' (the worst); 2. 'Most indicators suitable for OC care' (the best); 3. 'CEO with a poor relation with Primary Health Care (PHC) services'; and 4. 'CEO with a poor relation with tertiary hospital services'. The comparison of the LS transition between the two cycles revealed that 419 (45.7%) CEO remained in the same LS (1→1, 3→4, 2→2); 228 (24.9%) switched to a worse status (2→1, 2→4, 3→1) and 269 (29.4%) switched to a better LS (1→2, 1→4, 3→2). While the majority of the CEO improved, we identified a decline of 17.8% in those who reported performing biopsies and 18.3% in the number of CEO that had hospitals for referring confirmed OC cases. Almost all Brazilian states had CEO that improved the work process. The Southeast and South regions had the highest percentage of CEO with the better work process in both cycles. Hotspots showed areas concentrating improvements in the work process in the Northeast region. However, some hotspots in the North revealed some CEO where the work process deteriorated or remained unsatisfactory. CONCLUSIONS: There are regional inequities in the provision of OC care in CEO. Most services improved their work process or remained stable. However, the biopsies and the referral to hospital care for confirmed cases declined, indicating that CEO need to improve planning and care provision to reduce OC morbimortality.