Implementation of a digital tool for population management in Primary Health Care.

OBJECTIVE: Describe the implementation of a digital diagnostic and territorial monitoring tool in primary healthcare. METHODS: Quantitative and qualitative study, developed in 14 basic healthcare units in São Paulo, with community health workers, coordinators, nurses, and physicians. Data collection occurred in four phases: analysis of the instruments used by the team for territory management; development of the digital tool; training and implementation; and evaluation after 90 days using focus groups. Descriptive analyses were conducted by calculating absolute and relative frequencies to treat quantitative data. Qualitative data were subjected to content analysis. RESULTS: Three hundred thirty-four professionals participated in the study. In the first step, territory management's main challenges were filling out various instruments, system failures, data inconsistency, internet infrastructure/network, and lack of time. Therefore, a digital tool was developed consisting of 1) a spreadsheet recording the number of family members and markers of health conditions, date of visit, and number of return visits; 2) a spreadsheet with a summary of families visited, not visited, and refusals; and 3) a panel with a summary of the data generated instantly. In the evaluation, after the initial use of the tool, the themes that emerged were integration of the tool into daily work, evaluation of the digital tool implementation process, and improvement and opportunities for improvement. CONCLUSIONS: Faced with the challenges faced by family healthcare teams when filling out systems and managing the territory, the tool developed provided greater reliability and agility in data visualization, reduced the volume of instruments, and optimized the work process.

Family Vulnerability Scale: validity evidence in primary health care.

OBJECTIVE: Investigate evidence of validity of the Family Vulnerability Scale (EVFAM-BR) as an instrument to support population-based management in primary health care (PHC), in the scope of Health Care Planning (PAS). METHODS: This is a psychometric study to assess any additional evidence of the internal structure of EVFAM-BR using confirmatory factor analysis (CFA) and network analysis (NA). A preliminary version of the scale with 38 items was submitted to patients of PHC facilities that use the PAS methodology, distributed across the five regions of Brazil. For the primary CFA data, factor loadings and predictive power (R2) of the item were used. Seven model adjustment indices were adopted and reliability was measured by three indicators, using Bayesian estimation. RESULTS: The preliminary version of the scale was applied to 1,255 patients. Using the AFC, factor loadings ranged from 0.66 to 0.90 and R2 from 0.44 to 0.81. Both the primary indicators and the model adequacy indices presented satisfactory and consistent levels. According to the NA, the items were appropriately associated with their peers, respecting the established dimensions, thus demonstrating sustainability and stability of the proposed model. CONCLUSIONS: The evidence of validity presented by EVFAM-BR indicates, for the first time in Brazil, a concise instrument that is able to assertively measure family vulnerability, potentially supporting population-based management.

Brazilian Scale for Evaluation of Mental Health Care Needs: Additional Evidence.

OBJECTIVE: To investigate validity evidence of the Brazilian Scale for Evaluation of Mental Health Care Needs (CuidaSM). METHODS: This is a psychometric study, which seeks additional evidence of internal structure. Data collection was carried out in 11 Primary Health Care (PHC) services , which implement the Health Care Planning (HCP) methodology, distributed across the five Brazilian regions. The preliminary version of CuidaSM, containing a block self-referred by the user and another block evaluated by PHC professionals, was applied to users aged 18 or over who attended the PHC services for consultation with a higher education professional. The techniques of confirmatory factor analysis and network analysis were used to investigate validity evidence. For the primary data of the confirmatory factor analysis, the factorial loads and the item's predictive power (R2) were used. Six model adjustment indices were adopted and reliability was measured by three indicators using Bayesian estimation. RESULTS: A total of 879 users participated in the study. By confirmatory factor analysis, factorial loads ranged from 0.43 to 0.99 and R2 from 0.19 to 0.98. Both the primary indicators and the model adequacy indices were established at satisfactory and consistent levels. The network analysis showed that the items were appropriately associated with their peers, respecting the established dimensions, which again indicates the sustainability and stability of the proposed model. CONCLUSIONS: The study findings confirm a consistent and reliable model of the instrument, through a combination of techniques. Considering the importance of using solid instruments in clinical practice, CuidaSM is a promising tool for population-based management and network care organization, aligned with HCP proposals.

Práticas Avançadas de Enfermagem na Atenção Primária à Saúde: um protocolo de revisão sistemática / Advanced Practice Nursing in primary health care: a systematic review protocol

OBJETIVO: Sumarizar as evidências existentes acerca das ações de Prática Avançada em Enfermagem no âmbito da Atenção Primária à Saúde à nível mundial através de uma revisão sistemática. MÉTODO: Trata-se de um protocolo desenvolvido com base nas diretrizes do Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P). O protocolo foi registrado no International Prospective Register of Systematic Reviews (PROSPERO) sob o ID: CRD42022301785. Para condução da revisão, a busca sistemática será realizada nas bases de dados ScienceDirect, Scopus, Medical Literature Analyses and Retrieval System Online (MEDLINE/PubMed), Web of Science, Excerpta Medica Database (Embase) e Cumulated Index in Nursing and Allied Health Literature (CINAHL), sendo utilizada a seguinte expressão de busca: (("Advanced Practice Nursing" OR Nursing OR "Nursing specialities") AND "Primary Health Care" AND "Public Health"). Os critérios de inclusão incluem todos os estudos transversais publicados em inglês até outubro de 2022 que respondam à questão de pesquisa. Destes, serão excluídos: (i) estudos em animais; (ii) cartas, editoriais, revisões de literatura, revisões sistemáticas e metanálises.

OBECTIVE: To synthesize the existing evidence on advanced practice nursing interventions in primary health care settings worldwide through a systematic review. METHOD: A protocol was developed based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) guidelines. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under ID: CRD42022301785. To conduct the review, a systematic search will be performed in the databases ScienceDirect, Scopus, Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Web of Science, Excerpta Medica Database (Embase), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) using the following search terms: (("Advanced Practice Nursing" OR Nursing OR "Nursing specialties") AND "Primary Health Care" AND "Public Health"). Inclusion criteria include all cross-sectional studies published in English through October 2022 that address the research question. The following will be excluded: (i) animal studies; (ii) letters, editorials, literature reviews, systematic reviews, and meta-analyses.

Challenges and strategies for conducting research in primary health care practice: an integrative review.

BACKGROUND: Providing accessible and high-quality patient-centered healthcare remains a challenge in many countries, despite global efforts to strengthen primary health care (PHC). Research and knowledge management are integral to enhancing PHC, facilitating the implementation of successful strategies, and promoting the use of evidence-based practices. Practice-based research in primary care (PC-PBR) has emerged as a valuable approach, with its external validity to diverse PHC settings, making it an effective means of translating research findings into professional practice. OBJECTIVE: To identify challenges and strategies for conducting practice-based research in primary health care services. METHOD: An integrative literature review was conducted by searching the PubMed, Embase, Scopus, Web of Science, and Lilacs databases. The research question, guided by the PICo framework, directed the execution of study selection and data extraction. Data analysis followed the RAdAR method's three phases: pre-analysis, data analysis, and interpretation of results. RESULTS: Out of 440 initially identified articles, 26 met the inclusion criteria. Most studies were conducted in high-income countries, primarily the United States. The challenges and strategies for PC-PBR were categorized into six themes: research planning, infrastructure, engagement of healthcare professionals, knowledge translation, the relationship between universities and health services, and international collaboration. Notable challenges included research planning complexities, lack of infrastructure, difficulties in engaging healthcare professionals, and barriers to knowledge translation. Strategies underscore the importance of adapting research agendas to local contexts, providing research training, fostering stakeholder engagement, and establishing practice-based research networks. CONCLUSION: The challenges encountered in PC-PBR are consistent across various contexts, highlighting the need for systematic, long-term actions involving health managers, decision-makers, academics, diverse healthcare professionals, and patients. This approach is essential to transform primary care, especially in low- and middle-income countries, into an innovative, comprehensive, patient-centered, and accessible healthcare system. By addressing these challenges and implementing the strategies, PC-PBR can play a pivotal role in bridging the gap between research and practice, ultimately improving patient care and population health.

Family vulnerability scale: Evidence of content and internal structure validity.

INTRODUCTION: Territory view based on families' vulnerability strata allows identifying different health needs that can guide healthcare at primary care scope. Despite the availability of tools designed to measure family vulnerability, there is still a need for substantial validity evidence, which limits the use of these tools in a country showing multiple socioeconomic and cultural realities, such as Brazil. The primary objective of this study is to develop and gather evidence on the validity of the Family Vulnerability Scale for Brazil, commonly referred to as EVFAM-BR (in Portuguese). METHODS: Items were generated through exploratory qualitative study carried out by 123 health care professionals. The data collected supported the creation of 92 initial items, which were then evaluated by a panel of multi-regional and multi-disciplinary experts (n = 73) to calculate the Content Validity Ratio (CVR). This evaluation process resulted in a refined version of the scale, consisting of 38 items. Next, the scale was applied to 1,255 individuals to test the internal-structure validity by using the Exploratory Factor Analysis (EFA). Dimensionality was evaluated using Robust Parallel Analysis, and the model underwent cross-validation to determine the final version of EVFAM-BR. RESULTS: This final version consists of 14 items that are categorized into four dimensions, accounting for an explained variance of 79.02%. All indicators were within adequate and satisfactory limits, without any cross-loading or Heywood Case issues. Reliability indices also reached adequate levels (α = 0.71; ω = 0.70; glb = 0.83 and ORION ranging from 0.80 to 0.93, between domains). The instrument scores underwent a normalization process, revealing three distinct vulnerability strata: low (0 to 4), moderate (5 to 6), and high (7 to 14). CONCLUSION: The scale exhibited satisfactory validity evidence, demonstrating consistency, reliability, and robustness. It resulted in a concise instrument that effectively measures and distinguishes levels of family vulnerability within the primary care setting in Brazil.

Implementation of advanced practice nursing in Brazilian Primary Health Care: methodological path.

OBJECTIVES: to describe the operationalization of the steps of a model proposed by the Pan American Health Organization for implementing advanced practice nursing in Primary Health Care services. METHODS: a methodological study, with a qualitative approach, carried out in a local health system located in southern São Paulo. The first six steps of the model were followed: 1) improve health outcomes; 2) identify stakeholders; 3) determine unmet health needs; 4) identify priorities and goals to introduce advanced nursing practices in primary health care; 5) define advanced practice nursing in primary health care; 6) plan implementation strategies. RESULTS: in each step, the objectives, methodological strategies and operationalization were described. FINAL CONSIDERATIONS: the model proved to be effective to support the process of development and implementation of advanced practice nursing in the local system studied.

Diagnosis of vaccination rooms in Brazilian primary health care centers taking part in the PlanificaSUS project, 2019. / Diagnóstico das salas de vacinação em unidades básicas de saúde brasileiras participantes do projeto PlanificaSUS, 2019.

OBJECTIVE: To describe the diagnosis of vaccination rooms in primary healthcare centers in Brazil. METHODS: This was a cross-sectional study with secondary data of convenience sampling comprised of 25 rooms. Results of a checklist adapted from the Vaccine Room Supervision Tool of the National Immunization Program in 2019 regarding the dimensions 'general organization', 'general aspects', 'technical procedures', 'cold chain', 'information system', 'adverse events following vaccination', 'special immunobiological agents', 'epidemiological surveillance' and 'health education', were used. Percentages of scores, both overall and by dimensions were described in median, interquartile range, minimum and maximum values. RESULTS: The overall median was 77.1%, higher for 'health education' (100.0%) and 'cold chain' (86.7%), and lower for 'special immunobiological agents' (50.0%) and 'general organization' (58.3%). CONCLUSION: Using the checklist enabled the diagnosis in different macro-regions, inter- and intra-regional differences were found in the dimensions, and positive results and opportunities for improvement in the general plan.

What are the implications of problem-solving capacity at Primary Health Care in older adult health?

OBJECTIVE: To evaluate Primary Health Care attributes and analyze the association between the fulfilment of these attributes and problem-solving capacity of services for elderly patients. METHODS: A cross-sectional, observational, quantitative study. The Primary Care Assessment Tool, designed to assess Primary Health Care attributes, was employed to evaluate elderly users of Primary Care Units located in the south region of the city of São Paulo (SP). RESULTS: Many attributes assessed at the reference services were considered as unsatisfactory by users. Overall scores were also below the cut-off point. "First contact access - use", "longitudinality" and "coordination - information system" were the only attributes considered as satisfactory. Also, more than half (62.7%) of respondent patients reported having been referred to specialized services. A combined analysis of these three outcomes revealed users referred to other services had a significantly better perception of Primary Health Care attributes. CONCLUSION: The study provides important insights on satisfaction of elderly individuals and the problem-solving capacity of health care services, especially for the study population. Findings reported emphasize the association between Primary Health Care attributes and the problem-solving capacity of health care services at this level.

Diagnosis of vaccination rooms in Brazilian primary health care units participating in the PlanificaSUS project, 2019 / Diagnóstico de salas de vacunación en unidades básicas de salud brasileñas participantes del proyecto PlanificaSUS, 2019 / Diagnóstico das salas de vacinação em unidades básicas de saúde brasileiras participantes do projeto PlanificaSUS, 2019

Objective: To describe the diagnosis of vaccination rooms in basic health units in Brazil. Methods: Cross-sectional study carried out with secondary data from a convenience sample from 25 rooms. Checklist results adapted from the Vaccination Room Supervision Instrument of the National Immunization Program in 2019 was used, presenting dimensions: General Organization, General Aspects, Technical Procedures, Refrigeration, Information System, Adverse Events Following Immunization (AEFI), Special Immunobiologicals, Epidemiological Surveillance and Health Education. General and dimensional score percentages were described as median, interquartile range, minimum and maximum values. Results: The general median was 77.1%, higher for Health Education (100,0%) and Refrigeration (86.7%), and lower for Special Immunobiologicals (50.0%) and General Organization (58.3%). Conclusion: The use of the checklist allowed the diagnosis in different Brazilian macro-regions, with intra and inter-regional differences being found in the dimensions, and in general presenting positive results and opportunities for improvement.

Objetivo: Describir el diagnóstico de salas de vacunación en unidades básicas de salud en Brasil. Métodos: Estudio transversal realizado con datos secundários de una muestra por conveniencia de 25 salas. Se utilizaron los resultados de un checklist adaptado del Instrumento de Supervisión de Salas de Vacunación del Programa Nacional de Inmunizaciones 2019, presentando dimensiones: Organización General, Aspectos Generales, Procedimientos Técnicos, Cadena de Frío, Sistema de Información, Eventos Adversos Post-Vacunación (AEPV), Inmunobiológicos Especiales, Vigilancia Epidemiológica y Educación para la Salud. Los porcentajes generales y de dimensiones se describieron como mediana, rango intercuartil, valores mínimo y máximo. Resultados: La mediana de cumplimiento general fue 77,1%, mayor para Educación en Salud (100,0%) y Cadena de Frío (86,7%), y menor para Inmunobiológicos Especiales (50,0%) y Organización General (58,3%). Conclusión: El checklist permitió el diagnóstico en diferentes macroregiones brasileñas, encontrándose diferencias intra e interregionales, y em general presentando resultados positivos y oportunidades de mejora.

Objetivo: Descrever o diagnóstico de salas de vacinação de unidades básicas de saúde do Brasil. Métodos: Estudo transversal, sobre dados secundários de amostra de conveniência de 25 salas. Foram utilizados resultados de checklist adaptada do Instrumento de Supervisão em Sala de Vacinação, do Programa Nacional de Imunizações em 2019, nas dimensões 'organização geral', 'aspectos gerais', 'procedimentos técnicos', 'rede de frio', 'sistema de informação', 'eventos adversos pós-vacinação', 'imunobiológicos especiais', 'vigilância epidemiológica' e 'educação em saúde'. Percentuais de pontuação geral e das dimensões foram descritos em mediana, intervalo interquartil, valores mínimo e máximo. Resultados: A mediana geral foi de 77,1%, maior para 'educação em saúde' (100,0%) e 'rede de frio' (86,7%), e menor para 'imunobiológicos especiais' (50,0%) e 'organização geral' (58,3%). Conclusão: A utilização da checklist permitiu o diagnóstico em diferentes macrorregiões, sendo encontradas diferenças inter e intraregionais nas dimensões; e no plano geral, resultados positivos e oportunidades de melhoria.

Implementation of the drive-through strategy for COVID-19 vaccination: an experience report.

OBJECTIVE: To describe the experience of implementing a satellite vaccination unit in a drive-through system during a campaign against COVID-19. METHOD: This is an experience report carried out in a drive-through vaccination satellite unit. The study development was guided by the triad structure-process-results, proposed by Donabedian. RESULTS: The unit was structured in a soccer stadium, allowing it to serve large audiences safely. Care flow occurred in stages and professionals were organized by sectors, with emphasis on the nursing team' work. Initially, screening was performed; later, users went to the registration sector, and, finally, they were forwarded to the application station. The unit also had emergency sectors, a cold chain, space for professionals and a Basic Health Unit as a point of support. In 25 days of operation, 9698 doses were administered, with 1.8% of doses lost. CONCLUSION: The implementation of this system required planning, structure, process development and intense team articulation, with emphasis on the fundamental and strategic role of nurses in different points of action and leadership.

Assessment of staffing needs for registered nurses and licensed practical nurses at primary care units in Brazil using Workload Indicators of Staffing Need (WISN) method.

BACKGROUND: The balance between supply and demand for primary health care (PHC) services is one of the main challenges to the health system in Brazil. In this context, the application of planning methods could benefit the decision-making process for human resources organizations. Hence, the objective of this study was to assess the staffing needs for registered nurses (RNs) and licensed practical nurses (LPNs) at PHC services using the WISN method. METHODS: The Workload Indicators of Staffing Need (WISN) methodology was applied at 13 Primary Care Units (PCU) located in the city of São Paulo, Brazil. It included 87 RNs and 174 LPNs, and used data from 2017 to 2019. RESULTS: The WISN results found that RNs were under high workload pressure at 10 PCUs (77%) in 2017 and 2018, with a decrease to 8 PCUs (61%) in 2019. For LPNs, high workload pressure increased from 2 PCUs (15%) in 2017 to 13 PCUs (100%) in 2018, with a decrease to 11 (85%) in 2019. CONCLUSION: The assessment of staffing needs for RNs and LPNs at the PCUs included in the study identified a consistent deficit in the number of professionals, and high workload pressure in most services throughout the study period.

Implementation of advanced practice nursing in Brazilian Primary Health Care: methodological path / Implementación de prácticas avanzadas de enfermería en la Atención Primaria de Salud brasileña: camino metodológico / Implantação de práticas avançadas de enfermagem na Atenção Primária à Saúde brasileira: percurso metodológico

ABSTRACT Objectives: to describe the operationalization of the steps of a model proposed by the Pan American Health Organization for implementing advanced practice nursing in Primary Health Care services. Methods: a methodological study, with a qualitative approach, carried out in a local health system located in southern São Paulo. The first six steps of the model were followed: 1) improve health outcomes; 2) identify stakeholders; 3) determine unmet health needs; 4) identify priorities and goals to introduce advanced nursing practices in primary health care; 5) define advanced practice nursing in primary health care; 6) plan implementation strategies. Results: in each step, the objectives, methodological strategies and operationalization were described. Final Considerations: the model proved to be effective to support the process of development and implementation of advanced practice nursing in the local system studied.

RESUMEN Objetivos: describir la operacionalización de las etapas del modelo propuesto por la Organización Panamericana de la Salud para la implementación de prácticas avanzadas de enfermería en los servicios de Atención Primaria de Salud. Métodos: estudio metodológico, con enfoque cualitativo, realizado en un sistema local de salud ubicado en el sur de la ciudad de São Paulo. Se siguieron los primeros seis pasos del modelo: 1) mejorar los resultados de salud; 2) identificar a las partes interesadas; 3) determinar las necesidades de salud insatisfechas; 4) identificar prioridades y objetivos para introducir prácticas avanzadas de enfermería en la Atención Primaria de Salud; 5) definir prácticas avanzadas de enfermería en la atención primaria de salud; 6) estrategias de implementación del plan. Resultados: en cada etapa se describieron objetivos, estrategias metodológicas y operacionalización. Consideraciones Finales: el modelo demostró ser efectivo para apoyar el proceso de desarrollo e implementación de la práctica avanzada de enfermería en el sistema local estudiado.

RESUMO Objetivos: descrever a operacionalização das etapas do modelo proposto pela Organização Pan-Americana da Saúde para a implantação de práticas avançadas de enfermagem em serviços da Atenção Primária à Saúde. Métodos: estudo metodológico, de abordagem qualitativa, realizado em um sistema local de saúde localizado na zona sul do município de São Paulo. Foram seguidas as seis primeiras etapas do modelo: 1) melhorar os resultados de saúde; 2) identificar os interessados; 3) determinar as necessidades de saúde não atendidas; 4) identificar prioridades e metas para introduzir as práticas avançadas de enfermagem na Atenção Primária à Saúde; 5) definir as práticas avançadas de enfermagem em cuidados primários de saúde; 6) planejar as estratégias de implementação. Resultados: em cada etapa, foram descritas os objetivos, as estratégicas metodológicas e a operacionalização. Considerações Finais: o modelo mostrou-se eficaz para apoiar o processo de desenvolvimento e implantação da prática avançada de enfermagem no sistema local estudado.

Implementation of the drive-through strategy for COVID-19 vaccination: an experience report / Implementación de la estrategia drive-through para la vacunación contra el COVID-19: relato de experiencia / Implementação da estratégia drive-through para vacinação COVID-19: um relato de experiência

Abstract Objective: To describe the experience of implementing a satellite vaccination unit in a drive-through system during a campaign against COVID-19. Method: This is an experience report carried out in a drive-through vaccination satellite unit. The study development was guided by the triad structure-process-results, proposed by Donabedian. Results: The unit was structured in a soccer stadium, allowing it to serve large audiences safely. Care flow occurred in stages and professionals were organized by sectors, with emphasis on the nursing team' work. Initially, screening was performed; later, users went to the registration sector, and, finally, they were forwarded to the application station. The unit also had emergency sectors, a cold chain, space for professionals and a Basic Health Unit as a point of support. In 25 days of operation, 9698 doses were administered, with 1.8% of doses lost. Conclusion: The implementation of this system required planning, structure, process development and intense team articulation, with emphasis on the fundamental and strategic role of nurses in different points of action and leadership.

RESUMEN Objetivo: Describir la experiencia de implementación de una unidad de vacunación satélite en un sistema drive-through, durante la campaña contra el COVID-19. Método: Se trata de un relato de experiencia, realizado en una unidad satélite de vacunación drive-through. El desarrollo del estudio estuvo guiado por la tríada estructura-proceso-resultados, propuesta por Donabedian. Resultados: La unidad se estructuró en un estadio de fútbol, lo que le permitió atender grandes audiencias de manera segura. El flujo de la atención ocurrió por etapas, y los profesionales fueron organizados por sectores, con énfasis en el trabajo del equipo de enfermería. Inicialmente se realizaba el cribado, posteriormente el usuario se dirigía al sector de registro y finalmente se enviaba a la estación de aplicación. La unidad también contó con sectores de urgencia y emergencia, cadena de frío, espacio para profesionales y una Unidad Básica de Salud como punto de apoyo. En 25 días de operación, se administraron 9698 dosis, con un 1,8% de dosis olvidadas. Conclusión: La implementación de este sistema requirió planificación, estructuración, desarrollo de procesos y una intensa articulación de equipos, con énfasis en el papel fundamental y estratégico de los enfermeros en diferentes puntos de acción y liderazgo.

RESUMO Objetivo: Descrever a experiência de implementação de uma unidade satélite de vacinação em sistema drive-through, durante a campanha contra COVID-19. Método: Trata-se de um relato de experiência, realizado em uma unidade satélite de vacinação em sistema drive-through. O desenvolvimento do estudo foi norteado pela tríade estrutura-processo-resultados, proposta por Donabedian. Resultados: A unidade foi estruturada em um estádio de futebol, permitindo o atendimento de grandes públicos de forma segura. O fluxo de atendimento ocorreu por etapas, e os profissionais foram organizados por setores, com destaque para atuação da equipe de enfermagem. Inicialmente, realizou-se a triagem, posteriormente, o usuário dirigia-se ao setor de cadastramento, e, por fim, era encaminhado à estação de aplicação. A unidade contava também com os setores de urgência e emergência, rede de frio, espaço para os profissionais e uma Unidade Básica de Saúde como ponto de apoio. Em 25 dias de atuação, foram administradas 9698 doses, com 1,8% de doses perdidas. Conclusão: A implementação deste sistema exigiu planejamento, estrutura, desenvolvimento de processos e intensa articulação em equipe, com destaque para o papel fundamental e estratégico do enfermeiro em diferentes pontos de atuação e liderança.

What are the implications of problem-solving capacity at Primary Health Care in older adult health?

ABSTRACT Objective To evaluate Primary Health Care attributes and analyze the association between the fulfilment of these attributes and problem-solving capacity of services for elderly patients. Methods A cross-sectional, observational, quantitative study. The Primary Care Assessment Tool, designed to assess Primary Health Care attributes, was employed to evaluate elderly users of Primary Care Units located in the south region of the city of São Paulo (SP). Results Many attributes assessed at the reference services were considered as unsatisfactory by users. Overall scores were also below the cut-off point. "First contact access - use", "longitudinality" and "coordination - information system" were the only attributes considered as satisfactory. Also, more than half (62.7%) of respondent patients reported having been referred to specialized services. A combined analysis of these three outcomes revealed users referred to other services had a significantly better perception of Primary Health Care attributes. Conclusion The study provides important insights on satisfaction of elderly individuals and the problem-solving capacity of health care services, especially for the study population. Findings reported emphasize the association between Primary Health Care attributes and the problem-solving capacity of health care services at this level.

Diagnóstico das salas de vacinação em unidades básicas de saúde brasileiras participantes do projeto PlanificaSUS, 2019 / Diagnóstico de salas de vacunación en unidades básicas de salud brasileñas participantes del proyecto PlanificaSUS, 2019 / Diagnosis of vaccination rooms in Brazilian primary health care centers taking part in the PlanificaSUS project, 2019 PlanificaSUS, 2019

Objetivo: Descrever o diagnóstico de salas de vacinação de unidades básicas de saúde do Brasil. Métodos: Estudo transversal, com dados secundários de amostra de conveniência de 25 salas. Foram utilizados resultados de checklist adaptada do Instrumento de Supervisão em Sala de Vacinação, do Programa Nacional de Imunizações em 2019, nas dimensões 'organização geral', 'aspectos gerais', 'procedimentos técnicos', 'rede de frio', 'sistema de informação', 'eventos adversos pós-vacinação', 'imunobiológicos especiais', 'vigilância epidemiológica' e 'educação em saúde'. Percentuais de pontuação geral e das dimensões foram descritos em mediana, intervalo interquartil, valores mínimo e máximo. Resultados: A mediana geral foi de 77,1%, maior para 'educação em saúde' (100,0%) e 'rede de frio' (86,7%), e menor para 'imunobiológicos especiais' (50,0%) e 'organização geral' (58,3%). Conclusão: A utilização da checklist permitiu o diagnóstico em diferentes macrorregiões, sendo encontradas diferenças inter e intrarregionais nas dimensões; e, no plano geral, resultados positivos e oportunidades de melhoria.

Objetivo: Describir el diagnóstico de salas de vacunación en unidades básicas de salud en Brasil. Métodos: Estudio transversal realizado con datos secundarios de una muestra por conveniencia de 25 salas. Se utilizaron los resultados de un checklist adaptado del Instrumento de Supervisión de Salas de Vacunación del Programa Nacional de Inmunizaciones 2019, presentando las dimensiones 'organización general', 'aspectos generales', 'procedimientos técnicos', 'red de frío', 'sistema de información', 'eventos adversos post-vacunación', 'inmunobiológicos especiales', 'vigilancia epidemiológica' y 'educación para la salud'. Los porcentajes generales y de dimensiones se describieron como mediana, rango intercuartil, valores mínimo y máximo. Resultados: La mediana de cumplimiento general fue 77,1%, mayor para 'educación en salud' (100,0%) y 'red de frío' (86,7%), y menor para Inmunobiológicos 'especiales' (50,0%) y 'organización general' (58,3%). Conclusión: El checklist permitió el diagnóstico en diferentes macrorregiones brasileñas, encontrándose diferencias intra e interregionales y en general, presentando resultados positivos y oportunidades de mejora.

Objective: To describe the diagnosis of vaccination rooms in primary healthcare centers in Brazil. Methods: This was a cross-sectional study with secondary data of convenience sampling comprised of 25 rooms. Results of a checklist adapted from the Vaccine Room Supervision Tool of the National Immunization Program in 2019 regarding the dimensions 'general organization', 'general aspects', 'technical procedures', 'cold chain', 'information system', 'adverse events following vaccination', 'special immunobiological agents', 'epidemiological surveillance' and 'health education', were used. Percentages of scores, both overall and by dimensions were described in median, interquartile range, minimum and maximum values. Results: The overall median was 77.1%, higher for 'health education' (100.0%) and 'cold chain' (86.7%), and lower for 'special immunobiological agents' (50.0%) and 'general organization' (58.3%). Conclusion: Using the checklist enabled the diagnosis in different macro-regions, inter- and intra-regional differences were found in the dimensions, and positive results and opportunities for improvement in the general plan.

Dental vulnerability scale in primary health care: evidence of content and structure internal validity.

BACKGROUND: Access to oral health services remains a challenge in the Brazilian healthcare system, especially in the primary health care setting, where the use of a risk stratification tool that could identify individuals with higher dental vulnerability would be extremely valuable. However, there literature on this theme is scarce, and there is no validated instrument in Brazil that is capable of measuring dental vulnerability. Hence, this psychometric study aimed at the development and evaluation of content and internal structure validity of the Dental Vulnerability Scale for Primary Health Care (PHC). METHODS: The items were developed based on a qualitative exploratory analysis. A total of 172 items were prepared and submitted to a panel of specialists, with content validity analyzed with the Content Validity Ratio (CVR), resulting in an the initial version of the instrument composed by 41 items. Internal structure validity was analyzed by Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and by applying 3 reliability indicators (Cronbach's Alpha, McDonald's Omega and Greatest Lower Bound - GBL), with a sample of 1227 individuals. RESULTS: The final configuration indicated a scale of 15 items divided into 4 dimensions (overall health, oral health, infrastructure, and healthcare services) with explained variance of 72.11%. The factor loads varied from 0.37 to 0.96. The model adjustment indices were set at × 2/df(51) = 3.23, NNFI = 0.95, CFI = 0.98, GFI = 0.96, AGFI = 0.97, RMSEA = 0.04 and RMSR = 0.03. CONCLUSION: DVS presented satisfactory evidence of validity, indicating its suitability to be used by healthcare professionals, students and managers to plan oral health actions and services at PHC.

A seroprevalence survey of anti-SARS-CoV-2 antibodies among individuals 18 years of age or older living in a vulnerable region of the city of São Paulo, Brazil.

A second wave of COVID-19 has demonstrated how challenging it will be to achieve sustained control of the disease, even with vaccination underway in many countries. Therefore, it remains relevant to keep improving our understanding of the distribution of COVID-19, especially of asymptomatic individuals, among different populations, and particularly in vulnerable regions. Hence, this population-based serosurvey had the objective of estimating the prevalence of individuals 18 years of age or older infected by SARS-CoV-2, and the proportion of asymptomatic individuals, among a vulnerable population living in an urban setting. This was a cross-sectional single-stage cluster sampling serosurvey conducted between September and December of 2019, in a vulnerable region of the city of São Paulo, Brazil. Families covered by three public primary healthcare units represented the selected clusters. After study inclusion, participants were asked about signs and symptoms related to COVID-19, and had collected 10 mL of blood for serology testing. A total of 272 individuals from 185 families were included in the study, out of the 400 eligible individuals for inclusion, resulting in a non-response rate of 32%. The post stratified prevalence of individuals infected by SARS-CoV-2 was 45.2% (95% CI: 39.4-51.0%), with a proportion of asymptomatic cases of 30.2% (95% CI: 23.3-38.0%). This population-based serosurvey identified a greater prevalence of infected individuals by SARS-CoV-2 compared to data from the beginning of the pandemic, and from a recent citywide serosurvey, with a similar proportion of asymptomatic individuals. It demonstrated the value of primary healthcare services for disease surveillance activities, and the importance of more focused serosurveys, especially in vulnerable locations, and the need to evaluate new surveillance strategies to take into account asymptomatic cases.