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1.
BMC Health Serv Res ; 21(1): 911, 2021 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-34479554

RESUMEN

BACKGROUND: The introduction of new health professional roles, such as that of the nurse practitioner and pharmacist prescriber in primary health care can lead to changes in health service delivery. Consumers, having used these roles, often report high satisfaction. However, there is limited knowledge of how these individuals position nurse practitioner and pharmacist prescriber roles within existing practice structures. METHODS: Semi-structured interviews were conducted with 21 individuals receiving services from these practitioners in New Zealand primary health care. Interviews were recorded and transcribed verbatim for thematic analysis. RESULTS: Participant views reflect established practice hierarchies, placing advanced practitioners 'below' general practitioners. Participants are unable to articulate what it was about these practitioners that meant they operated at lower tiers and often considered practitioners to act as 'their doctor'. They also highlight structural barriers impairing the ability of these providers to operate within their full scope of practice. CONCLUSIONS: While seeing value in the services they receive, consumers are often unable to position nurse practitioner and pharmacist prescriber roles within health system contexts or to articulate how they value their practitioner's skills. Embedded structural barriers may be more visible to consumers than their interactions with the health system suggest. This may influence peoples' ability to receive intended or optimal health services. Consumer 'health professional literacy' around the functions of distinct health practitioners should be supported so that they may make informed service provision choices.


Asunto(s)
Médicos Generales , Enfermeras Practicantes , Humanos , Percepción , Farmacéuticos , Atención Primaria de Salud
2.
BMC Public Health ; 21(1): 1649, 2021 09 09.
Artículo en Inglés | MEDLINE | ID: mdl-34503478

RESUMEN

BACKGROUND: The proposed National Health Insurance (NHI) system aims to re-engineer primary healthcare (PHC) in South Africa, envisioning both private sector providers and public sector clinics as independent contracting units to the NHI Fund. In 2017, 16% of the South African population had private medical insurance and predominately utilised private providers. However, it is estimated that up to 28% of the population access private PHC services, with a meaningful segment of the low-income, uninsured population paying for these services out-of-pocket. The study objective was to characterise the health seeking behaviour of low-income, patients accessing PHC services in both the public and private sectors, patient movement between sectors, and factors influencing their facility choice. METHODS: We conducted once-off patient interviews on a random sample of 153 patients at 7 private PHC providers (primarily providing services to the low-income mostly uninsured patient population) and their matched public PHC clinic (7 facilities). RESULTS: The majority of participants were economically active (96/153, 63%), 139/153 (91%) did not have health insurance, and 104/153 (68%) earned up to $621/month. A multiple response question found affordability (67%) and convenience (60%) were ranked as the most important reasons for choosing to usually access care at public clinics (48%); whilst convenience (71%) and quality of care (59%) were key reasons for choosing the private sector (32%). There is movement between sectors: 23/76 (30%) of those interviewed at a private facility and 8/77 (10%) of those interviewed at a public facility indicated usually accessing PHC services at a mix of private and public facilities. Results indicate cycling between the private and public sectors with different factors influencing facility choice. CONCLUSIONS: It is imperative to understand the potential impact on where PHC services are accessed once affordability is mitigated through the NHI as this has implications on planning and contracting of services under the NHI.


Asunto(s)
Sector Privado , Sector Público , Humanos , Aceptación de la Atención de Salud , Atención Primaria de Salud , Sudáfrica
3.
BMC Health Serv Res ; 21(Suppl 1): 691, 2021 Sep 13.
Artículo en Inglés | MEDLINE | ID: mdl-34511083

RESUMEN

BACKGROUND: Recording and reporting health data in facilities is the backbone of routine health information systems which provide data collected by health facility workers during service provision. Data is firstly collected in a register, to record patient health data and care process, and tallied into nationally designed reporting forms. While there is anecdotal evidence of large numbers of registers and reporting forms for primary health care (PHC) facilities, there are few systematic studies to document this potential burden on health workers. This multi-country study aimed to document the numbers of registers and reporting forms use at the PHC level and to estimate the time it requires for health workers to meet data demands. METHODS: In Cambodia, Ghana, Mozambique, Nigeria and Tanzania, a desk review was conducted to document registers and reporting forms mandated at the PHC level. In each country, visits to 16 randomly selected public PHC facilities followed to assess the time spent on paper-based recording and reporting. Information was collected through self-reports of estimated time use by health workers, and observation of 1360 provider-patient interactions. Data was primarily collected in outpatient care (OPD), antenatal care (ANC), immunization (EPI), family planning (FP), HIV and Tuberculosis (TB) services. RESULT: Cross-countries, the average number of registers was 34 (ranging between 16 and 48). Of those, 77% were verified in use and each register line had at least 20 cells to be completed per patient. The mean time spent on recording was about one-third the total consultation time for OPD, FP, ANC and EPI services combined. Cross-countries, the average number of monthly reporting forms was 35 (ranging between 19 and 52) of which 78% were verified in use. The estimated time to complete monthly reporting forms was 9 h (ranging between 4 to 15 h) per month per health worker. CONCLUSIONS: PHC facilities are mandated to use many registers and reporting forms pausing a considerable burden to health workers. Service delivery systems are expected to vary, however an imperative need remains to invest in international standards of facility-based registers and reporting forms, to ensure regular, comparable, quality-driven facility data collection and use.


Asunto(s)
Países en Desarrollo , Personal de Salud , Instituciones de Atención Ambulatoria , Recolección de Datos , Femenino , Instituciones de Salud , Humanos , Embarazo , Atención Primaria de Salud
4.
BMC Health Serv Res ; 21(1): 956, 2021 Sep 13.
Artículo en Inglés | MEDLINE | ID: mdl-34511119

RESUMEN

BACKGROUND: Early detection and management of poverty-related disorders is a recommended pediatric practice; however, little is known about variations of practice between pediatric primary care physicians and subspecialists. The objectives of this study were to assess (1) provider perceptions and attitudes toward caring for low-income children in an urban academic medical center, and (2) variations between primary care physicians and subspecialists in social and financial needs screening and referral practices for low-income children. DESIGN/METHODS: Primary care providers (pediatric and family medicine) and subspecialists providing direct patient care in an urban academic medical center (response rate = 24 %, n = 85/356) completed a 24-item survey (adapted with permission from the AAP Periodic Survey of Fellows No.90) assessing feasibility and comfort screening and addressing social and financial needs, rates of screening for financial hardship, and referrals to local resources. Chi-square tests were performed. RESULTS: Among respondents, 88 % (75/85) reported comfort caring for low-income children, while 28 % (24/85) reported comfort inquiring about social and financial needs and 34 % (29/85) referring to community resources. Primary care providers more commonly than subspecialists screened for childcare (80 % vs. 59 %, p = 0.04), parental: employment (84 % vs. 59 %, p = 0.01), education (40 % vs. 17 %, p = 0.02) and mental health (86 % vs. 46 %, p = 0.0001), and less commonly screened for transportation (47 % vs. 73 %, p = 0.01). Primary care providers more commonly referred for public health insurance (74 % vs. 39 %, p = 0.001), public food assistance (30 % vs. 12 %, p = 0.04), and adult mental health services (65 % vs. 44 %, p < 0.05). CONCLUSIONS: In an urban academic institution serving a population with high poverty rates, pediatric providers feel comfortable providing medical care for low-income children but lack comfort screening and addressing SDH. Though most feel it is their job to refer to resources, less than half felt it was feasible to screen for or address financial needs. Pediatric primary care providers report higher rates of screening and referring than subspecialists. Understanding variations in practice and perceptions among primary care providers and subspecialists may aid in creating interventions to increase screening and referral rates.


Asunto(s)
Atención Primaria de Salud , Determinantes Sociales de la Salud , Adulto , Actitud , Niño , Humanos , Tamizaje Masivo , Derivación y Consulta
5.
BMC Public Health ; 21(1): 1603, 2021 08 31.
Artículo en Inglés | MEDLINE | ID: mdl-34465334

RESUMEN

BACKGROUND: The 2014-2015 Ebola epidemic in West Africa became a humanitarian crisis that exposed significant gaps in infection prevention and control (IPC) capacity in primary care facilities in Sierra Leone. Operational partners recognized the national gap and rapidly scaled-up an IPC training and infrastructure package. This prompted us to carry out a mixed-methods research study which aimed to evaluate adherence to IPC practices and understand how to improve IPC at the primary care level, where most cases of Ebola were initially presenting. The study was carried out during the national peak of the epidemic. DISCUSSION: We successfully carried out a rapid response research study that produced several expected and unexpected findings that were used to guide IPC measures during the epidemic. Although many research challenges were similar to those found when conducting research in low-resource settings, the presence of Ebola added risks to safety and security of data collectors, as well as a need to balance research activities with the imperative of response to a humanitarian crisis. A participatory approach that attempted to unify levels of the response from community upwards helped overcome the risk of lack of trust in an environment where Ebola had damaged relations between communities and the health system. CONCLUSION: In the context of a national epidemic, research needs to be focused, appropriately resourced, and responsive to needs. The partnership between local academics and a humanitarian organization helped facilitate access to study sites and approvals that allowed the research to be carried out quickly and safely, and for findings to be shared in response forums with the best chance of being taken up in real-time.


Asunto(s)
Epidemias , Fiebre Hemorrágica Ebola , Instituciones de Atención Ambulatoria , Brotes de Enfermedades/prevención & control , Epidemias/prevención & control , Fiebre Hemorrágica Ebola/epidemiología , Fiebre Hemorrágica Ebola/prevención & control , Humanos , Atención Primaria de Salud , Sierra Leona/epidemiología
6.
Cad Saude Publica ; 37(8): e00235120, 2021.
Artículo en Portugués | MEDLINE | ID: mdl-34468563

RESUMEN

This study aimed to understand the forms of professional work and proposed actions to achieve the human right to adequate food (HRAF) in the context of primary healthcare (PHC). Using a qualitative approach, the authors conducted semi-structured interviews (from May 2013 to July 2014) with healthcare workers that conducted educational groups on food and nutrition in PHC in the city of São Paulo, Brazil. Content analysis was performed to identify the proposed actions on food, with HRAF as the theoretical basis. We identified three categories of professional work based on the proposed actions for food and nutrition. The first approaches food as a biomedical dimension. The second focuses on access and availability of foods in the territory. The third approaches users' local food reality, centered on the team's work. The proposed actions feature those conducted by individuals with obligations towards HRAF (healthcare workers in PHC) and those performed by rights-holder (users of PHC in the Brazilian Unified National Health System). Food in contexts of poverty is treated as a problem with no solution. This study allowed approximations between "what to do" and "how to act" based on ways of grasping food through the definitions, professional work, and proposed actions to achieve HRAF in PHC. It also allowed elucidating the need to understand food as a human right and strengthening the responsibility of healthcare workers in PHC as duty-bearers towards HRAF in the context of social policies.


Asunto(s)
Derechos Humanos , Atención Primaria de Salud , Brasil , Programas de Gobierno , Personal de Salud , Humanos
7.
BMC Public Health ; 21(1): 1625, 2021 09 06.
Artículo en Inglés | MEDLINE | ID: mdl-34488704

RESUMEN

BACKGROUND: Sexually Transmitted Infections (STIs) are a public health problem, especially for reproductive-age women. The aim of this study was to determine the incidence and trend of STIs during 11 years in Tunisia (2007-17). METHODS: We conducted a descriptive study including all women with curable STIs (chlamydia, gonorrhea, syphilis and trichomoniasis) diagnosed with the syndromic approach in all basic health care centers of the Governorate of Monastir (Tunisia) from 2007 to 2017. Syndromes included, Pelvic Pain (PP), Vaginal Discharge (VD) and Genital Ulceration (GU). RESULTS: We analyzed 40,388 episodes of curable STIs with a crude incidence rate and age standardized incidence rate of 1393 (95% Confidence Interval (CI); 1348-1438) / 100,000 Person Year (PY) and 1328 (95%CI; 1284-1372) /100,000 PY respectively. The incidence rate showed a positive trend over 11 years for all age groups and syndromes. VD was the most common syndrome with a crude incidence rate of 1170/100,000 PY. For all syndromes, women aged 20 to 39 were the most affected age group (p < 0.001). CONCLUSION: In conclusion, the incidence rate of STIs episodes among women diagnosed with the syndromic approach was high, consistent with the global evidence. Focusing on reviewing STIs surveillance system in low and middle-income countries could allow the achievement of the ending of STIs epidemics by 2030.


Asunto(s)
Gonorrea , Enfermedades de Transmisión Sexual , Femenino , Gonorrea/epidemiología , Humanos , Atención Primaria de Salud , Vigilancia de Guardia , Enfermedades de Transmisión Sexual/epidemiología , Túnez/epidemiología
8.
Cad Saude Publica ; 37(8): e00027321, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34495087

RESUMEN

Although tuberculosis preventive therapy is one of the cornerstones for eliminating the disease, many barriers exist in the cascade of care for latent tuberculosis infection, including the need to certify healthcare professionals for reading tuberculin skin tests (TST). This paper proposes and evaluates a simple protocol for TST reading training. Primary care workers from different backgrounds received a 2-hour theoretical course, followed by a practical course on bleb reading. Blebs were obtained by injecting saline into sausages and then in volunteers. A certified trainer then evaluated the effectiveness of this protocol by analyzing the trainees' ability to read TST induration in clinical routine, blinded to each other's readings. Interobserver agreement was analyzed using the Bland-Altman test. The trainees' reading accuracy was calculated using two cut-off points - 5 and 10mm - and the effect of the number of readings was analyzed using a linear mixed model. Eleven healthcare workers read 53 saline blebs and 88 TST indurations, with high agreement for TST reading (0.07mm average bias). Sensitivity was 100% (94.6; 100.0) at 5mm cut-off and 87.3% (75.5; 94.7) at 10mm cut-off. The regression model found no effect of the number of readings [coefficient: -0.007 (-0.055; 0.040)]. A simple training protocol for reading TST with saline blebs simulations in sausages and volunteers was sufficient to achieve accurate TST induration readings, with no effect observed for the number of readings. Training with saline blebs injected into voluntary individuals is safer and easier than the traditional method.


Asunto(s)
Tuberculosis Latente , Prueba de Tuberculina , Brasil , Certificación , Humanos , Atención Primaria de Salud
9.
Einstein (Sao Paulo) ; 19: eGS5914, 2021.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-34468592

RESUMEN

OBJECTIVE: To evaluate a p-median model for health care services accessibility based on decentralization and optimal allocation of Primary Health Care Units in the State of São Paulo, Brazil. METHODS: Using geographical data of Primary Health Care Units located in the State of São Paulo, potential support and supply facility allocations were simulated by means of a random approach. Several constraints were then imposed on the system to simulate different scenarios. Results were assessed according to geographic disposition. RESULTS: Using a fixed number of supply facilities, ten as a constraint, the p-median approach allocated three facilities near the state capital (the area with the highest concentration of Primary Health Care Units), while remaining facilities were spread throughout the west of the state. A second round of tests assessed the impact of fixed costs alone on optimization, ranging from 71 optimal locations with a fixed unit cost to six optimal locations at a cost 300-fold higher. This finding was relevant to decision-making, since it encompassed scenarios in which only the final number of facilities or only the budget was known. A third set of simulations contemplates an intermediate scenario. CONCLUSION: The p-median approach was capable of optimizing a wide range of scenarios with an average running time of less than 2 hours and 30 minutes while considering a large dataset of more than 4,000 locations. In spite of some shortcomings, such as estimation of Euclidean distances, the method is simple yet powerful enough to be considered a useful tool to assist decision makers in the distribution of resources, and facilities across large areas with high number of locations to be supplied.


Asunto(s)
Accesibilidad a los Servicios de Salud , Atención Primaria de Salud , Brasil , Humanos , Política
10.
Cien Saude Colet ; 26(suppl 2): 3397-3408, 2021.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-34468637

RESUMEN

The paper presents the relationship between the allocation of financial resources and the type of local basic health infrastructure in an initial sample of 5,570 Brazilian municipalities. This is an explanatory research using multiple correspondence analysis and quantile regression between expenditure/control variables and the type of structure of PHC Units. The correspondence between the type and the representative variables of expenditure shows that inferior typologies are related to lower per capita expenditure in these variables, and vice versa. Quantile regression showed a positive relationship with the type of infrastructure in the two cycles evaluated. There is evidence that expenditure variables are positively related to infrastructure, which allows us to understand that allocating more resources leads to better infrastructure. Results point to the need to improve the governance of financial resources for health, as municipalities with lower socioeconomic indicators have an infrastructure in the lower categories. We can conclude that there are multiple actors, and the various criteria for allocating and decentralizing resources bring about difficulties of coordination and integration between the entities, restricting the appropriate prioritization in the distribution of resources.


Asunto(s)
Gastos en Salud , Atención Primaria de Salud , Brasil , Ciudades , Humanos , Factores Socioeconómicos
11.
Cien Saude Colet ; 26(suppl 2): 3567-3579, 2021.
Artículo en Portugués | MEDLINE | ID: mdl-34468652

RESUMEN

Health services, the access to which is a right of all citizens and the duty of the state, must be efficiently provided, as public resources are scarce and there is a growing demand called for by the population. In this context, the objective was to evaluate the efficiency of public spending on Primary Health Care in the municipalities of Rio de Janeiro (n = 70) in 2015. Initially, the jackstrap procedure was used to identify possible outliers, and Data Envelopment Analysis was then applied to calculate robust efficiency scores. In the second stage, the efficiency scores were regressed into non-discretionary variables using the Tobit method, that may affect the efficiency of municipalities. The results show that 63.9% of municipalities efficiently applied ABS resources, however, given the expenses incurred, ABS outputs could have been, on average, 6% higher. In addition, no evidence was found that wealthier, more socially developed and/or populous municipalities, were more (or less) efficient in public spending on ABS than not.


Asunto(s)
Eficiencia , Atención Primaria de Salud , Brasil , Ciudades
12.
Cien Saude Colet ; 26(suppl 2): 3589-3597, 2021.
Artículo en Portugués | MEDLINE | ID: mdl-34468654

RESUMEN

Oral health resolvability in primary care of municipalities in the State of Paraíba, Brazil, was analyzed, and a cross-sectional study was conducted, using an inductive approach, comparative procedure and indirect documentation. The Resolvability Indicator (RI) consisted of the ratio between the number of Completed Treatments and First Programmatic Dental Consultations in municipalities in Paraíba (n = 223), between 2011 and 2014, by using data collected from the DATASUS/TABNET platform. The following explanatory variables were considered: Coverage of First Programmatic Dental Consultation (CFPDC), Coverage of Primary Care Teams (CPCT), Coverage of Oral Health Teams (COHT), Coverage of Family Health Teams (CFHT), Percentage of Tooth Extraction (PTE), Gross Domestic Product (GDP), Municipal Human Development Index (MHDI) and Gini Coefficient (GC). Descriptive statistics and negative binomial multiple regression were performed (α = 0.05). The median RI in 2011, 2012, 2013 and 2014 was, respectively, 20.4, 17.5, 15.2 and 15.7. There was a positive association between RI and CFPDC (PR = 1.14, CI = 1.02-1.28), CPCT (PR = 1.02, CI = 1.01-1.03), in addition to a negative association. between RI and year (PR = 0.83; IC = 0.74-0.94). The resolvability of oral health in primary care is influenced by coverage-related factors.


Asunto(s)
Salud Bucal , Atención Primaria de Salud , Brasil , Estudios Transversales , Humanos , Factores Socioeconómicos
13.
Cien Saude Colet ; 26(suppl 2): 3671-3682, 2021.
Artículo en Portugués | MEDLINE | ID: mdl-34468661

RESUMEN

Little is known regarding the use of emergency contraception among women from different regions of Brazil. The use of emergency contraception as well as contraceptive methods before and after coitus was analyzed. This cross-sectional study assessed the use of emergency contraception by interviewing 2,051 women aged between 18 and 49 attending 76 basic health units in three capitals: São Paulo-SP, Aracaju-SE and Cuiabá-MT. Aspects associated with the use of emergency contraception were analyzed by means of multiple logistic regression. Over half of the women reported the use of emergency contraception (56.7%). Having a high level of education, being from a more privileged socioeconomic group, having a paid job and having had four or more sexual partners were associated with the use of emergency contraception. Being 35 years of age or older and being in a stable relationship was negatively associated. The last time they used emergency contraception, 53.2% used another method, with the male condom and oral pill being the most frequent. Of those who did not use the method, half adopted the regular method after using it (51.7%). The conclusion drawn is that emergency contraception is widely used and does not appear to affect the use of the regular contraceptive method.


Asunto(s)
Anticoncepción Postcoital , Anticonceptivos Poscoito , Adolescente , Adulto , Brasil , Ciudades , Conducta Anticonceptiva , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Atención Primaria de Salud , Adulto Joven
14.
Cien Saude Colet ; 26(suppl 2): 3683-3692, 2021.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-34468662

RESUMEN

Colombia is currently implementing a new health model, which is being tested initially in a region of the Amazon, with the main objective of primary health care with an intercultural approach. It is a cut of a doctoral thesis outlined by the case study methodology, which aimed to understand the daily construction process of primary health care from the perspective of indigenous and health professionals in Guainía, Colombia. Twenty-two indigenous users and 26 health professionals participated in the study, as well as three key participants. The data were collected through semi-structured interviews and direct observation, and were later transcribed and analyzed by Bardin's thematic content analysis technique. The results show that interculturality, as a permanent process of negotiations and articulations present in the daily lives of indigenous and health professionals, is a fundamental part of the construction of primary health care in Guainía. In it materializes the encounter and exchange of heterogeneous forms of thinking-knowledge, that allow new interpretations and reinventions of knowledge and practices in health, although this process is permeated by conflicts, ambiguities, asymmetries and contradictions.


Asunto(s)
Personal de Salud , Atención Primaria de Salud , Colombia , Humanos , Conocimiento
15.
Cien Saude Colet ; 26(suppl 2): 3715-3724, 2021.
Artículo en Portugués | MEDLINE | ID: mdl-34468665

RESUMEN

The scope of this study was to evaluate the influence of contextual and individual factors associated with dissatisfaction of users of the Unified Health System (SUS) with the care provided by dentists in Primary Health Care. It is a cross-sectional and multilevel study, based on secondary data derived from a national basic research project to assess user satisfaction with the SUS. Data were collected by the Ombudsman's Department of the SUS by telephone contact with a sample of 35,393 individuals from around the country. Contextual and individual variables were associated with dissatisfaction with the dental service provided by the SUS. For the analysis, Stata version 11.0 software was used together with multilevel random effects logistic regression. A total of 2,331 individuals from 61 municipalities were included in the final sample of satisfaction with the dental service. Only 43% of the participants reported that their claims had been resolved, and a seven times greater chance of dissatisfaction was perceived for those individuals who had unresolved demand in relation to those who resolved it. This research provides input that can subsidize the government in actions aimed at improving access and quality of care provided in dental care.


Asunto(s)
Atención Odontológica , Atención Primaria de Salud , Brasil , Estudios Transversales , Humanos , Factores Socioeconómicos
16.
Cien Saude Colet ; 26(suppl 2): 3743-3752, 2021.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-34468668

RESUMEN

This paper presents partial results of a research-intervention, through training of PHC work teams. Initial consultation was made in a group by HC professionals, and the osteopath then performed the consultation. The socialization and training of practical knowledge and techniques of the osteopathic approach was done between consultations. Multiprofessional teams from three health centers from Florianópolis, southern Brazil, participated in the training, and the process was audio and videorecorded, along with a final interview. Data was analyzed using the Grounded Theory. Apprehending the osteopathic knowledge was a triggering tool for reflective processes about care. Faced with the efficiency and resolution of this approach in practice, participants showed a willingness to transform their acts of care of patients and also their self-care. The professionals argue that the common understanding about self-regulating mechanisms and the inclusion of the tissue mobility in their anamnesis, including the stimulation of endogenous mechanisms, contributed to less protocol-based care, more appropriate care for each case, better multidisciplinary team work, the rational use of additional tests, medication, and surgical procedures.


Asunto(s)
Educación Continua , Atención Primaria de Salud , Brasil , Personal de Salud/educación , Humanos , Derivación y Consulta
17.
Cien Saude Colet ; 26(suppl 2): 3765-3780, 2021.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-34468670

RESUMEN

This paper aimed to characterize actions directed to children's mental health (CMH) in Primary Health Care (PHC), based on an integrative review of Brazilian literature (2006-2017). The searches were carried out from LILACS, SciELO and VHL Network databases. After applying the inclusion and exclusion criteria, 13 articles were identified for analysis, which were presented in three thematic axes: 1) Characterization of the demands on CMH for PHC; 2) Actions and interventions on CMH carried out in PHC; and 3) Difficulties and propositions for the implementation of actions on CMH in PHC. The literature points, as the main actions, the identification of CMH problems and their referral to care by specialties. Some studies described specific actions of professionals such as physicians, pediatricians, and psychologists. Interventions of a local character or in partnerships with universities were also identified. The analysis of this material indicated that PHC has been considered as an important field of action in CMH, but that nevertheless requires greater investments, especially in professional training and work organization.


Asunto(s)
Salud Mental , Atención Primaria de Salud , Brasil , Niño , Salud del Niño , Programas de Gobierno , Humanos
18.
Cien Saude Colet ; 26(suppl 2): 3781-3786, 2021.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-34468671

RESUMEN

Since 2017, the Brazilian health system is facing a wave of counter-reforms in policies that have expanded coverage and access and intended to change the care model. Primary Health Care (PHC) has been substantially modified by synergistic and complementary federal official acts. The creation of federal autonomous social service for the provision of doctors; public consultation to institute basket of consumption in healthcare; the flexibility of the weekly workload of doctors and nurses, who may integrate more than one team; the non-setting of a minimum number of community health workers per team form the context in which the Previne Brasil Program was launched to be in force by 2020. The government's argument is to increase: flexibility and local autonomy to organize services, greater efficiency and valorization. of performance. Criticism from sanitarians, some state councils of municipal authorities and the National Health Council points to the privatizing, marketing, selective and focused character of the proposal that is moving towards universal health coverage. This paper analyzes the Previne Brazil Program which, among other things, alters funding and suggests increasing resources for PHC in a context of freezing social spending. Contradictions and alternatives are identified to minimize potential damage to existing policies.


Asunto(s)
Atención a la Salud , Atención Primaria de Salud , Brasil , Programas de Gobierno , Humanos , Cobertura Universal del Seguro de Salud
19.
Rev Lat Am Enfermagem ; 29: e3457, 2021.
Artículo en Inglés, Portugués, Español | MEDLINE | ID: mdl-34495186

RESUMEN

OBJECTIVE: to evaluate family and community guidance in adolescence, within the scope of Primary Health Care. METHOD: an evaluative and descriptive study with a quantitative approach, developed through the application of the Primary Care Assessment Instrument (PCATool), with 70 professionals from the Family Health Strategy and 140 adolescents from the widerange areas. Data collection took place in Basic Health Units and in the adolescents' homes in a municipality of southern Brazil, from May to September 2019. The data were analyzed using descriptive and inferential statistics using ANOVA and Tukey's test, performed using the R Studio software. RESULTS: there was divergence in the assessment of the attributes of family and community guidance between users and responsible professionals, showing weaknesses in the communication process and in the formation of the care bond in this reality, with impacts on quality of care. CONCLUSION: there was a need for continued assessment of the care practice in primary health care, as well as for permanent education with a focus on increasing qualification of care for adolescents.


Asunto(s)
Salud de la Familia , Atención Primaria de Salud , Adolescente , Brasil , Ciudades , Estudios Transversales , Humanos
20.
Rev Lat Am Enfermagem ; 29: e3480, 2021.
Artículo en Inglés, Portugués, Español | MEDLINE | ID: mdl-34495191

RESUMEN

OBJECTIVE: to investigate associations between depressive symptoms during pregnancy, low birth weight, and prematurity among women with low-risk pregnancies assisted in public Primary Health Care services. METHOD: prospective cohort with 193 pregnant women, using the Edinburgh Postnatal Depression Scale, telephone interviews, and medical records available in the health services. Associations of interest were obtained using the Cox regression model. RESULTS: the participants were aged 24.9 years old (median) and had 11 years of schooling (median); 82.4% lived with their partners, and gestational age at the birth was 39 weeks (median). Twenty-five percent of the participants scored ≥13 on the Edinburgh scale. Depressive symptoms did not appear associated with low birth weight (RR=2.06; CI95%=0.56-7.61) or prematurity (RR=0.86; CI95%=0.24-3.09) in the adjusted analysis. However, premature labor increased the risk of low birth weight (RR=4.81; CI95%=1.01-23.0) and prematurity (RR=7.70; CI95%=2.50-23.7). Additionally, each week added to gestational age decreased the risk of low birth weight (RR=0.76; CI95%=0.61-0.95). CONCLUSION: the presence of depressive symptoms among women with low-risk pregnancies was not associated with low birth weight or prematurity.


Asunto(s)
Depresión , Mujeres Embarazadas , Adulto , Peso al Nacer , Depresión/epidemiología , Depresión/etiología , Femenino , Servicios de Salud , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Embarazo , Atención Primaria de Salud , Estudios Prospectivos , Adulto Joven
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