Compreensão do consentimento informado em pesquisa clínica de vacina contra o Zika vírus: estudo transversal / Understanding of informed consent in clinical research for a vaccine against Zika virus: a cross-sectional study / Comprensión del consentimiento informado en la investigación clínica de una vacuna contra el virus del Zika: un estudio transversal

OBJETIVO: avaliar a compreensão das informações do Termo de Consentimento Livre e Esclarecido pelos participantes de uma pesquisa clínica de vacina contra o Zika vírus. MÉTODO: estudo transversal com amostra por conveniência e participação de 101 voluntários de uma pesquisa clínica em Belo Horizonte, Minas Gerais. Utilizou-se um questionário estruturado. A análise dos dados foi realizada no programa R, segundo a estatística descritiva e inferencial. RESULTADOS: a média de acertos dos participantes sobre as informações do documento de consentimento foi de 66,9%. A maioria dos participantes assinou o documento sem o conhecimento suficiente das informações da pesquisa. O Índice de compreensão foi maior entre os participantes que tinham se voluntariado em pesquisas prévias (p=0,039). CONCLUSÃO: verificaram-se limitações importantes na compreensão dos participantes sobre informações do termo de consentimento, o que comprometeu a decisão autônoma. São necessárias adaptações e melhorias nos processos de consentimento informado em prol da sua validade.

OBJECTIVE: to assess the understanding of the information contained in the Informed Consent Form by the participants of a clinical trial of a vaccine against the Zika virus. METHOD: cross-sectional study using intentional sampling, including a total of 101 volunteers in clinical research in Belo Horizonte, Minas Gerais. A structured questionnaire was used. Data analysis was performed using R software, according to descriptive and inferential statistics. RESULTS: the mean of correct answers of the participants regarding the information in the consent form was 66.9%. Most participants signed the document without sufficient knowledge of the research information. The comprehension index was higher among participants who had volunteered in previous research (p=0.039). CONCLUSION: there were important limitations in the participants' understanding of information in the consent form, which compromised the autonomous decision. Adaptations and improvements are necessary in the processes of informed consent for its validity.

OBJETIVO: evaluar la comprensión de las informaciones contenidas en el Término de Consentimiento Libre e Informado por los participantes de un ensayo clínico de una vacuna contra el virus del Zika. MÉTODO: estudio transversal con muestra de conveniencia y participación de 101 voluntarios en una investigación clínica en Belo Horizonte, Minas Gerais. Se utilizó un cuestionario estructurado. El análisis de datos se realizó mediante el programa R, según estadística descriptiva e inferencial. RESULTADOS: el promedio de aciertos de los participantes con respecto a las informaciones del documento de consentimiento fue de 66,9%. La mayoría de los participantes firmó el documento sin conocimiento suficiente de las informaciones de la investigación. El índice de comprensión fue mayor entre los participantes que se habían ofrecido como voluntarios en investigaciones anteriores (p=0,039). CONCLUSIÓN: hubo limitaciones importantes en la comprensión de las informaciones del formulario de consentimiento por parte de los participantes, lo que comprometió la decisión autónoma. Son necesarias adecuaciones y mejoras en los procesos de consentimiento informado para su validez.

Factors associated with the performance of primary dental health care in Brazil: A multilevel approach.

This study evaluated the factors associated with the performance of Brazilian Oral Health Teams (OHTs).This is multilevel research that used data from 12,386 Brazilian OHTs in 2012. The OHTs performance was estimated in previous research by using Item Response Theory model, which employed 20 questions about dental procedures in Primary Care. The first level covariates were based on OHTs procedures such as: the record of pregnant woman dental appointment, provision of dentistry home care, dental appointments scheduled choices, and OHTs in charge for more than 5000 individuals. Moreover, the use of guidelines was accessed concerning delivering prostheses in primary care, referring to secondary care, referring to suspected oral cancer, and providing care towards patients with special needs. Variables included in level 2 were GINI and Human Development Index. Multilevel linear regression models were constructed, estimating linear regression coefficients, 95% confidence intervals, and P values.OHTs performance was different among the 3,613 municipalities analyzed (P < .001), with 36.7% of the variation in the performance of the OHTs being attributed to the variability between municipalities. The adjusted model showed that higher performance OHTs reported attention to pregnant women, dentistry home care and use of dental care guidelines (P < .001). There were lower performance scores for those OHTs with more restricted scheduling (P < .05), compared to those that reported scheduling appointments at any day and time. The best OHTs and population ratio led to a better performance score (P = .010). At the municipal level, better socioeconomic status was associated with better performance of the OHTs (P < .001).OHTs with higher performance are associated with oral health services organizations and municipalities' socioeconomic status.

Service users' perception about healthcare provided by teams participating in the National Program for Primary Care Access and Quality Improvement in Brazil. / Percepção dos usuários sobre o cuidado prestado por equipes participantes do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica no Brasil.

OBJECTIVE: to analyze service users' perception of health care provided by the teams participating in the National Program for Primary Care Access and Quality Improvement (PMAQ-AB) in Brazil. METHODS: this was a cross-sectional study using data from interviews with users of services provided by PMAQ-AB teams in 2012. Multinomial logistic regression was used to analyze the association between perception level (very good/good, regular, poor/very poor) and variables of four primary care attributes: accessibility, integrality, longitudinality and care coordination. RESULTS: out of 65,391 users, 78.9% evaluated care as very good/good, 19.0% as regular and 2.1% as poor/very poor. Associations with care by the same physician (OR 3.21; 95% CI 2.68, 3.83) and physical examination at consultation (OR 3.08; 95% CI 2.50, 3.79) were the most prominent. CONCLUSION: the majority of users evaluated care positively, however there is perception of care problems within the recommended attributes.

Percepção dos usuários sobre o cuidado prestado por equipes participantes do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica no Brasil / Percepción de los usuarios sobre el cuidado prestado por los equipos participantes del Programa Nacional de Mejora del Acceso y la Calidad de la Atención Básica en Brasil / Service users' perception about healthcare provided by teams participating in the National Program for Primary Care Access and Quality Improvement in Brazil

Objetivo: analisar a percepção dos usuários sobre o cuidado prestado por equipes participantes do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) no Brasil. Métodos: estudo transversal com dados de entrevistas com usuários das equipes, em 2012. Empregou-se regressão logística multinomial para analisar a associação entre nível de percepção (muito bom/bom, regular, ruim/muito ruim) e variáveis de quatro atributos da atenção básica: acessibilidade, integralidade, longitudinalidade e coordenação do cuidado. Resultados: dos 65.391 entrevistados, 78,9% avaliaram o atendimento como muito bom/bom, 19,0% como regular e 2,1% como ruim/muito ruim. A avaliação muito bom/bom foi associada a questões sobre os quatro atributos estudados. Destacam-se as associações com atendimento pelo mesmo médico (OR 3,21; IC95% 2,68; 3,83) e realização do exame físico na consulta (OR 3,08; IC95% 2,50; 3,79). Conclusão: a maioria dos usuários avaliou positivamente o atendimento, contudo existe percepção de problemas no cuidado conforme os atributos recomendados.

Objetivo: analizar la percepción de los usuarios sobre el cuidado prestado por los equipos del Programa Nacional de Mejora del Acceso y de la Calidad de la Atención Básica (PMAQ-AB) en Brasil. Métodos: estudio transversal, con datos de entrevistas con usuarios de los equipos evaluados por el PMAQ-AB en 2012. Se empleó regresión logística multinomial para analizar la asociación entre nivel de percepción (muy bueno/bueno, regular, malo/muy malo) y variables de atributos de la AB: accesibilidad, integralidad, longitudinalidad y coordinación del cuidado. Resultados: de los 65.391 usuarios, 78,9% evaluaron la atención como muy bueno/bueno, 19,0% como regular y 2,1% como malo/muy malo. Se destacan las asociaciones con atención por el mismo médico (OR 3,21; IC95% 2,68; 3,83) y realización del examen físico en la consulta (OR 3,08; IC95% 2,50; 3,79). Conclusión: la mayoría de los usuarios evaluaron positivamente la atención, sin embargo existe percepción de problemas en el cuidado.

Objective: to analyze service users' perception of health care provided by the teams participating in the National Program for Primary Care Access and Quality Improvement (PMAQ-AB) in Brazil. Methods: this was a cross-sectional study using data from interviews with users of services provided by PMAQ-AB teams in 2012. Multinomial logistic regression was used to analyze the association between perception level (very good/good, regular, poor/very poor) and variables of four primary care attributes: accessibility, integrality, longitudinality and care coordination. Results: out of 65,391 users, 78.9% evaluated care as very good/good, 19.0% as regular and 2.1% as poor/very poor. Associations with care by the same physician (OR 3.21; 95% CI 2.68, 3.83) and physical examination at consultation (OR 3.08; 95% CI 2.50, 3.79) were the most prominent. Conclusion: the majority of users evaluated care positively, however there is perception of care problems within the recommended attributes.

[Incorporation of Information and Communication Technologies and quality of primary healthcare in Brazil]. / Incorporação de Tecnologias de Informação e Comunicação e qualidade na atenção básica em saúde no Brasil.

Information and Communication Technologies (ICTs) are means to handle information, streamline communication, and contribute to patient care. This article describes the incorporation of Information and Communication Technologies in primary care and its association with quality, based on the Brazilian National Program for the Improvement of Access and Quality in Primary Care (PMAQ in portuguese). This was a cross-sectional study with 17,053 teams. An Index of Incorporation of ICTs was created, which included: information infrastructure, systems, and utilization. Regression analysis was used to assess associations. Only 13.5% of the teams had a high degree of ICTs. The strongest association was seen in the utilization of information. ICTs can contribute to improving quality of primary care.

Primary dental care evaluation in Brazil: an item response theory approach.

OBJECTIVES: Item response theory (IRT) is a method used to design, analyze, and score tests, questionnaires, and similar instruments measuring abilities, attitudes, or other variables. The aim of this study was to assess the psychometric properties of dental care questions in the "Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica-PMAQ-AB," Brazil, using IRT. METHODS: Dentists in primary health care units in Brazil (n = 12,403) were interviewed face-to-face using a structured questionnaire. The questions were primarily dichotomous, with a no answer/do not know option. The items about dental care from a Brazilian national evaluation survey were analyzed using the IRT model (20 items). Oral health teams (OHTs) received scores that varied from the lowest performance level to the highest performance level. Scores for the Brazilian states and the Federal District were calculated to evaluate the regional distribution of OHT performance. RESULTS: The questions about dental care exhibited higher discrimination power for OHTs with below average performance. In general, the teams, including those with low performance, performed the actions, and procedures included in the questionnaire. Actions such as making prostheses and tracking and monitoring oral cancer cases characterized the high-performing teams. The performance of the teams distributed throughout the Brazilian states indicated that OHTs in the south and southeast performed better than OHTs in the rest of the country. CONCLUSIONS: Although the analyzed items are insufficient to determine the performance of OHTs, the items related to prosthesis and oral cancer tend to discriminate high-performing OHTs from other OHTs.

Incorporação de Tecnologias de Informação e Comunicação e qualidade na atenção básica em saúde no Brasil / Incorporation of Information and Communication Technologies and quality of primary healthcare in Brazil / Incorporación de Tecnologías de la Información y Comunicación y calidad en la atención básica en salud en Brasil

Resumo: As Tecnologias de Informação e Comunicação (TIC) - meios para tratar informação e agilizar comunicação - contribuem para o cuidado. Este artigo descreve a incorporação de TIC na atenção básica e sua associação com a qualidade, utilizando Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ). É um estudo transversal. O universo englobou 17.053 equipes. Criou-se o Índice de Incorporação de Tecnologias de Informação e Comunicação (ITIC) englobando: infraestrutura, sistemas e utilização de informação. Para as associações, realizou-se análise de regressão. Somente 13,5% das equipes possuem grau alto de TIC. É na utilização da informação que se observou a maior força de associação. As TIC contribuem para a melhoria da qualidade da atenção básica.

Abstract: Information and Communication Technologies (ICTs) are means to handle information, streamline communication, and contribute to patient care. This article describes the incorporation of Information and Communication Technologies in primary care and its association with quality, based on the Brazilian National Program for the Improvement of Access and Quality in Primary Care (PMAQ in portuguese). This was a cross-sectional study with 17,053 teams. An Index of Incorporation of ICTs was created, which included: information infrastructure, systems, and utilization. Regression analysis was used to assess associations. Only 13.5% of the teams had a high degree of ICTs. The strongest association was seen in the utilization of information. ICTs can contribute to improving quality of primary care.

Resumen: Las Tecnologías de la Información y Comunicación (TIC), los medios para tratar información y agilizar la comunicación, contribuyen al cuidado de los pacientes. Este artículo describe la incorporación de las TIC en la atención básica y su asociación con la calidad, utilizando Programa Nacional para el Mejoramiento del Acceso y Calidad de Atención Primaria (PMAQ). Es un estudio transversal. El universo englobó a 17.053 equipos. Se creó el Índice de Incorporación de las Tecnologías de la Información y Comunicación (ITIC) englobando: infraestructura, sistemas y utilización de la información. Para las asociaciones, se realizó un análisis de regresión. Solamente un 13,5% de los equipos poseen un grado alto de TIC. Es en la utilización de la información donde se observó la mayor fuerza de asociación. Las TIC contribuyen a una mejora de la calidad de la atención primaria.

Relationship between Primary and Secondary Dental Care in Public Health Services in Brazil.

This cross-sectional study evaluated the relationship between primary and secondary oral health care in Brazil. For this purpose, data from the National Program for Improving Access and Quality of Primary Care were used. Dentists from 12,403 oral health teams (OHTs) answered a structured questionnaire in 2012. The data were analyzed descriptively and by cluster analysis. Of the 12,387 (99.9%) OHTs that answered all the questions, 62.2% reported the existence of Dental Specialties Centers (DSCs) to which they could refer patients. The specialties with the highest frequencies were endodontics (68.4%), minor oral surgery (65.8%), periodontics (63.0%), radiology (46.8%), oral medicine (40.2%), orthodontics (20.5%) and implantology (6.2%). In all percentiles, the shortest wait time for secondary care was for radiology, followed by oral medicine and the other specialties. In the 50th percentile, the wait for endodontics, periodontics, minor oral surgery and orthodontics was 30 days, while for implantology, the wait was 60 days. Finally, in the 75th percentile, the wait for endodontics, orthodontics and implantology was 90 days or more. Two clusters, with different frequencies of OHT access to specialties, were identified. Cluster 1 (n = 7,913) included the OHTs with lower frequencies in all specialties except orthodontics and implantology compared with Cluster 2 (n = 4,474). Of the Brazilian regions, the South and Southeast regions had the highest frequencies for Cluster 2, with better rates for the relationship between primary and secondary care. This study suggests certain difficulties in the relationship between primary and secondary care in specific specialties in oral health, with a great number of OHTs with limited access to DSCs, in addition to different performance in terms of OHT access to DSCs across Brazilian regions.

[Health care, quality certification and institutional support: a focus on primary health care in Brazil]. / Asistencia sanitaria, certificación de calidad y apoyo institucional: la atención primaria en Brasil.

OBJECTIVE: To provide an overview of the distribution of institutional support in primary care in Brazil and to identify associations between the activities of institutional support and the outcome of the certification of the National Programme for Improving Access and Quality in Primary Health Care (PMAQ). MATERIALS AND METHODS: A cross-sectional study was conducted through interviews with 16 960 professionals in Brazil in 2012.To examine the relationship between the received support and the quality of health care it was made a multiple binary logistic regression. RESULTS: A positive relationship between high-level support and certification in the sub-dimensions analyzed was observed: women and child care, diabetes mellitus/ hypertension and mental health.The support activities which contributed most were: self-assessment, shared assessment, targeted workshops and training. CONCLUSION: Institutional support activities have helped to improve the quality and access of the population to healthcare in the country.

Asistencia sanitaria, certificación de calidad y apoyo institucional: la atención primaria en Brasil / Health care, quality certification and institutional support: a focus on primary health care in Brazil

Resumen: Objetivo: Ofrecer un panorama de la distribución del apoyo institucional a la atención primaria en Brasil e identificar la relación entre actividades de apoyo institucional y los resultados de la certificación del Programa Nacional para Mejorar el Acceso y la Calidad de la Atención Primaria (PMAQ). Material y métodos: Se efectuó un estudio transversal mediante entrevistas con 16 960 equipos en Brasil, en 2012. Para examinar la relación entre apoyo recibido y la calidad de la atención, se efectuó una regresión logística binaria múltiple. Resultados: Se observó una relación positiva entre el alto apoyo y la certificación en las subdimensiones analizadas: atención de la mujer y niños, diabetes mellitus/ hipertensión y salud mental. Las actividades de apoyo que más contribuyeron fueron autoevaluación, evaluación compartida, talleres con objetivos específicos y formación permanente. Conclusiones: Las actividades de apoyo institucional ayudaron a mejorar la calidad y el acceso de la población a la asistencia sanitaria en Brasil.

Abstract: Objective: To provide an overview of the distribution of institutional support in primary care in Brazil and to identify associations between the activities of institutional support and the outcome of the certification of the National Programme for Improving Access and Quality in Primary Health Care (PMAQ). Materials and methods: A cross-sectional study was conducted through interviews with 16 960 professionals in Brazil in 2012.To examine the relationship between the received support and the quality of health care it was made a multiple binary logistic regression. Results: A positive relationship between high-level support and certification in the sub-dimensions analyzed was observed: women and child care, diabetes mellitus/ hypertension and mental health.The support activities which contributed most were: self-assessment, shared assessment, targeted workshops and training. Conclusion: Institutional support activities have helped to improve the quality and access of the population to healthcare in the country.

Análise do desempenho das equipes de saúde bucal na estratégia saúde da família no Brasil: um estudo misto / Evaluating primary dental care in Brazil: a mixed methods study

A Estratégia Saúde da Família (ESF) constitui o principal modelo de organização da Atenção Primária (APS) no Brasil. A Saúde Bucal foi inserida na ESF em 2001 com a criação das equipes de saúde bucal (ESB) como área prioritária diante da necessidade de melhorar as condições de saúde bucal da população. Na última década, observou-se uma expressiva expansão da ESF com o alcance de serviços chegando a cerca de 63% da população brasileira em 2016. Com o objetivo de avaliar a qualidade dos serviços da ESF, o Ministério da Saúde lançou em 2011 o Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). O principal desafio do PMAQ é instituir uma cultura de avaliação entre os profissionais e gestores da ESF que monitore e avalie processos e resultados das equipes. O objetivo desse estudo foi descrever as ações de APS realizadas pelas ESB no Brasil e compreender aspectos que levam ao diferente desempenho das ESB. Para isso, foi desenvolvido um estudo misto explanatório sequencial. Na fase quantitativa, análise descritiva e de cluster foram aplicadas em dados do PMAQ-AB para descrever a produção de 12.403 ESB. Também foi utilizada a Teoria de Resposta ao Item (TRI) para avaliar as qualidades psicométricas de 20 questões de saúde bucal do PMAQ-AB. Resultados da TRI foram usados para selecionar ESB com desempenhos extremos para a próxima fase. Na fase qualitativa foi realizado um estudo descritivo em dez ESB da região metropolitana de Belo Horizonte com desempenhos extremos classificados pela TRI na fase anterior. Os resultados quantitativos demonstraram que as ESB realizam procedimentos clínicos da odontologia básica, mas fazem menos reabilitação com próteses e coordenação do cuidado de câncer bucal. A análise da TRI demonstrou que os itens do questionário foram insuficientes para discriminar ESB de alto e baixo desempenho. No entanto, foi observado que ESB de alto desempenho tendem a realizar ações de prevenção e acompanhamento de câncer e confecção de prótese na APS. Os resultados da fase qualitativa confirmaram que ESB de alto desempenho tendem a trabalhar mais ações de promoção e prevenção de câncer de boca, inclusive utilizando contatos pessoais para encaminhar pacientes para serviço especializado. Já em relação à questão da prótese na APS, os dados qualitativos confirmaram os achados quantitativos e demonstraram que ESB de alto desempenho fazem prótese na APS, garantindo a reabilitação do usuário

The Family Health Strategy is the main organizational model of primary health care in Brazil. Dental care was included in the FHS in 2001 as a priority area due to the need to improve the oral health status of the population, and the oral health teams were created. In the last decade, there was a significant expansion of the ESF with the range of services reaching about 63% of the population in 2016. In 2011, the Brazilian Ministry of Health launched a program to assess the quality of FHS Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica ­ PMAQ-AB. The main challenge of PMAQ-AB was to stimulate a culture of evaluation among FHS professionals and managers who evaluate processes and outcomes of the teams. This study aimed to describe the actions performed at primary health care by oral health teams in Brazil and to understand factors that contribute to different performance of each team. For this, a mixed sequential explanatory study was developed. In the quantitative phase, we undertook descriptive statistics and cluster analysis to describe the production of 12,403 OHTs, and applied Item Response Theory (IRT) to assess survey's 20 dental care questions psychometric properties. IRT results were used to sample OHTs with extreme scores performance to the next phase. In the qualitative phase, we used descriptive approach applying thematic analysis in 10 dentists from extreme performance OHTs. Quantitative results showed OHTs provided basic dentistry clinical care, but underprovided rehabilitation with dentures and oral cancer care coordination. IRT analysis showed survey limitation to discriminate OHTs performance, except for rehabilitation with dentures and oral cancer-related items that tend to discriminate high-performance OHTs. Qualitative data showed barriers to access oral health services and failures for integrating oral cancer delivery services. Dentists' empathy and altruism determine the quality of oral cancer care coordination by means of their own network to refer patients suspect of oral cancer. OHTs that deliver dentures know better the population rehabilitation needs. Mixed method results showed the improvements in oral health services in Brazil, but pointed that in low performance OHT, patients face multiples barriers to access services. Also, low performance OHT failed to following oral câncer patients, and provided dentures

Describing the primary care actions of oral health teams in Brazil.

OBJECTIVE: To describe the primary care actions performed by oral health teams (OHTs) that participated in a large national survey led by the Ministry of Health in 2012. METHODS: A total of 12,403 dentists from OHTs completed a set of survey questions (response rate = 85.01%) on the organization of care, basic dental procedures and oral health surveillance actions of OHTs. Descriptive and hierarchical cluster analyses were developed. RESULTS: The majority of OHTs (85.2%) reported that they performed "patient welcoming". The delivery of services was based on a patient's identified disease risk (83.1%), and continuity of care was ensured by 85.9% of OHTs. Individual preventive, restorative and surgical procedures were performed by the majority of the teams; however, screening for oral cancer and construction of dental prostheses/dentures occurred less frequently. Cluster 1 was composed of OHTs with the lowest proportion of oral healthcare actions related to oral cancer and dental prostheses/dentures, and the Southeastern and Southern regions had higher proportions of OHTs from cluster 2. CONCLUSIONS: OHTs adhere to some of the principles of primary care organizations; however, the teams perform fewer actions related to oral cancer treatment and rehabilitation with complete dentures. The geographical distribution of the clusters was unequal in Brazil.

Institutional and matrix support and its relationship with primary healthcare / Apoio institucional e matricial e sua relação com o cuidado na atenção básica à saúde

OBJECTIVE To analyze whether the level of institutional and matrix support is associated with better certification of primary healthcare teams.METHODS In this cross-sectional study, we evaluated two kinds of primary healthcare support - 14,489 teams received institutional support and 14,306 teams received matrix support. Logistic regression models were applied. In the institutional support model, the independent variable was "level of support" (as calculated by the sum of supporting activities for both modalities). In the matrix support model, in turn, the independent variables were the supporting activities. The multivariate analysis has considered variables with p < 0.20. The model was adjusted by the Hosmer-Lemeshow test.RESULTS The teams had institutional and matrix supporting activities (84.0% and 85.0%), respectively, with 55.0% of them performing between six and eight activities. For the institutional support, we have observed 1.96 and 3.77 chances for teams who had medium and high levels of support to have very good or good certification, respectively. For the matrix support, the chances of their having very good or good certification were 1.79 and 3.29, respectively. Regarding to the association between institutional support activities and the certification, the very good or good certification was positively associated with self-assessment (OR = 1.95), permanent education (OR = 1.43), shared evaluation (OR = 1.40), and supervision and evaluation of indicators (OR = 1.37). In regards to the matrix support, the very good or good certification was positively associated with permanent education (OR = 1.50), interventions in the territory (OR = 1.30), and discussion in the work processes (OR = 1.23).CONCLUSIONS In Brazil, supporting activities are being incorporated in primary healthcare, and there is an association between the level of support, both matrix and institutional, and the certification result.

OBJETIVO Analisar se o grau de apoio institucional e matricial está associado à melhor certificação das equipes da atenção básica à saúde.MÉTODOS Neste estudo transversal analisamos dois tipos de apoio na atenção básica, sendo que 14.489 equipes receberam apoio institucional e 14.306 equipes receberam apoio matricial. Foram aplicados modelos de regressão logística. No de apoio institucional, a variável independente foi grau de apoio (calculado pelo somatório de atividades de apoio das duas modalidades), enquanto no de apoio matricial, as variáveis independentes foram as atividades de apoio. A análise multivariada considerou variáveis que apresentaram p < 0,20. O ajuste do modelo foi realizado pelo teste de Hosmer-Lemeshow.RESULTADOS As equipes contavam com atividades de apoio institucional e matricial em 84,0% e 85,0%, respectivamente, sendo que 55,0% realizavam entre seis e oito atividades. Para o apoio institucional, observamos chances de 1,96 e 3,77 de possuir certificação ótima ou boa quando as equipes possuíam médio e alto grau de apoio, respectivamente. Para o apoio matricial, as chances de possuir certificação ótima ou boa foram de 1,79 e 3,29, respectivamente. Quanto à associação entre atividades de apoio institucional e a certificação, a certificação ótima ou boa associou-se positivamente com autoavaliação (OR = 1,95), educação permanente (OR = 1,43), avaliação compartilhada (OR = 1,40) e monitoramento e avaliação de indicadores (OR = 1,37). Quanto ao apoio matricial, a certificação ótima ou boa associou-se positivamente com educação permanente (OR = 1,50), intervenções no território (OR = 1,30) e discussão nos processos de trabalho (OR = 1,23).CONCLUSÕES No Brasil, as atividades de apoio estão sendo incorporadas na atenção básica, existindo associação entre o grau de apoio tanto matricial quanto institucional e o resultado da certificação.

Compreendendo o apoio matricial e o resultado da certificação de qualidade nas áreas de atenção à criança, mulher, diabetes/hipertensão e saúde mental / Understanding matrix support and quality certification results in the areas of care for women, care for children, hypertension and diabetes as well as mental health

Este artigo apresenta a distribuição do apoio matricial (AM) no Brasil, identificando relações entre as atividades de AM e a certificação do PMAQ-AB. Utilizaram-se dois modelos de regressão logística múltipla. As atividades de AM na Atenção Básica são significativas mas desiguais, com altos graus de AM em lugares desenvolvidos. Existe associação positiva entre o grau de apoio e o resultado obtido na certificação. Elevados graus de AM correspondem a 89%, 80%, 89% e 63% de chances de as equipes obterem uma melhor certificação na atenção à mulher, criança, hipertensão e diabetes e saúde mental, respectivamente. O AM tem ajudado a melhorar a qualidade da Atenção Básica no Brasil.

This article aims to present the distribution of matrix support (MS) in Brazil and identify relations between MS activities and PMAQ-AB certification results. Two multiple logistic regression models were run. MS activities in primary care are significant, although uneven. There is a positive association between the level of support and result obtained in certification. High degrees of MS correspond to the probabilities of 89%, 80%, 89% and 63% that teams obtain better certification on attention to woman, child, hypertension and diabetes, and to mental health, respectively. MS has progressively helped to improve primary care in Brazil.