Digital home care interventions and quality of primary care for older adults: a scoping review.

BACKGROUND: Population aging is forcing the transformation of health care. Long-term care in the home is complex and involves complex communication with primary care services. In this scenario, the expansion of digital health has the potential to improve access to home-based primary care; however, the use of technologies can increase inequalities in access to health for an important part of the population. The aim of this study was to identify and map the uses and types of digital health interventions and their impacts on the quality of home-based primary care for older adults. METHODS: This is a broad and systematized scoping review with rigorous synthesis of knowledge directed by the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The quantitative data were analyzed through descriptive statistics, and the qualitative data were analyzed through basic qualitative content analysis, considering the organizational, relational, interpersonal and technical dimensions of care. The preliminary results were subjected to consultation with stakeholders to identify strengths and limitations, as well as potential forms of socialization. RESULTS: The mapping showed the distribution of publications in 18 countries and in the Sub-Saharan Africa region. Older adults have benefited from the use of different digital health strategies; however, this review also addresses limitations and challenges, such as the need for digital literacy and technological infrastructure. In addition to the impacts of technologies on the quality of health care. CONCLUSIONS: The review gathered priority themes for the equitable implementation of digital health, such as access to home caregivers and digital tools, importance of digital literacy and involvement of patients and their caregivers in health decisions and design of technologies, which must be prioritized to overcome limitations and challenges, focusing on improving quality of life, shorter hospitalization time and autonomy of older adults.

Preparation and validation of the instrument "QualiAPS digital-Brazil" for assessing digital health care in primary health care: a required tool.

Introduction: The use of Information and Communication Technologies in the field of health is increasing across the world, demarcating the field of digital health. The goal of this study is to formulate and validate a matrix of indicators, design assessment scripts and indicate data collection techniques for assessing the quality of digital health care in Brazilian Primary Health Care (PHC). Methodology: This is a validation study divided into three phases: preparation of the instrument, analysis of validity and pilot study. The instrument was prepared based on the PHC assessment model from a literature review; the analysis of validity used the Delphi technique associated with the nominal group and the evidence from the literature reference. In the pilot study, audio-recorded interviews were conducted with strategic primary care actors. Results: The matrix of indicators "QualiAPS Digital-Brazil" introduces a set of 37 indicators, distributed into three distinct components and their respective dimensions. The component "Structure" includes the dimension "Resources"; the component "Processes" includes the dimensions "Technical," "Organizational" and "Relational"; and the component "Results" includes the dimensions "Short-Term Results" and "Medium-Term Results." The general values obtained for CVI and IRR were 0.89 and 1.00; respectively. Therefore, it was possible to design assessment scripts and indicate qualitative data collection techniques for assessing digital health in Brazilian PHC. Conclusion: The instrument presented was validated regarding its relevance, content and theoretical support to evaluate the quality of digital health care, supporting decision-making by managers and health professionals in the search for improving remote primary care provided to the population.

Validity and reliability of a health care service evaluation instrument for tuberculosis.

OBJECTIVE To evaluate the validity and reliability of an instrument that evaluates the structure of primary health care units for the treatment of tuberculosis. METHODS This cross-sectional study used simple random sampling and evaluated 1,037 health care professionals from five Brazilian municipalities (Natal, state of Rio Grande do Norte; Cabedelo, state of Paraíba; Foz do Iguaçu, state of Parana; Sao José do Rio Preto, state of Sao Paulo, and Uberaba, state of Minas Gerais) in 2011. Structural indicators were identified and validated, considering different methods of organization of the health care system in the municipalities of different population sizes. Each structure represented the organization of health care services and contained the resources available for the execution of health care services: physical resources (equipment, consumables, and facilities); human resources (number and qualification); and resources for maintenance of the existing infrastructure and technology (deemed as the organization of health care services). The statistical analyses used in the validation process included reliability analysis, exploratory factor analysis, and confirmatory factor analysis. RESULTS The validation process indicated the retention of five factors, with 85.9% of the total variance explained, internal consistency between 0.6460 and 0.7802, and quality of fit of the confirmatory factor analysis of 0.995 using the goodness-of-fit index. The retained factors comprised five structural indicators: professionals involved in the care of tuberculosis patients, training, access to recording instruments, availability of supplies, and coordination of health care services with other levels of care. Availability of supplies had the best performance and the lowest coefficient of variation among the services evaluated. The indicators of assessment of human resources and coordination with other levels of care had satisfactory performance, but the latter showed the highest coefficient of variation. The performance of the indicators "training" and "access to recording instruments" was inferior to that of other indicators. CONCLUSIONS The instrument showed feasibility of application and potential to assess the structure of primary health care units for the treatment of tuberculosis.

Organização do cuidado à tuberculose na atenção básica do Rio Grande do Norte / Care organization for tuberculosis in the primary care of Rio Grande do Norte / Organización del cuidado a la tuberculosis en la atención básica de Rio Grande do Norte

Objetivo: avaliar a organização do cuidado à tuberculose (TB) na atenção básica do Rio Grande do Norte. Método: estudo descritivo, de corte transversal, recorte de um projeto multicêntrico, baseado nos dados secundários do componente Avaliação Externa disponíveis no banco do PMAQ-AB, referentes ao primeiro ciclo de avaliação, realizado em 2012. Os dados foram analisados pelo programa SPSS for Windows. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa, parecer 21904. Resultados: embora 27,7% dos serviços de saúde não possuam protocolos assistenciais, 97,3% e 95,6% das equipes solicitam baciloscopia e radiografia de tórax, respectivamente; 63,1% das equipes acompanham o tratamento diretamente observado (TDO), mas apenas 57,3% realizam a busca ativa de pacientes faltosos a esta modalidade de tratamento. Conclusão: a inexistência de procolocos assistenciais em uma parcela dos serviços de saúde se revelou como uma das principais fragilidades no cuidado aos doentes.(AU)

Objective: to evaluate the care organization of tuberculosis (TB) in primary care in Rio Grande do Norte. Method: descriptive study, cross-sectional cut of a multicenter project, based on the External Evaluation component of secondary data available in PMAQ-AB bank, for the first evaluation cycle conducted in 2012. Data were analyzed using SPSS software for Windows. The Research Ethics Committee, Opinion 21904, approved the research project. Results: although 27.7% of health services have not care protocols, 97.3% and 95.6% of the teams requesting smear and chest X-ray, respectively; 63.1% of the teams accompany the directly observed treatment (TDO), but only 57.3% conducts an active search for missing patients to this treatment modality. Conclusion: the lack of assistance protocols in a portion of health services has proved to be one of the main weaknesses in patient care.(AU)

Objetivo: evaluar la organización del cuidado a la tuberculosis (TB) en la atención básica de Rio Grande do Norte. Método: estudio descriptivo, de cohorte transversal, recorte de un proyecto multi-céntrico, basado en los datos secundarios del componente Evaluación Externa disponibles en el banco de PMAQ-AB, referentes al primer ciclo de evaluación, realizado en 2012. Los datos fueron analizados por el programa SPSS for Windows. El proyecto de investigación fue aprobado por el Comité de Ética en Investigación, parecer 21904. Resultados: aunque 27,7% de los servicios de salud no posean protocolos asistenciales, 97,3% y 95,6% de los equipos solicitan baciloscopia y radiografía de tórax, respectivamente; 63,1% de los equipos acompañan el tratamiento directamente observado (TDO), pero apenas 57,3% realiza la búsqueda activa de pacientes faltosos a esta modalidad de tratamiento. Conclusión: la inexistencia de protocolos asistenciales en una porción de los servicios de salud, se reveló como una de las principales fragilidades en el cuidado a los enfermos.(AU)

Validity and reliability of a health care service evaluation instrument for tuberculosis / Validação e confiabilidade: instrumento para avaliação de serviços que tratam tuberculose

OBJECTIVE To evaluate the validity and reliability of an instrument that evaluates the structure of primary health care units for the treatment of tuberculosis. METHODS This cross-sectional study used simple random sampling and evaluated 1,037 health care professionals from five Brazilian municipalities (Natal, state of Rio Grande do Norte; Cabedelo, state of Paraíba; Foz do Iguaçu, state of Parana; Sao José do Rio Preto, state of Sao Paulo, and Uberaba, state of Minas Gerais) in 2011. Structural indicators were identified and validated, considering different methods of organization of the health care system in the municipalities of different population sizes. Each structure represented the organization of health care services and contained the resources available for the execution of health care services: physical resources (equipment, consumables, and facilities); human resources (number and qualification); and resources for maintenance of the existing infrastructure and technology (deemed as the organization of health care services). The statistical analyses used in the validation process included reliability analysis, exploratory factor analysis, and confirmatory factor analysis. RESULTS The validation process indicated the retention of five factors, with 85.9% of the total variance explained, internal consistency between 0.6460 and 0.7802, and quality of fit of the confirmatory factor analysis of 0.995 using the goodness-of-fit index. The retained factors comprised five structural indicators: professionals involved in the care of tuberculosis patients, training, access to recording instruments, availability of supplies, and coordination of health care services with other levels of care. Availability of supplies had the best performance and the lowest coefficient of variation among the services evaluated. The indicators of assessment of human resources and coordination with other levels of care had satisfactory performance, but the ...

OBJETIVO Analisar a validade e confiabilidade de instrumento de avaliação da estrutura dos serviços de atenção básica para o tratamento da tuberculose. MÉTODOS Estudo transversal com amostragem aleatória simples para 1.037 profissionais de saúde de cinco municípios (Natal, RN; Cabedelo, PB; Foz do Iguaçu, PR; São José do Rio Preto, SP e Uberaba, MG) em 2011. Foram identificados e validados indicadores estruturais, considerando as diferentes modalidades de organização do sistema de saúde de municípios de diferentes portes populacionais. A “estrutura” correspondeu aos recursos existentes para a execução dos serviços: físicos (equipamentos, materiais de consumo e instalações); humanos (número e qualificação); e fontes para manutenção da infraestrutura e da tecnologia existente, entendida como organização do serviço de saúde. Os procedimentos estatísticos utilizados no processo de validação foram análise de confiabilidade, análise fatorial exploratória e confirmatória. RESULTADOS O processo de validação determinou a retenção de cinco fatores com 85,9% de variância total explicada, consistência interna entre 0,6460 e 0,7802 e qualidade de ajustamento da análise confirmatória de 0,995 para o goodness-of-fit index. Os fatores retidos compuseram os cinco indicadores estruturais: profissionais envolvidos com o atendimento de tuberculose; capacitação; acesso a instrumentos de registro; disponibilidade de insumos; e articulação do serviço de saúde com outros níveis de atenção. O indicador com melhor desempenho foi disponibilidade de insumos, com menor coeficiente de variação nos serviços avaliados. Os indicadores de avaliação dos recursos humanos e articulação com outros níveis de serviços apresentaram percentuais satisfatórios; entretanto, este último apresentou o maior coeficiente de variação. Os indicadores de capacitação e acesso a instrumentos de registro apresentaram percentuais de avaliação inferiores aos demais. CONCLUSÕES O ...

[Reflections around the performance of community health agents in oral health strategies]. / Reflexões acerca da atuação do agente comunitário de saúde nas ações de saúde bucal.

The Community Health Agent (CHA) has traditionally been linked to doctors and nurses, being considered exclusive 'property' of these professionals. Historically, oral health tended to operate isolated, disconnecting the mouth from the rest of the body and the individual from his environment. The Family Health Program (FHP) points to important changes in the organization of services as well as in the work process. One of the differences is the teamwork joining different professionals, including oral health which was previously excluded. The objective of the study is to show the experience of the CHA qualifying course, which allowed the entrance of different professional categories into teaching. The course included three odontologists as lecturers, and CHA recognized other individuals as health team members, as well as expand the view of its role within oral health. The professors also had their practices modified, given that they could understand the often ignored suffering and limitations of the CHAs.

Reflexões acerca da atuação do agente comunitário de saúde nas ações de saúde bucal / Reflections around the performance of community health agents in oral health strategies

O agente comunitário de saúde (ACS) tradicionalmente esteve mais vinculado ao profissional de enfermagem e ao profissional médico para realização das suas atividades práticas, sendo visto como um elemento de "propriedade" exclusiva desses profissionais da saúde. A saúde bucal historicamente tendeu a trabalhar isoladamente, separando a boca do resto do corpo e o indivíduo do seu meio ambiente. O Programa Saúde da Família (PSF) aponta para importantes mudanças na organização dos serviços e no processo de trabalho. Um dos diferenciais é o trabalho de diversos tipos de profissionais em equipe, inclusive a saúde bucal, que até então estava excluída. Este trabalho objetiva mostrar a experiência do curso de qualificação do ACS, que possibilitou a diversidade de categorias profissionais de nível superior, na docência. O curso contou com três docentes odontólogos; nele, foi possível para o ACS reconhecer outros atores como participantes da equipe de saúde, além de ampliar sua visão em relação ao seu papel na saúde bucal. Os docentes também tiveram suas práticas modificadas, uma vez que passaram a entender melhor a angústia e limitações dos ACS, muitas vezes ignoradas.

The Community Health Agent (CHA) has traditionally been linked to doctors and nurses, being considered exclusive "property" of these professionals. Historically, oral health tended to operate isolated, disconnecting the mouth from the rest of the body and the individual from his environment. The Family Health Program (FHP) points to important changes in the organization of services as well as in the work process. One of the differences is the teamwork joining different professionals, including oral health which was previously excluded. The objective of the study is to show the experience of the CHA qualifying course, which allowed the entrance of different professional categories into teaching. The course included three odontologists as lecturers, and CHA recognized other individuals as health team members, as well as expand the view of its role within oral health. The professors also had their practices modified, given that they could understand the often ignored suffering and limitations of the CHAs.

Saúde bucal no PSF, da inclusão ao momento atual: percepções de cirurgiões-dentistas e auxiliares no contexto de um município / Oral health care in the family health program, from its implementation to today’s moment: perceptions of dentists and assistants in municipality context

O presente trabalho caracteriza-se como uma pesquisa-ação, com enfoque qualitativo. Refere-se especificamente àsEquipes de Saúde Bucal (ESB) que foram inseridas no Programa Saúde da Família (PSF) implantadas no ano de 2001no município de São Gonçalo do Amarante – RN. Tem como objetivo descrever este processo de implantação, identificandoa percepção dos profissionais de saúde bucal com relação às atividades desenvolvidas, ao processo de trabalhoe à expectativa de melhoria das condições de saúde bucal das famílias adscritas. A coleta de dados foi realizada atravésde uma entrevista semi-estruturada onde os sujeitos de pesquisa eram os cirurgiões-dentistas e auxiliares de consultóriosdentários das sete ESB, sendo entrevistados 92,85% do total destes profissionais. Os principais resultados encontradosforam os anseios de mudanças das práticas realizadas no modelo tradicional, bem como, a interação dos profissionaisque compõem as ESB, na perspectiva de propiciar aos usuários do serviço uma assistência integral e resolutiva. Destacasetambém a necessidade da valorização dos profissionais como parte integrante das Equipes de Saúde da Família.Conclui-se que a mudança do quadro epidemiológico em saúde bucal a partir da inclusão das ESB no PSF é uma dasmetas a ser alcançada, bem como a melhoria do acesso dos usuários, à medida que esta estratégia possibilitará ofereceruma assistência à saúde universal e igualitária.

Caminhada, saúde e vida: fortalecendo as práticas corporais e atividades físicas do Grupo Viver / Walking, health and life: strengthening the

Apresenta-se, aqui, o trabalho do Grupo Viver: caminhada, saúde e vida, iniciado em maio de 2007, em São José de Mipibu (RN), através de uma parceria entre as secretarias municipais de Saúde, de Promoção Social e de Educação e Cultura, representada pela equipe da Divisão de Esportes. Este trabalho tem como objetivo implantar a política de promoção à saúde, através da realização de atividades físicas e caminhadas diárias, envolvendo os usuários cadastrados no programa do Hiperdia, nos grupos Conviver e Melhor Idade. Resultados identificados por meio de indicadores de saúde ainda são incipientes. Considera-se, entretanto, o alcance de outros resultados que estão além dos olhares pautados em mensurações. Referem-se a processos e vivências pessoais e coletivas, inscritas em um amplo campo de corporeidade, transcendência e subjetividade, que indicam mudança de comportamento e adoção de hábitos saudáveis.

It shows the work of the Grupo Viver: Caminhada, Saúde e Vida(Group Living: Hiking, Health and Life) launched in May 2007, in San Joséde Mipibu–RN city, by a partnership between Municipal Secretary of Healthand Municipal Secretary of Education and Culture, represented by staff of theSports Division. It aims at implementing the policy of promoting the health, byphysical activities and daily hikes in bandstand in the downtown. Initially, it was intended for users registered in the program Hiperdia by Municipal Secretary of Health and the elderly of groups Conviver and Melhor Idade. Results identified by means of health indicators are still incipient. It is, however, the scope of otherresults that are beyond the eyes guided in measurements. Referring to the processes and personal and collective experiences, inserted in a broad embodiment field, transcendence and subjectivity that indicate changes in behavior and adoptionof healthy habits.