[Contribution of hospitalizations for primary care-sensitive conditions to the profile of admissions in the public health care system]. / Contribuição das internações por condições sensíveis à atenção primária no perfil das admissões pelo sistema público de saúde.

OBJECTIVE: To describe the epidemiological profile of hospitalizations in the city of Divinópolis, state of Minas Gerais, Brazil, to estimate the prevalence of hospitalizations for primary care-sensitive conditions (HPCSC), and to evaluate the factors associated with the occurrence of HPCSC. METHODS: A cross-sectional study was conducted of the two public health care institutions in Divinópolis qualified to hospitalize individuals; that is, a general hospital and an urgent care unit. The data were collected between July and October 2011. Admissions were screened based on information available through the state of Minas Gerais data exchange software SUS Fácil, hospital admission authorizations, and patient records. Descriptive analyses were carried out, with estimation of the prevalence of admissions according to the groups of the 10th revision of the International Classification of Diseases (ICD-10). The identification and classification of HPCSC was based on the Brazilian List of primary-care sensitive conditions published by the Ministry of Health. The strength of the association between HPCSC and selected variables was estimated based on the prevalence ratio. RESULTS: Two thousand seven hundred seventy five admissions were identified. The main causes were neoplasms (18%), diseases of the circulatory system (16%), pregnancy and childbirth (15%), and external causes (12%). The prevalence of HPCSC was 36.6%, with the main diagnoses being diseases of the circulatory and respiratory systems. One third of the admissions occurred through the urgent care unit, which was also responsible for more than half of the HPCSC. Female sex, age younger than 13 years and older than 40 years, and living in Divinópolis were associated with higher chance of admission due to HPCSC (P < 0.01). CONCLUSIONS: The results show a high prevalence of HPCSC, especially through the urgent care unit. This indicates an overburdening of urgent care services, hindering the implementation of a longitudinal continuum of care at the primary level.

Primary health care as assessed by health professionals: comparison of the traditional model versus the Family Health Strategy.

INTRODUCTION: The Family Health Strategy (FHS) should be first-contact care in the Brazilian Health System. However, Primary Health Care (PHC) still encompasses two models: the FHS and the traditional health care facilities. The expansion of the FHS has been slow and heterogeneous in many cities, rendering a comparative evaluation of key quality-related elements of PHC models crucial. OBJECTIVE: To compare the performance of PHC models as perceived by health professionals. METHODS: A cross-sectional study involving managers and health professionals from PHC of a medium-size city in South-eastern Brazil. Data were collected by applying the Primary Care Assessment Tool. The performance was estimated through primary health care indexes (general and partial PHCI by attributes). Univariate polytomous logistic regression was performed to compare care model performances according to their attributes. Strength of association was estimated by odds ratio with 95% confidence interval. RESULTS: Three managers and 81 health professionals participated in the study. The FHS had a better index rating than the traditional care model for general PHCI and for the attributes longitudinality, comprehensiveness, family focus and professional level. CONCLUSION: Although the FHS attained higher scores compared to the traditional model, it has not yet achieved the performance expected. This scenario points to the need for increased FHS cover and quality improvements at the existing units.

Primary health care as assessed by health professionals: comparison of the traditional model versus the Family Health Strategy / Avaliação da atenção primária à saúde por profissionais de saúde: comparação entre modelo tradicional versus Estratégia Saúde da Família

ABSTRACT: Introduction: The Family Health Strategy (FHS) should be first-contact care in the Brazilian Health System. However, Primary Health Care (PHC) still encompasses two models: the FHS and the traditional health care facilities. The expansion of the FHS has been slow and heterogeneous in many cities, rendering a comparative evaluation of key quality-related elements of PHC models crucial. Objective: To compare the performance of PHC models as perceived by health professionals. Methods: A cross-sectional study involving managers and health professionals from PHC of a medium-size city in South-eastern Brazil. Data were collected by applying the Primary Care Assessment Tool. The performance was estimated through primary health care indexes (general and partial PHCI by attributes). Univariate polytomous logistic regression was performed to compare care model performances according to their attributes. Strength of association was estimated by odds ratio with 95% confidence interval. Results: Three managers and 81 health professionals participated in the study. The FHS had a better index rating than the traditional care model for general PHCI and for the attributes longitudinality, comprehensiveness, family focus and professional level. Conclusion: Although the FHS attained higher scores compared to the traditional model, it has not yet achieved the performance expected. This scenario points to the need for increased FHS cover and quality improvements at the existing units.

RESUMO: Introdução: A Estratégia de Saúde da Família (ESF) deve ser o primeiro contato do Sistema Único de Saúde (SUS). Contudo dois modelos de atenção operam concomitantemente no âmbito da Atenção Primária à Saúde (APS): a ESF e o modelo tradicional. A expansão da ESF tem sido lenta e heterogênea em muitos municípios, tornando fundamental a condução de avaliações comparativas de atributos relacionados à qualidade dos modelos da APS. Objetivo: Comparar o desempenho dos modelos de atenção da APS de acordo com a percepção dos profissionais de saúde. Métodos: Estudo transversal com gestores e profissionais de saúde da APS do município de Divinópolis, Minas Gerais. Dados foram coletados por meio do Primary Care Assessment Tool. O desempenho dos modelos foi estimado por meio do Índice de Atenção Primária à Saúde (IAPS geral e específico). Regressão logística politômica univariada foi conduzida para comparação do desempenho dos modelos da APS de acordo com os atributos. A força da associação foi estimada por meio do odds ratio com intervalo de confiança de 95%. Resultados: Três gestores e 81 profissionais de saúde participaram do estudo. A ESF obteve melhor avaliação do que o modelo tradicional com relação ao IAPS geral e aos atributos vínculo, elenco de serviços, enfoque familiar e formação profissional. Conclusão: A ESF obteve escores superiores aos do modelo tradicional, entretanto ainda não atingiu o seu desempenho esperado. Esse cenário aponta para a necessidade de ampliação da cobertura da ESF e para a melhoria da qualidade das unidades de ESF existentes no Brasil.

Contribuição das internações por condições sensíveis à atenção primária no perfil das admissões pelo sistema público de saúde / Contribution of hospitalizations for primary care-sensitive conditions to the profile of admissions in the public health care system

OBJETIVO: Descrever o perfil epidemiológico das internações ocorridas na Cidade de Divinópolis (MG), Brasil, estimar a prevalência de internações por condições sensíveis à atenção primária (ICSAP) e avaliar os fatores associados com a ocorrência de ICSAP. MÉTODOS: Foi conduzido um estudo de transversal nos dois serviços públicos de internação do município: um hospital geral e uma unidade de pronto atendimento. Os dados foram coletados de julho a outubro de 2011. Foram triadas todas as internações mediante análise de informações do sistema SUS Fácil, autorizações para internação hospitalar e prontuários. Foram conduzidas análises descritivas e estimada a prevalência de internações de acordo com os grandes grupos da décima revisão do Código Internacional de Doenças e Causas de Morte (CID-10). A classificação das ICSAP foi baseada na Lista Brasileira publicada pelo Ministério da Saúde. A força da associação entre internações por ICSAP e variáveis selecionadas foi estimada pela razão de prevalência. RESULTADOS: Foram identificadas 2 775 internações. As principais causas foram neoplasias (18%), doenças do aparelho circulatório (16%), gravidez e parto (15%) e causas externas (12%). A prevalência de ICSAP foi 36,6% e os principais diagnósticos foram doenças dos aparelhos circulatório e respiratório. Um terço das internações ocorreu na unidade de pronto atendimento, que atendeu mais da metade das ICSAP. Ser mulher, menor de 13 anos e maior de 40 anos e residir em Divinópolis foram associados com maior chance de internação por ICSAP (P < 0,01). CONCLUSÕES: Foi encontrada alta prevalência de ICSAP, atendidas principalmente na unidade de pronto atendimento. Isso indica uma sobrecarga dos serviços de urgência em detrimento da longitudinalidade da atenção primária à saúde.

OBJECTIVE: To describe the epidemiological profile of hospitalizations in the city of Divinópolis, state of Minas Gerais, Brazil, to estimate the prevalence of hospitalizations for primary care-sensitive conditions (HPCSC), and to evaluate the factors associated with the occurrence of HPCSC. METHODS: A cross-sectional study was conducted of the two public health care institutions in Divinópolis qualified to hospitalize individuals; that is, a general hospital and an urgent care unit. The data were collected between July and October 2011. Admissions were screened based on information available through the state of Minas Gerais data exchange software SUS Fácil, hospital admission authorizations, and patient records. Descriptive analyses were carried out, with estimation of the prevalence of admissions according to the groups of the 10th revision of the International Classification of Diseases (ICD-10). The identification and classification of HPCSC was based on the Brazilian List of primary-care sensitive conditions published by the Ministry of Health. The strength of the association between HPCSC and selected variables was estimated based on the prevalence ratio. RESULTS: Two thousand seven hundred seventy five admissions were identified. The main causes were neoplasms (18%), diseases of the circulatory system (16%), pregnancy and childbirth (15%), and external causes (12%). The prevalence of HPCSC was 36.6%, with the main diagnoses being diseases of the circulatory and respiratory systems. One third of the admissions occurred through the urgent care unit, which was also responsible for more than half of the HPCSC. Female sex, age younger than 13 years and older than 40 years, and living in Divinópolis were associated with higher chance of admission due to HPCSC (P < 0.01). CONCLUSIONS: The results show a high prevalence of HPCSC, especially through the urgent care unit. This indicates an overburdening of urgent care services, hindering the implementation of a longitudinal continuum of care at the primary level.

A prática do enfermeiro na avaliação da assistência de enfermagem de um hospital geral / La práctica del enfermero en la evaluación de cuidados de enfermería de un hospital general / The nurse practice in the assessment of nursing care of a general hospital

técnicos de enfermagem em um hospital geral. Conhecer como esse profissionalavalia a assistência proporciona umareflexão sobre sua competência no exercício de suasatividades, o que garante um serviço de qualidade.O objetivo destetrabalho foi, portanto, identificar os métodos e meios que os enfermeiros utilizam para avaliar sua equipe deenfermagem. A pesquisa foi descritiva e exploratória, fundamentada na abordagem qualitativa. A população estudada foicomposta por enfermeiros coordenadores de unidadesde internação clínica de um hospital geral de grande porte deDivinópolis-MG. Os dados foram coletados através deuma entrevista gravada, transcritos e analisados através da análisede conteúdo. Percebeu-se que, entre os enfermeiros,existe um padrão único de resposta que segue uma mesma linha depensamento e práticas referentes ao modo e frequência em que é avaliada a assistência prestada pelos auxiliares. Foramelaboradas as seguintes categorias de discussão: omomento da avaliação; a descrição das avaliações dos enfermeiros; atendência para uma avaliação educativa e o método de avaliação.

This study describes the means and methods used bynurses to evaluate the practices performed by nursing assistants in ageneral hospital. Knowing how this professional evaluates the assistance provides a reflection on their competence inperforming their activities, which ensures a quality service. Therefore, the objective of this study was to identify themethods and means that nurses use to assess their nursing staff. The research was descriptive and exploratory with aqualitative approach. The studied population consisted of coordinators nurses of the inpatient clinical unit of a largegeneral hospital in Divinópolis-MG. Data were collected from a recorded interview, transcribed and analyzed using contentanalysis. It was noticed that among the nurses there is a unique pattern of response which follows thesame line ofthought and practice regarding the manner and frequency in which the subordinates assistance is evaluated. The followingcategories of discussion were elaborated: the moment of assessment, the nurses’ description of the evaluations, the trendfor educational assessment, and the evaluation method.

Este estudio describe los medios y métodos utilizados por enfermeros para evaluar las prácticas realizadas por auxiliaresde enfermería en un hospital general. Saber cómo ese profesional evalúa la asistencia profesional ofrece una reflexiónsobre su competencia para desempeñar sus actividades, lo que asegura un servicio de calidad. El objetivo de este estudiofue identificar los métodos y medios de evaluaciónque los enfermeros utilizan para evaluar a su personal de enfermería.La investigación se basó en el enfoque cualitativo,descriptivo y exploratorio. La población del estudiofue compuesta porenfermeros coordinadores de las unidades de internación clínica de un hospital general de gran porte en Divinópolis-MG.Los datos fueron recolectados a través de una entrevista grabada, transcriptos y analizados mediante análisis decontenido. Se observó que, entre los enfermeros, hay un patrón único de respuesta que sigue la misma línea depensamiento y práctica sobre la forma y frecuenciacon la que se evalúa la asistencia prestada por lossubordinados. Seprepararon las siguientes categorías de análisis: el momento de la evaluación, la descripción de las evaluaciones de losenfermeros, la tendencia para una evaluación educativa y el método de evaluación.