Calidad del cuidado en la Atención Básica en Brasil: la visión de los usuarios

Figueiredo, Daniela Cristina Moreira Marculino de; Shimizu, Helena Eri; Ramalho, Walter Massa; Figueiredo, Alexandre Medeiros de; Lucena, Kerle Dayana Tavares de

doi:10.1590/0034-7167-2017-0656

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Brasil

Revista Brasileira de Enfermagem

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Sumário

RESEARCH • Rev. Bras. Enferm. 71 (suppl 6) • 2018 • https://doi.org/10.1590/0034-7167-2017-0656 copiar

Calidad del cuidado en la Atención Básica en Brasil: la visión de los usuarios

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Describir la evaluación de los usuarios que participaron del Programa Nacional de Melhoria do Acesso e da Qualidade na Atenção Básica en cuanto a la atención integral, al vínculo y a la coordinación del cuidado en las macro regiones del país.

Método:

Estudio descriptivo, transversal, a partir de entrevistas con 65.391 usuarios de la Atención Básica, en 3.944 municipios, referente a la utilización de los servicios de salud.

Resultados:

Los profesionales buscan resolver los problemas de los usuarios en la propia unidad (73,1%), pero con atención orientada principalmente al alcance de la consulta (65,6%) y a la oferta de cuidado distante de la realidad de la población (69,4%). Se observaron dificultades en el rescate de la historia clínica (50,3%) y en el cuidado realizado en otros servicios de salud (29,2%).

Conclusión:

La atención integral, el vínculo y la coordinación del cuidado son aún desafíos para la Atención Básica en el país, exigiendo reflexiones sobre la implantación de políticas nacionales, sobre todo considerando las diversidades regionales de Brasil.

Descriptores:
Atención Primaria de Salud; Evaluación en Salud; Política de Salud; Salud Pública; Investigación en Servicios de Salud

Variable	Brazil n (%)	95%CI
Gender^* * number of interviewed patients = 65,391;
Male	14,600 (22.3)	22 - 22.6
Female	50,791 (77.7)	77.4 - 78
Age (average in years)^* * number of interviewed patients = 65,391;	49,3	49.1 - 49.5
Family monthly income (R$)^* * number of interviewed patients = 65,391;	1,163.1	1159.4 - 1166.7
Race/color^ patients who did not know/did not answer = 599. Patients who answered regarding race/color = 64,792.
White	25,164 (38.8)	38.5 - 39.2
Black	7,966 (12.3)	12 - 12.5
Yellow	1,735 (2.7)	2.6 - 2.8
Brown/mixed	29,311 (45.2)	44.9 - 45.6
Indigenous	616 (1)	0.9 - 1

Variable	North n (%) [95%CI]	Northeast n (%) [95%CI]	Southeast n (%) [95%CI]	South n (%) [95%CI]	Central-West n (%) [95%CI]	Brazil n (%) [95%CI]
When you are treated in this health unit, do you think that the team tries to solve your needs/problems in the health unit itself?^* * N = 64,857 (99.2% of the interviewed patients);
Yes	2,556 (69.3) [67.8 - 70.8]	15,077 (70.5) [69.9 - 71.1]	18,783 (74.5) [74 - 75.1]	7,914 (77) [76.2 - 77.9]	3,061 (71.2) [69.8 - 72.5]	47,391 (73.1) [72.7 - 73.4]
Yes, sometimes	786 (21.3) [20 - 22.6]	4,947 (23.1) [22.6 - 23.7]	4,714 (18.7) [18.2 - 19.2]	1,945 (18.9) [18.2 - 19.7]	908 (21.1) [19.9 - 22.3]	13,300 (20.5) [20.2 - 20.8]
Never	346 (9.4) [8.4 - 10.3]	1,371 (6.4) [6.1 - 6.7]	1,702 (6.8) [6.4 - 7.1]	414 (4) [3.6 - 4.4]	333 (7.7) [6.9 - 8.5]	4,166 (6.4) [6.2 - 6.6]
Do the health professionals ask questions about other health needs that you have or may have beyond those related to the reason for your appointment?^ N = 64,378 (98.5% of the interviewed patients);
Always/Usually	2,103 (57.6) [56.0 - 59.2]	13,459 (63.4) [62.7 - 64.0]	17,620 (70.3) [69.8 - 70.9]	6,458 (63.3) [62.4 - 64.2]	2,615 (61.6) [60.1 - 63.1]	42,255 (65.6) [65.3 - 66.0]
Hardly ever/Never	1,546 (42.4) [40.8 - 44.0]	7,770 (36.6) [36.0 - 37.3]	7,433 (29.7) [29.1 - 30.2]	3,744 (36.7) [35.8 - 37.6]	1,630 (38.4) [36.9 - 39.9]	22,123 (34.4) [34.0 - 34.7]
In your opinion, during the appointments, do the professionals of this team suggest solutions that are adequate to your reality?^* ***** N = 63,164 (96.6% of the interviewed patients).
Always/Usually	2,119 (60.1) [58.5 - 61.8]	13,892 (66.6) [66.0 - 67.3]	17,778 (72.4) [71.8 - 72.9]	7,328 (73.1) [72.2 - 74.0]	2,691 (64.0) [62.5 - 65.4]	43,808 (69.4) [69.0 - 69.7]
Hardly ever/Never	1,404 (39.9) [38.2 - 41.5]	6,957 (33.4) [32.7 - 34.0]	6,785 (27.6) [27.1 - 28.2]	2,694 (26.9) [26.0 - 27.8]	1,516 (36.0) [34.6 - 37.5]	19,356 (30.6) [30.3 - 31.0]

Variable	North n (%) [95%CI]	Northeast n (%) [95%CI]	Southeast n (%) [95%CI]	South n (%) [95%CI]	Central-West n (%) [95%CI]	Brazil n (%) [95%CI]
In this unit, are you treated by the same doctor?^* * N = 64,658 (98.9% of the interviewed patients);
Always/Usually	2,707 (73.0) [71.6 - 74.4]	17,656 (83.6) [83.1 - 84.1]	21,373 (84.7) [84.3 - 85.2]	8,387 (81.4) [80.6 - 82.1]	3,635 (84.5) [83.4 - 85.5.]	53,758 (83.1) [82.9 - 83.4]
Hardly ever/Never	1,000 (27.0) [25.6- 28.4]	3,460 (16.4) [15.9 - 16.9]	3,855 (15.3) [14.8 - 15.7]	1,917 (18.6) [17.9 - 19.4]	668 (15.5) [14.5 - 16.6]	10,900 (16.9) [16.6 - 17.1]
In this unit, are you assisted by the same nurse?^ N = 61,532 (94.1% of the interviewed patients);
Always/Usually	2,765 (76.2) [74.8 - 77.6]	17,640 (87.8) [87.3 - 88.3]	18,450 (77.2) [76.6 - 77.7]	7,047 (71.4) [70.5 - 72.3]	3,327 (82.4) [81.2 - 83.5]	49,229 (80.0) [79.7 - 80.3]
Hardly ever/Never	862 (23.8) [22.4 - 25.2]	2,449 (12.2) [11.7 - 12.7]	5,455 (22.8) [22.3 - 23.4]	2,826 (28.6) [27.7 -29.5]	711 (17.6) [16.5 - 18.8]	12,303 (20.0) [19.7 - 20.3]
Do the professionals remember what happened in your last appointments?
Yes	1,600 (44.2) [42.6 - 45.8]	9,781 (47.5) [46.8 - 48.2]	13,200 (54.3) [53.7 - 54.9]	4,949 (50.2) [49.2 - 51.2]	1,918 (46.4) [44.9 - 47.9]	31,448 (50.3) [49.9 - 50.7]
Yes, sometimes	518 (14.3) [13.2 - 15.5]	3,535 (17.2) [16.7 - 17.7]	3,869 (15.9) [15.5 - 16.4]	1,836 (18.6) [17.9 - 19.4]	596 (14.4) [13.3 - 15.5]	10,354 (16.6) [16.3 - 16.9]
No	1,501 (41.5) [39.9 - 43.1]	7,270 (35.3) [34.7 - 36]	7,230 (29.8) [29.2 - 30.3]	3,073 (31.2) [30.3 - 32.1]	1,622 (39.2) [37.7 - 40.7]	20,696 (33.1) [32.7 - 33.5]
When you need to ask questions after the appointment, is it easy to talk to the professionals that assisted you?^** ****** N = 64,895 (99.2% of the interviewed patients).
Always/Usually	1,395 (38) [36.4 - 39.5]	9,939 (46.4) [45.8 - 47.1]	12,115 (48) [47.4 - 48.6]	4,790 (46.5) [45.5 - 47.5]	1,673 (38.9) [37.4 - 40.4]	29,912 (46.1) [45.7 - 46.5]
Never	461 (12.5) [11.5 - 13.6]	1,973 (9.2) [8.8 - 9.6]	2,270 (9) [8.6 - 9.4]	956 (9.3) [8.7 - 9.8]	388 (9) [8.2 - 9.9]	6,048 (9.3) [9.1 - 9.5]
Did not have to ask questions	1,044 (28.4) [27 - 29.9]	5,828 (27.2) [26.6 - 27.8]	6,557 (26) [25.5 - 26.5]	2,659 (25.8) [25 - 26.7]	1,540 (35.8) [34.4 - 37.2]	17,628 (27.2) [26.8 - 27.5]

Variable	North n (%) [95%CI]	Northeast n (%) [95%CI]	Southeast n (%) [95%CI]	South n (%) [95%CI]	Central-West n (%) [95%CI]	Brazil n (%) [95%CI]
After you were treated by other professionals outside this health unit, did the team talked to you about this treatment?^* * N = 47,443 (72.6% of the interviewed patients) Does not know/Did not answer = 17,792 (27.2% of the interviewed patients);
Yes	796 (21.4) [20.1 - 22.7]	5,560 (25.9) [25.3 - 26.4]	8,341 (32.9) [32.3 - 33.5]	3,375 (32.7) [31.8 - 33.6]	1,006 (23.3) [22 - 24.5]	19,078 (29.2) [28.9 - 29.6]
Yes, sometimes	310 (8.3) [7.4 - 9.2]	1,983 (9.2) [8.8 - 9.6]	2,380 (9.4) [9 - 9.7]	1,208 (11.7) [11.1 - 12.3]	318 (7.4) [6.6 - 8.1]	6,199 (9.5) [9.3 - 9.7]
Never	1,309 (35.2) [33.6 - 36.7]	7,202 (33.5) [32.9 - 34.1]	8,645 (34.1) [33.5 - 34.7]	3,578 (34.6) [33.7 - 35.5]	1,432 (33.1) [31.7 - 34.5]	22,166 (34) [33.6 - 34.3]
Do you think it is easy to access your test results that arrive at this health unit?^ N = 65,229 (99.8% of the interviewed patients).
Yes	2,200 (59.1) [57.5 - 60.7]	12,399 (57.7) [57 - 58.3]	18,095 (71.4) [70.8 - 71.9]	7,393 (71.5) [70.7 - 72.4]	2,852 (66) [64.5 - 67.4]	42,939 (65.8) [65.5 - 66.2]
Yes, sometimes	576 (15.5) [14.3 - 16.6]	3,988 (18.6) [18 - 19.1]	3,400 (13.4) [13 - 13.8]	1,449 (14) [13.4 - 14.7]	643 (14.9) [13.8 - 15.9]	10,056 (15.4) [15.1 - 15.7]
Never	946 (25.4) [24 - 26.8]	5,111 (23.8) [23.2 - 24.3]	3,857 (15.2) [14.8 - 15.7]	1,491 (14.4) [13.8 - 15.1]	829 (19.2) [18 - 20.3]	12,234 (18.8) [18.5 - 19.1]

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[1] CORRESPONDING AUTHOR Helena Eri Shimizu E-mail: shimizu@unb.br