Avaliação da integralidade em serviços de atenção primária à saúde nas regiões da 4ª Coordenadoria Regional de Saúde do Rio Grande do Sul

Abstract

The goal of the research was to evaluate the presence and extent of integrality in Primary Health Care services in municipalities of the 4th Regional Health Coordination and to identify possible associated factors. A mixed study with a sequential explanatory design was developed. Phase I (quantitative) was carried out in 2018 and phase II (qualitative) was carried out in 2020. In phase I, a cross-sectional descriptive evaluative design was used. Phase II had a descriptive qualitative design. Both stages were carried out with doctors and nurses from the Primary Health Care services. The quantitative sample consisted of 221 health professionals and the qualitative sample consisted of 24 professionals from the in the services that obtained an average greater than or equal to 6.6. Professionals working for at least six months in the services were included in both phases. In the phase I, interviews were carried out using the Primary Care Assessment Tool Professional Version, preceded by a questionnaire with the sociodemographic profile of the professionals, and in the phase II, discursive interviews were carried out. Data analysis: Phase I - For analysis, the arithmetic mean was used. The answers were converted into a Likert scale, according to the instrument's orientation. The presence and extent of integrality were considered in the services that obtained an average greater than or equal to 6.6. The Statistical Package for the Social Sciences (SPSS®) program, version 26.0 for Windows was used. To verify if there was an association between the scores of completeness and the variables, a Correspondence Analysis was used. In the Phase II- the Cardano’s method was used, which associates three steps for the analysis of empirical documentation: data segmentation, the qualification of all identified segments, and the individuation of the relationships between the attributes conferred on the various segments. The combination of methods occurred from the connection between the research stages and the integration of results and discussion. The ethical aspects of the research followed the guidelines contained in Resolution No. 466/12, No. 510/2016, and No. 580/2018 of the National Health Council. Phase I was evaluated by the Research Ethics Committee, obtaining approval under the number CAAE 34137314.4.0000. 5346. Phase II followed the same precepts and was approved under No. CAEE 40224820.0.0000.5346. Results Phase I: there is the presence of integrality in the services evaluated. The overall score for Available Services is 8.01 with a standard deviation of 1.25, and for Services Provided is 8.37 with a standard deviation of 1.22. A total of 216 healthcare professionals were interviewed. The Family Health Strategy model was associated with comprehensiveness scores. There was an association between the presence of the attribute and additional training, nurse training, sex, medical training, participation in team meetings, and hosting. Phase II: 18 health professionals were interviewed, n=8 physicians and n=10 nurses. The testimonies made it possible to identify convergence between the items best evaluated in both components. The infrastructure of the units and the lack of means of transport to carry out home visits emerged as weaknesses for integrality practices. It was concluded that the units and professionals are organized so that users have access to comprehensive care with actions aimed at promotion, prevention, cure, and rehabilitation.