Qualidade do cuidado na perspectiva das Equipes de Saúde da Família e dos usuários: uma análise considerando o contexto socioeconômico.

Abstract

Introduction: In order to strengthen Primary Health Care (PHC), it is important to create mechanisms to evaluate the services offered. With this intent, the Ministry of Health created in 2011 a Program for Improving Access and Quality of Primary Care (PMAQ-AB). This program has its main objective to expand access and improve the quality of PHC, also having the user as its ultimate purpose. User satisfaction can be influenced by several factors. Among these, socioeconomic factors are not yet fully established in the literature. Objective: Verify the association between the quality of care in PHC from the perspective of family health teams (FHT), users and the Social Vulnerability Index (SVI). Methodology: Cross-sectional study that used secondary data obtained from the 2nd cycle of PMAQ-AB, related to the External Evaluation part. In the first stage of the study, the identification and descriptive analysis of similar variables between modules I and II with module III and the variables identified as very related to user satisfaction with Dimensions II and IV. The variables were summed by thematic block, creating categorized Quality Scores. The existing correlation per block was also verified. In the 2nd stage, the sample was selected through the municipalities that had representativeness of the users surveyed (CI = 90%) and who had adherence greater than 80% of the FHT (n = 106). The analysis of the quality of care was performed from the perspective of the FHT and the users, and the existing correlation was also observed. The 3rd stage, which used the same sample from the previous stage, had as independent variable the SVI. The influence of SVI on the quality of care according to the FHT and users was verified. This influence was measured by association analysis. Results: All correlation analyzes in the 1st and 2nd stage were significant and positive (p-value <0.001). In the second stage, the data indicate that for most of the FHT, of the evaluated municipalities, the quality of care is considered average (71.7%), users showed to be more demanding, and the high prevalence (92.5%) portrayed the quality as low. In the 3rd stage, most municipalities were classified as medium/high quality for Dimensions I and IV and low quality for Dimensions II and III. The “User Satisfaction Index” was considered for most (67%) users as medium/high quality. Some associations were considered significant: Dimension I and Region (p = 0.020), Dimension III and PHC Coverage (p = 0.039) and Region (p = 0.037), quality of care from the perspective of FHT and SVI (p = 0.031) and user satisfaction and the SVI (p = 0.047) and Region (p = 0.014). Discussion: This study showed that there is a disparity in the assessment of the quality of care offered by FHT and the perception of this care by users. Users point out the problems that exist in the work process of the FHT, but are considered satisfied. There is a tendency for increase satisfaction when care is improved. The association of the quality of care from the perspective of the FHT showed that teams from municipalities with low rates of SVI seem to have better quality when compared with municipalities with high SVI. Users who live in municipalities considered more vulnerable, rank worse the quality of care. Individuals living in municipalities with medium and low SVI were more satisfied. Final Considerations: The study allowed a global and generalized analysis of the perception of professionals and users. The small amount of national studies on the subject guarantees the relevance of the findings. The differences found between the socioeconomic and sociogeographic context reinforce the inequalities present in Brazil.