Avaliação da Atenção Primária à Saúde em Belo Horizonte: a perspectiva dos usuários entrevistados por inquérito telefônico

Abstract

Introduction: Primary Health Care is considered a key element for a Health Care Network to become efficient. In Belo Horizonte, investments were made in expanding the Family Health Strategy seeking to qualify assistance and expand access. However, it is necessary to know the user's perception considering the attributes of Primary Health Care. Objective: To evaluate the performance of Primary Health Care services by the presence and extension of its attributes in the city of Belo Horizonte, from the users' perspective and its association with sociodemographic characteristics, self-reported conditions and behavioral risk factors for Chronic Non-Communicable Diseases. Method: This is a cross-sectional population-based study from the Vigitel 2015 telephone survey. The study population is adults (≥18 years old) residing in Belo Horizonte in households with at least one landline and who used some health service in last 12 months. In that year, Vigitel had an additional module on the evaluation of Primary Health Care (Vigitel evaluation module). 2,125 adults were interviewed, where 2,006 reported having sought some health service and 872 used the services of Primary Health Care. The calculation of the scores considered the data collected in the Vigitel evaluation module. Descriptive analysis of variables and Person's χ2 test were performed to identify associations, with a significance level of 5%. Initially, crude and adjusted Prevalence Ratios were calculated by education and skin color with 95% confidence intervals using the Poisson regression model with robust variance estimator in the analysis of associated factors. Subsequently, logistic regression was performed, which estimated the Odds Ratio. The analyzes were performed using the Survey module available in Data Analysis and Statistical Softwares (STATA) version 14.0 so that it was possible to incorporate the weighting of Vigitel data. Results: It was observed that the use of Primary Health Care was higher among respondents without health insurance (PR 1.76; 95% CI 1.55-1.99), with low education, that is, ≤8 years of study ( PR 1.59; 95% CI 1.35 - 1.87), followed by 9 to 11 years of study (PR 1.37; 95% CI 1.16 - 1.61) and women (PR 1.34; 95% CI) % 1.19 - 1.51). Respondents who reported alcohol abuse (PR 0.79; 95% CI 0.66 - 0.95) and in the 40-59 age group (PR 0.93; 95% CI 0.88 - 0.99) used minus Primary Health Care. The general score calculated with the data from the Vigitel evaluation module was 5.48 (95% CI 5.35 - 5.61) and considering the reduced PCATool items was 5.01 (95% CI 4.86 - 5.15). In both instruments, the scores for the attributes first contact (use), longitudinality and coordination (care) presented means higher than the general score with the highest value (5.48). In general, the evaluations of the instruments are coincident, however the attribute first contact (use) was the best evaluated by users considering the instrument of the module Vigitel Evaluation (7.09; 95% CI 6.93 - 7.26). There was no difference in the assessment according to Regional Health. The users who reported a high score (≥ 6.6) for the quality of PHC were users without health insurance with 3.21 more chances (95% CI 2.08 - 4.96) than adults with health insurance, also users with low education have 2.81 more chances (95% CI 1.48 - 5.32) than adults with higher education, diabetics have 1.84 more chances (95% CI 1, 05 - 3.24), the obese have 1.97 more chances (95% CI 1.20 -3.24), the elderly have 1.19 chances (95% CI 1.00 - 1.41) to report a high score for quality of PHC, than the others. Conclusion: The study innovates when using PCATool in a telephone survey and proved to be useful in evaluating the performance of Primary Health Care in the city of Belo Horizonte, from the perspective of users and its association with sociodemographic characteristics, self-reported conditions and behavioral risk factors. for NCDs. It proved to be an innovative form of assessment that can be replicated throughout the country, in addition to contributing to the management of services, as well as being of low cost and speed in the application of the instrument. As it is a tool used worldwide with different versions validated for local contexts, it allows comparability of findings.