Avaliação da qualidade da assistência à saúde da criança na Atenção Primária à Saúde no município de Diamantina, Minas Gerais, Brasil

Abstract

OBJECTIVE: This study aim to analyze the degree of presence and extent of attributes of Primary Health Care in the health care of the child in the view of users and professionals working in the health services of the municipality of Diamantina. METHODOLOGY: This is a cross-sectional observational study carried out in the municipality of Diamantina located in the region of the Jequitinhonha Valley in the State of Minas Gerais, Brazil. The sample of users was composed of 707 children from 0 to 4 years old, 498 of the urban area and 209 of the rural area. Respondents were chosen by simple random draw based on Family Health Team (FHT) staff records. We interviewed 14 physicians and 8 nurses who met the inclusion criteria. For data collection, three instruments were used: a questionnaire to trace the profile of professionals and users; The Socioeconomic Evaluation Instrument of the Brazilian Association of Research Companies (ABEP); And the Primary care assessor tool (PCATool- Brazil), child and professionals versions. The analysis was based on the calculation on the calculation of the Primary Attention to Health (PSA) attributes scores proposed by PCATool, comparing the results of rural and urban areas and between professionals and users. The Mann-Whitney test was used to compare the results between urban and rural areas, and the multivariate logistic regression analysis was used to evaluate the influence of the explanatory variables on the occurrence of the general score lower than the cut-off index. RESULTS: The professionals interviewed were generally young, with a few graduate programs specific to PHC and with weak labor ties with the municipality. Among the users, the mothers were the main interviewees. The families were mostly low-income and dependent on income distribution programs, such as the Bolsa Família, and had the FHT as the main source of care for their children. The children had a mean age of 29.9±17.5 months; 51.6% of the female sex, 85.8% had any of the prevalent diseases of childhood, 22.1% had a history of hospitalization and 95.2% had a vaccination schedule. The results of the evaluation of the PSA attributes showed that there was a difference between the evaluations of the professionals and the users. Professionals tended to assign a strong degree of implantation to most attributes, with emphasis on the component of care coordination - information systems (8.9) and family orientation (8,9). As for users, PSA attributes scores are generally bellow the PCATool index, and only the coordination - information system (7.8) and first contact access utilization (6.8) reached the cutoff value. There was no statistically significant difference between the scores attributed by professionals to urban and rural services. In theopinion of the users, PHC tended to have significantly higher mean scores in the rural area. In the analysis of the factors associated with lower scores attributed by users to the care received by children in the urban and rural areas of the municipality, the results suggested that users who did not receive Bolsa Família (OR=1.6, CI=1.2-2,2), who lived in the urban area (OR=1.5, CI=1.1-2.1) and had no affiliation to FHT (OR=3.2, CI=2.1-5.1) had a greater chance of evaluate the services scores lower than the cut-off index, independently of other variables. CONCLUSION: the results of this research showed that the evaluation of the PHC for the care of the child of Diamantina coincides with the context of other studies carried out in Brazil. The evaluation of PHC is associated with aspects related to the characteristics of the users and the organization of services that still refer to the biomedical model of care, which mainly compromises access to services, the integrality of care and the lack of the family and community approach in the provision of services.