Avaliação do desempenho da atenção primária à saúde e associação com características sociodemográficas, comorbidades, estado de saúde, estilo de vida e uso dos serviços de saúde no Brasil, Pesquisa Nacional de Saúde 2019.

Abstract

Objective: To evaluate the performance of Primary Health Care (PHC) in Brazil, through its attributes, from the perspective of users and their association with sociodemographic characteristics, comorbidities, health condition, lifestyle, and use of health services, and to characterize individuals who use public PHC services. Methods: Cross-sectional study with data from the 2019 National Health Survey, in which 9,562 adults responded to the Primary Care Assessment Tool (PCATool). For the evaluation of the PHC, the score values were standardized for a scale from 0 to 10, where values equal to or greater than 6.6 were considered as high score, with strong orientation to the attributes of PHC. The PHC assessment was stratified according to sociodemographic information. The association between high PHC assessment (overall score ≥6.6) and individual characteristics was assessed, using crude prevalence ratios (PR) and ratio adjusted for sex and age, calculated by Poisson regression. Results: The study found that women, people aged 40 to 59 years, individuals with no education or with incomplete primary education and brown people are the users who most frequent public PHC and that only 38% (CI 95% 36.2- 39.9) of Brazilians rated better scores for PHC. Regarding the association of sociodemographic variables with high PHC assessment, the best PHC assessments were made by women [RPaj 1.10 (95% confidence interval — 95%CI 1.00–1.21) ]; elderly users (aged 60 years and over) [RPaj 1.27 (95%CI 1.09–1.48)]; people with a per capita income of 1 to 3 minimum wages (MW) [RPaj 1.14 (95%CI 1.03–1.27)] and ≥5 MW [RPaj 1.75 (95%CI 1.39–2.21 )] when comparing with income up to 1 SM; residents of the South, Southeast and Midwest regions compared to the North Region. Considering comorbidities, individuals with hypertension [RPaj 1.29 (95%CI 1.17–1.43)]; diabetes [RPaj 1.21 (95%CI 1.08–1.36)]; heart disease [RPaj 1.23 (95%CI 1.07–1.41)]; musculoskeletal disorder [RPaj 1.36 (95%CI 1.10–1.69)]; lung disease [RPaj 1.48 (95%CI 1.13–1.95)] and obesity [RPaj 1.15 (95%CI 1.03–1.28)] compared with eutrophic people, evaluated PHC well. Regarding the association of high PHC scores and the explanatory variables, it was found that individuals who use the same health service [RPaj= 1.34 (95%CI 1.14-1.56)], those who sought care at a health service in the last two weeks before the interview [(RPaj= 1.17 (95%CI 1.06-1.28)] and people who were hospitalized in the last 12 months [(RPaj= 1.19 (95%CI 1.03-1.37)] rated APS better. Considering the association of lifestyle variables with a high APS rating, it was found that individuals who consume fruits and vegetables (FV) [RPaj 1.21 (95%CI 1.09-1.35)] and smokers [RPaj 1.16 (95%CI 1.02-1.32)], better evaluated PHC. Conclusion: Users who evaluated the PHC well are women, elderly, with high prevalence of chronic non-communicable diseases, who have the habit of smoking and consuming FV and the individuals who most sought or used health services, that is, better evaluation of PHC, in general, results from the higher use of health services. From the perspective of the users, the satisfactory evaluation of the PHS occurred in about 40% of its users.