Estrutura das Unidades Básicas de Saúde e práticas integrativas e complementares em saúde: um estudo a partir do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ- AB – 2º Ciclo).

Abstract

Recently, the Brazilian Public Health System (SUS) has expanded the primary care offer. There is a significant increase in the Integrative and Complementary Practices in Primary Care. This research aimed at analyzing the association between the structure of Basic Health Units and the offer of Integrative and Complementary Practices (PICS) by the Primary Care Teams in Brazil. Through a cross-sectional study, 29,778 primary care teams participated in the second cycle of the Program for Improving Access and Quality in Primary Care PMAQ-AB in the years 2013-2014. In order to do so two typologies were elaborated: the PIC typology in the Basic Health Units, based on the supply and type of practices offered, and the type of structure of the units, based on structural, material and basic material. In order to estimate the association between the levels of the typology of structure and the typology of PIC supply, a Multinominal Logistic Regression with the sample structure in clusters was performed. Of the 29,778 teams evaluated, 5,666 (19.0%) offer PICS. Indeed, most of services that were better classified in structure are in the South region and they also demonstrated greater supply in all the levels of PICS, when compared to the other ones. It could be seen an association between the structure of the basic health units and the supply of PICS, once the teams of units with medium and high levels of structure demonstrated a chance of 2.34 and 16.23 times in offering the high level of PICS compared respectively. This association was maintained after adjustments by PMAQ-AB geographic / stratum regions. It was also noted that there is an association between Integrative and Complementary Practices and better structured health units. PICS go side by side with the improvements in quality and organization of APS. Thus, its implementation in the peripheral regions and desolate places of the country can happen continuously, to the extent that APS is homogeneously structuring itself and conquering better quality of the services.