Primary health care organization in municipalities of São Paulo, Brazil: a model of care aligned with the Brazilian Unified National Health System’s guidelines
Autor(a) principal: | |
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Data de Publicação: | 2024 |
Outros Autores: | , , , , , |
Tipo de documento: | Artigo |
Idioma: | por eng |
Título da fonte: | Cadernos de Saúde Pública |
Texto Completo: | https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8519 |
Resumo: | This study analyzes the main organization patterns used by primary health care (PHC) services in municipal networks and evaluates them according to indicators of local management-administration interface. Evaluative research analyzed 461 municipalities in São Paulo, Brazil, that participated in the Primary Care Services Quality Assessment Survey (QualiAB) in 2017/2018, classified according to the organizational arrangements composition of 2,472 PHC services. Eight indicators of local management and administration were selected to evaluate the identified patterns. Results indicate two groups of municipalities: homogeneous, with services presenting the same arrangement (43.6%); and heterogeneous, with different arrangements (56.4%). These were subdivided into seven patterns that ranged from homogeneous-traditional, homogeneous-Family Health Strategy, homogeneous-mixed, and different combinations in the heterogeneous group. All indicators showed significant differences between groups (p < 0.001), especially the homogeneous-traditional group, which presented an organizational pattern far from the desired model of a comprehensive and problem-solving PHC. Those integrated with family health units (FHU) and basic health units with community health workers and/or family health teams (BHU/FHU) showed a pattern closer to a comprehensive model – with planning and evaluation actions committed to the local reality and qualification of care. Implementation of federal and state policies are essential for defining the PHC health care model adopted by municipalities. |
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Primary health care organization in municipalities of São Paulo, Brazil: a model of care aligned with the Brazilian Unified National Health System’s guidelinesOrganización de la atención primaria de salud de municipios de São Paulo, Brasil: modelo de atención y coherencia con las directrices del Sistema Único de SaludOrganização da atenção primária à saúde de municípios de São Paulo, Brasil: modelo de atenção e coerência com as diretrizes do Sistema Único de SaúdeAtenção Primária à Saúde; Modelos de Assistência à Saúde; Avaliação de Serviços de Saúde; Organização e AdministraçãoAtención Primaria de Salud; Modelos de Atención de Salud; Evaluación de Servicios de Salud; Organización y AdministraciónPrimary Health Care; Healthcare Models; Health Services Evaluation; Organization and AdministrationThis study analyzes the main organization patterns used by primary health care (PHC) services in municipal networks and evaluates them according to indicators of local management-administration interface. Evaluative research analyzed 461 municipalities in São Paulo, Brazil, that participated in the Primary Care Services Quality Assessment Survey (QualiAB) in 2017/2018, classified according to the organizational arrangements composition of 2,472 PHC services. Eight indicators of local management and administration were selected to evaluate the identified patterns. Results indicate two groups of municipalities: homogeneous, with services presenting the same arrangement (43.6%); and heterogeneous, with different arrangements (56.4%). These were subdivided into seven patterns that ranged from homogeneous-traditional, homogeneous-Family Health Strategy, homogeneous-mixed, and different combinations in the heterogeneous group. All indicators showed significant differences between groups (p < 0.001), especially the homogeneous-traditional group, which presented an organizational pattern far from the desired model of a comprehensive and problem-solving PHC. Those integrated with family health units (FHU) and basic health units with community health workers and/or family health teams (BHU/FHU) showed a pattern closer to a comprehensive model – with planning and evaluation actions committed to the local reality and qualification of care. Implementation of federal and state policies are essential for defining the PHC health care model adopted by municipalities.El trabajo tiene el objetivo de analizar los principales patrones de organización de las redes municipales de servicios de atención primaria de salud (APS) y evaluarlos conforme los indicadores de interfaz entre la dirección y gestión local. Se trata de una investigación evaluativa que analizó 461 municipios de São Paulo, Brasil, que participaron de la Encuesta de Evaluación de la Calidad de los Servicios de Atención Primaria (QualiAB) en 2017/2018, clasificados según la composición de los arreglos organizativos de 2.472 servicios de APS. Para evaluar los patrones identificados, se seleccionaron ocho indicadores de dirección y gestión local. Los resultados indican dos grupos de municipios: homogéneos, con servicios de un mismo arreglo (43,6%) e heterogéneos, con arreglos diferentes (56,4%). Los grupos se subdividieron en siete patrones que iban desde homogéneo-tradicional, homogéneo-Estrategia de Salud de la Familia, homogéneo-mixto y diferentes combinaciones en el grupo heterogéneo. Todos los indicadores señalaron diferencias significativas entre los grupos (p < 0,001), con destaque para el grupo homogéneo-tradicional, con patrón organizativo alejado del modelo deseado para una APS completa y resolutiva, mientras aquellos con unidades de salud de la familia (USF), y con unidades básicas con agentes comunitarios de salud y/o equipos de salud de la familia (UBS/USF) demostraron un patrón más cercano a este modelo -con acciones de planificación y evaluación comprometidas con la realidad local y con la calificación del trabajo. Se discute la importancia de las políticas implementadas por la gestión federal y la gestión estatal y su poder de inducción para definir el modelo de atención a la salud en la APS de los municipios.Este trabalho tem como objetivo analisar os principais padrões de organização das redes municipais de serviços de atenção primária à saúde (APS) e avaliá-los segundo os indicadores de interface entre gestão e gerenciamento local. Trata-se de pesquisa avaliativa que analisou 461 municípios de São Paulo, Brasil, que participaram do Inquérito de Avaliação da Qualidade de Serviços de Atenção Básica (QualiAB) em 2017/2018, classificados segundo a composição dos arranjos organizacionais de 2.472 serviços de APS. Para avaliar os padrões identificados, foram selecionados oito indicadores de gestão e gerenciamento local. Os resultados apontam dois grupos de municípios: homogêneos, com serviços de um mesmo arranjo (43,6%); e heterogêneos, com diferentes arranjos (56,4%). Os grupos foram subdivididos em sete padrões que variaram entre homogêneo-tradicional, homogêneo-Estratégia Saúde da Família, homogêneo-misto e diferentes combinações no grupo heterogêneo. Todos os indicadores apontaram diferenças significativas entre os grupos (p < 0,001), com destaque para o grupo homogêneo-tradicional, com padrão organizacional distante do modelo desejado para uma APS abrangente e resolutiva, enquanto aqueles com unidades de saúde da família (USF), e com unidades básicas com agentes comunitários de saúde e/ou equipes de saúde da família (UBS/USF) demonstraram um padrão mais aproximado desse modelo – com ações de planejamento e avaliação comprometidos com a realidade local e com a qualificação do trabalho. Discute-se a importância das políticas implementadas pela gestão federal e estadual e seu poder de indução na definição do modelo de atenção à saúde na APS dos municípios.Reports in Public HealthCadernos de Saúde Pública2024-02-23info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdftext/xmlhttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8519Reports in Public Health; Vol. 40 No. 2 (2024): FebruaryCadernos de Saúde Pública; v. 40 n. 2 (2024): Fevereiro1678-44640102-311Xreponame:Cadernos de Saúde Públicainstname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZporenghttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8519/18995https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8519/18996https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8519/18997Copyright (c) 2024 Cadernos de Saúde Públicainfo:eu-repo/semantics/openAccessRose Lodeiro Castanheira, ElenSchiavon Duarte, LígiaMartins de Oliveira Viana, MônicaOlívia Nunes, LuceimeFernanda Tortorelli Zarili, ThaisSiqueira Mendonça, CarolinaRodrigues Sanine, Patricia2024-02-23T13:31:39Zoai:ojs.teste-cadernos.ensp.fiocruz.br:article/8519Revistahttps://cadernos.ensp.fiocruz.br/ojs/index.php/csphttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/oaicadernos@ensp.fiocruz.br||cadernos@ensp.fiocruz.br1678-44640102-311Xopendoar:2024-03-06T13:09:42.342484Cadernos de Saúde Pública - Fundação Oswaldo Cruz (FIOCRUZ)true |
dc.title.none.fl_str_mv |
Primary health care organization in municipalities of São Paulo, Brazil: a model of care aligned with the Brazilian Unified National Health System’s guidelines Organización de la atención primaria de salud de municipios de São Paulo, Brasil: modelo de atención y coherencia con las directrices del Sistema Único de Salud Organização da atenção primária à saúde de municípios de São Paulo, Brasil: modelo de atenção e coerência com as diretrizes do Sistema Único de Saúde |
title |
Primary health care organization in municipalities of São Paulo, Brazil: a model of care aligned with the Brazilian Unified National Health System’s guidelines |
spellingShingle |
Primary health care organization in municipalities of São Paulo, Brazil: a model of care aligned with the Brazilian Unified National Health System’s guidelines Rose Lodeiro Castanheira, Elen Atenção Primária à Saúde; Modelos de Assistência à Saúde; Avaliação de Serviços de Saúde; Organização e Administração Atención Primaria de Salud; Modelos de Atención de Salud; Evaluación de Servicios de Salud; Organización y Administración Primary Health Care; Healthcare Models; Health Services Evaluation; Organization and Administration |
title_short |
Primary health care organization in municipalities of São Paulo, Brazil: a model of care aligned with the Brazilian Unified National Health System’s guidelines |
title_full |
Primary health care organization in municipalities of São Paulo, Brazil: a model of care aligned with the Brazilian Unified National Health System’s guidelines |
title_fullStr |
Primary health care organization in municipalities of São Paulo, Brazil: a model of care aligned with the Brazilian Unified National Health System’s guidelines |
title_full_unstemmed |
Primary health care organization in municipalities of São Paulo, Brazil: a model of care aligned with the Brazilian Unified National Health System’s guidelines |
title_sort |
Primary health care organization in municipalities of São Paulo, Brazil: a model of care aligned with the Brazilian Unified National Health System’s guidelines |
author |
Rose Lodeiro Castanheira, Elen |
author_facet |
Rose Lodeiro Castanheira, Elen Schiavon Duarte, Lígia Martins de Oliveira Viana, Mônica Olívia Nunes, Luceime Fernanda Tortorelli Zarili, Thais Siqueira Mendonça, Carolina Rodrigues Sanine, Patricia |
author_role |
author |
author2 |
Schiavon Duarte, Lígia Martins de Oliveira Viana, Mônica Olívia Nunes, Luceime Fernanda Tortorelli Zarili, Thais Siqueira Mendonça, Carolina Rodrigues Sanine, Patricia |
author2_role |
author author author author author author |
dc.contributor.author.fl_str_mv |
Rose Lodeiro Castanheira, Elen Schiavon Duarte, Lígia Martins de Oliveira Viana, Mônica Olívia Nunes, Luceime Fernanda Tortorelli Zarili, Thais Siqueira Mendonça, Carolina Rodrigues Sanine, Patricia |
dc.subject.por.fl_str_mv |
Atenção Primária à Saúde; Modelos de Assistência à Saúde; Avaliação de Serviços de Saúde; Organização e Administração Atención Primaria de Salud; Modelos de Atención de Salud; Evaluación de Servicios de Salud; Organización y Administración Primary Health Care; Healthcare Models; Health Services Evaluation; Organization and Administration |
topic |
Atenção Primária à Saúde; Modelos de Assistência à Saúde; Avaliação de Serviços de Saúde; Organização e Administração Atención Primaria de Salud; Modelos de Atención de Salud; Evaluación de Servicios de Salud; Organización y Administración Primary Health Care; Healthcare Models; Health Services Evaluation; Organization and Administration |
description |
This study analyzes the main organization patterns used by primary health care (PHC) services in municipal networks and evaluates them according to indicators of local management-administration interface. Evaluative research analyzed 461 municipalities in São Paulo, Brazil, that participated in the Primary Care Services Quality Assessment Survey (QualiAB) in 2017/2018, classified according to the organizational arrangements composition of 2,472 PHC services. Eight indicators of local management and administration were selected to evaluate the identified patterns. Results indicate two groups of municipalities: homogeneous, with services presenting the same arrangement (43.6%); and heterogeneous, with different arrangements (56.4%). These were subdivided into seven patterns that ranged from homogeneous-traditional, homogeneous-Family Health Strategy, homogeneous-mixed, and different combinations in the heterogeneous group. All indicators showed significant differences between groups (p < 0.001), especially the homogeneous-traditional group, which presented an organizational pattern far from the desired model of a comprehensive and problem-solving PHC. Those integrated with family health units (FHU) and basic health units with community health workers and/or family health teams (BHU/FHU) showed a pattern closer to a comprehensive model – with planning and evaluation actions committed to the local reality and qualification of care. Implementation of federal and state policies are essential for defining the PHC health care model adopted by municipalities. |
publishDate |
2024 |
dc.date.none.fl_str_mv |
2024-02-23 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8519 |
url |
https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8519 |
dc.language.iso.fl_str_mv |
por eng |
language |
por eng |
dc.relation.none.fl_str_mv |
https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8519/18995 https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8519/18996 https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8519/18997 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2024 Cadernos de Saúde Pública info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2024 Cadernos de Saúde Pública |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf application/pdf text/xml |
dc.publisher.none.fl_str_mv |
Reports in Public Health Cadernos de Saúde Pública |
publisher.none.fl_str_mv |
Reports in Public Health Cadernos de Saúde Pública |
dc.source.none.fl_str_mv |
Reports in Public Health; Vol. 40 No. 2 (2024): February Cadernos de Saúde Pública; v. 40 n. 2 (2024): Fevereiro 1678-4464 0102-311X reponame:Cadernos de Saúde Pública instname:Fundação Oswaldo Cruz (FIOCRUZ) instacron:FIOCRUZ |
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Fundação Oswaldo Cruz (FIOCRUZ) |
instacron_str |
FIOCRUZ |
institution |
FIOCRUZ |
reponame_str |
Cadernos de Saúde Pública |
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Cadernos de Saúde Pública |
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Cadernos de Saúde Pública - Fundação Oswaldo Cruz (FIOCRUZ) |
repository.mail.fl_str_mv |
cadernos@ensp.fiocruz.br||cadernos@ensp.fiocruz.br |
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1798943400182939648 |