Essential attributes and qualifiers of primary health care - doi:10.5020/18061230.2012.p3

Detalhes bibliográficos
Autor(a) principal: Aguiar, Andréa Sílvia Walter de
Data de Publicação: 2012
Outros Autores: Martins, Pollyanna
Tipo de documento: Artigo
Idioma: por
eng
Título da fonte: Revista Brasileira em Promoção da Saúde
Texto Completo: https://ojs.unifor.br/RBPS/article/view/2237
Resumo: Historically, the primary health care (PHC) has been associated with the first level of care from a health system and characterized by the kind of professional that in it operates, where is expected a predominance of specialists in this area. However, the major limitation for this type of characterization is that the profile of professionals engaged in this service may vary from country to country. Several theoretical and conceptual landmarks proposed approaches and indicators to assess and characterize the APS. In 1978, the American Institute of Medicine suggested an approach in which listed its attributes such as accessibility, integrality, coordination, continuity and responsibility. This was an important landmark in an attempt to outline a normative approach to measure it. However, most indicators and specific definition was not suggested. The selected indicators required a high level of performance, were difficult to be achieved, and focused on the capacity of services and not in its concrete realization(1).A 1996 report, from the same institution, defined PHC as the provision of integrated services and accessible by clinicians who are responsible for attending a large majority of personal care needs, developing a continued partnership with patients and working within family and community. This definition does not include the first contact and focuses on individual attention.The Canadian Medical Association, in 1996, considered the APS as a front door of the health system and community interventions included in the definition of the functions of APS. In the same year was published a Charter for General Practice / Family Medicine in Europe (Letter to General Practice / Family Medicinein Europe), which describes 12 characteristics: general, accessible, integrated,continuous, as a team, holistic, personalized, targeted for the family and the community, coordinated, confidential and protectress(2).Donabedian(3) systematized a group of important variables that can assess the quality of a system or health service and rated according to their characteristics in structure, process and outcome. The evaluation of the process includes the quality of services provided by health professionals individually or in groups and refer to professional qualifications, organization and coordination of the work process of teams. The evaluation of the structure includes environmental conditions and equipment in which the services are provided and the results are evaluated starting from the verification of changes in health status of a population that can be attributed to the care process. Among the theoretical and conceptual landmarks of the PHC highlights the publication “Primary Care: Balancing Health Needs, Services, and Technology”, by Professor Barbara Starfield, in 1998, translated into Portuguese and published in Brazil in 2002. The book provides evidence on the role of PHC in health systems, evidence of its impact on population health, and compares the cost-effectiveness between countries with different forms and different degrees of implementation of this strategy, and propose a structure for measure it and set its attributes(1). The views of PHC, centered in the individual and in the population, provided the normative basis for evaluating it in a health system and contributed to the construction of the evaluation framework proposed by Starfield(1).The author also proposed a framework for evaluating the PHC which considered the concepts of the essential attributes and derivative measures of structure (capacity) and process (performance).The essential and exclusive attributes of the PHC include: access / care on first contact, longitudinality, integrality and coordination of care. A high level of reach of essential attributes of the PHC results in three additional aspects, denominated derivatives, which qualify the actions and services at this level of care(1,4).The aspects qualifiers are: centered on the family, cultural competence and community orientation. In most countries, nor centered on the family nor the community orientation are systems focus. The community orientation is an ideal rather than a reality(1,4).The National Primary Care Policy points out, in its guidelines, the universal and continuing access to health care quality and resolute, featuring primary care as the entry door and preferred care network. This care network should embrace users and promote linking and co-responsibility for the attention to their health needs(5). In the current issue of Brazilian Journal of Health Promotion, the reader can look into the User of the Family Health Strategy: knowledge and satisfaction with embracement, which contains important information that demonstrate mechanisms to ensure accessibility and embracement, from the comprehension of the user. Among the strategies for the development of integrality and coordinated care, now are exalted communities of practice, in which groups are formed around the practice of profession, linked from the need to share experiences so that knowledge can be collective(6). Articles “Community of practice as way of collective learning” and “Development of practices and knowledge in the Family Health Strategy: theoretical study” emphasize the learning derived from the exchange of experiences, sharing of meanings, observations, reflections on PHC.
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spelling Essential attributes and qualifiers of primary health care - doi:10.5020/18061230.2012.p3Atributos essenciais e qualificadores da atenção primária a saúde - doi:10.5020/18061230.2012.s1qualifiers of primary health careatenção primária a saúdeHistorically, the primary health care (PHC) has been associated with the first level of care from a health system and characterized by the kind of professional that in it operates, where is expected a predominance of specialists in this area. However, the major limitation for this type of characterization is that the profile of professionals engaged in this service may vary from country to country. Several theoretical and conceptual landmarks proposed approaches and indicators to assess and characterize the APS. In 1978, the American Institute of Medicine suggested an approach in which listed its attributes such as accessibility, integrality, coordination, continuity and responsibility. This was an important landmark in an attempt to outline a normative approach to measure it. However, most indicators and specific definition was not suggested. The selected indicators required a high level of performance, were difficult to be achieved, and focused on the capacity of services and not in its concrete realization(1).A 1996 report, from the same institution, defined PHC as the provision of integrated services and accessible by clinicians who are responsible for attending a large majority of personal care needs, developing a continued partnership with patients and working within family and community. This definition does not include the first contact and focuses on individual attention.The Canadian Medical Association, in 1996, considered the APS as a front door of the health system and community interventions included in the definition of the functions of APS. In the same year was published a Charter for General Practice / Family Medicine in Europe (Letter to General Practice / Family Medicinein Europe), which describes 12 characteristics: general, accessible, integrated,continuous, as a team, holistic, personalized, targeted for the family and the community, coordinated, confidential and protectress(2).Donabedian(3) systematized a group of important variables that can assess the quality of a system or health service and rated according to their characteristics in structure, process and outcome. The evaluation of the process includes the quality of services provided by health professionals individually or in groups and refer to professional qualifications, organization and coordination of the work process of teams. The evaluation of the structure includes environmental conditions and equipment in which the services are provided and the results are evaluated starting from the verification of changes in health status of a population that can be attributed to the care process. Among the theoretical and conceptual landmarks of the PHC highlights the publication “Primary Care: Balancing Health Needs, Services, and Technology”, by Professor Barbara Starfield, in 1998, translated into Portuguese and published in Brazil in 2002. The book provides evidence on the role of PHC in health systems, evidence of its impact on population health, and compares the cost-effectiveness between countries with different forms and different degrees of implementation of this strategy, and propose a structure for measure it and set its attributes(1). The views of PHC, centered in the individual and in the population, provided the normative basis for evaluating it in a health system and contributed to the construction of the evaluation framework proposed by Starfield(1).The author also proposed a framework for evaluating the PHC which considered the concepts of the essential attributes and derivative measures of structure (capacity) and process (performance).The essential and exclusive attributes of the PHC include: access / care on first contact, longitudinality, integrality and coordination of care. A high level of reach of essential attributes of the PHC results in three additional aspects, denominated derivatives, which qualify the actions and services at this level of care(1,4).The aspects qualifiers are: centered on the family, cultural competence and community orientation. In most countries, nor centered on the family nor the community orientation are systems focus. The community orientation is an ideal rather than a reality(1,4).The National Primary Care Policy points out, in its guidelines, the universal and continuing access to health care quality and resolute, featuring primary care as the entry door and preferred care network. This care network should embrace users and promote linking and co-responsibility for the attention to their health needs(5). In the current issue of Brazilian Journal of Health Promotion, the reader can look into the User of the Family Health Strategy: knowledge and satisfaction with embracement, which contains important information that demonstrate mechanisms to ensure accessibility and embracement, from the comprehension of the user. Among the strategies for the development of integrality and coordinated care, now are exalted communities of practice, in which groups are formed around the practice of profession, linked from the need to share experiences so that knowledge can be collective(6). Articles “Community of practice as way of collective learning” and “Development of practices and knowledge in the Family Health Strategy: theoretical study” emphasize the learning derived from the exchange of experiences, sharing of meanings, observations, reflections on PHC.Historicamente, a atenção primária à saúde (APS) tem sido associada ao primeiro nível de atenção de um sistema de saúde e caracterizada pelo tipo de profissional que nela atua, em que se espera que haja predominância de especialistas nessa área. Entretanto, a maior limitação para esse tipo de caracterização é que o perfil de profissionais que atuam nesse serviço pode variar de país para país.Diversos marcos teórico-conceituais propuseram abordagens e indicadores para avaliar e caracterizar a APS. Em 1978, o Institute of Medicine American sugeriu uma abordagem em que listou seus atributos como: acessibilidade, integralidade, coordenação, continuidade e responsabilidade. Este foi um marco importante na tentativa de delinear um método normativo para medi-la. Contudo, a maioria dos indicadores e definições sugeridas não era específica. Os indicadores selecionados exigiam um alto nível de desempenho e eram difíceis de serem atingidos, e centravam-se na capacidade instalada de serviços e não na sua realização concreta(1).Um relatório de 1996, da mesma instituição, definiu a APS como a oferta de serviços integrados e acessíveis por meio de clínicos que sejam responsáveis por atender a uma grande maioria de necessidades pessoais de atenção desenvolvendo uma parceria constante com os pacientes e trabalhando no contexto da família e da comunidade. Essa definição não inclui o primeiro contato e enfoca a atenção individual.A Associação Médica Canadense, em 1996, considerou a APS como porta de entrada do sistema de saúde e incluiu intervenções comunitárias na definição das funções da APS. No mesmo ano foi divulgada a Charter for General Practice/ Family Medicine in Europe (Carta para Clínica Geral/Medicina de Família na Europa) que descreve 12 características: geral, acessível, integrada, continuada, em equipe, holística, personalizada, orientada para a família e para comunidade, coordenada, confidencial e defensora(2).Donabedian(3) sistematizou um conjunto de variáveis importantes que podem avaliar a qualidade de um sistema ou serviço de saúde e classificou de acordo com suas características em estrutura, processo e resultado. A avaliação do processo inclui a qualidade dos serviços prestados pelos profissionais de saúde individualmente ou em grupo e referem-se à qualificaçãoprofissional, organização e coordenação do processo de trabalho das equipes. A avaliação da estrutura abrange as condições do ambiente e equipamentos em que os serviços são prestados e os resultados são avaliados a partir da verificação de mudanças no estado de saúde de uma população que possam ser atribuídos ao processo de cuidado.Entre os marcos teórico-conceituais da APS destaca-se a publicação “PrimaryCare: Balancing Health Needs, Services, and Technology”, da Professora Barbara Starfield, em 1998, traduzido para língua portuguesa e publicada no Brasil em 2002. O livro traz evidências sobre o papel da APS nos sistemas de saúde, evidências científicas dos seus impactos na saúde da população e compara o custo benefício entre países com diferentes formas e em diferentes graus de implantação dessa estratégia, além de propor uma estrutura para mensura-la e definir seus atributos(1).As visões de APS, centrada no indivíduo e na população, ofereceram a base normativa para avalia-la dentro de um sistema de saúde e colaboraram na construção da estrutura de avaliação proposta por Starfield (1).A autora, ainda, propôs uma estrutura para avaliação da APS que considerou os conceitos dos atributos essenciais e derivativos em medidas de estrutura (capacidade) e processo (desempenho).Os atributos essenciais e exclusivos da APS compreendem: acesso/atenção ao primeiro contato,longitudinalidade, integralidade e coordenação do cuidado. Um alto nível de alcance dos atributos essenciais da APS resulta em três aspectos adicionais denominados aspectos derivativos, os quais qualificam as ações e serviços deste nível de atenção(1,4).Os aspectos qualificadores são centralização na família, competência cultural e orientação comunitária.Na maioria dos países nem a centralização na família, nem a orientação para a comunidade são um enfoque dos sistemas. A orientação para a comunidade é um ideal, mais do que uma realidade(1,4).A Política Nacional de Atenção Básica aponta em suas diretrizes, o acesso universal e contínuo a serviços de saúde de qualidade e resolutivos, caracterizando a Atenção Básica como a porta de entrada aberta e preferencial da rede de atenção. Esta rede de atenção deverá acolher usuários e promover a vinculação e corresponsabilização pela atenção às suas necessidades de saúde(5). No atual número da Revista Brasileira em Promoção da Saúde o leitor poderá se debruçar sobre o artigo Usuário da Estratégia de Saúde da Família: conhecimento e satisfação sobre acolhimento traz informações importantes que demonstram os mecanismos que assegurem a acessibilidade e acolhimento a partir da compreensão do usuário.Dentre as estratégias para o desenvolvimento da integralidade e coordenação do cuidado, atualmente se exalta as comunidades de práticas, em que são grupos formados em torno da prática da profissão, ligados a partir da necessidade de (com)partilhamento de experiências e assim o conhecimento possa ser coletivo(6). Os artigos Comunidade de prática enquanto modo coletivo de aprendizagem e desenvolvimento de práticas e saberes na Estratégia Saúde da Família: um estudo teórico ressaltam a aprendizagem derivada da troca de experiências, do compartilhamento de significados, observações, reflexões na APS.Universidade de Fortaleza2012-11-27info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion"Non-refereed Book Review""Artigo não avaliado pelos pares"application/pdfapplication/pdfhttps://ojs.unifor.br/RBPS/article/view/223710.5020/2237Brazilian Journal in Health Promotion; Vol. 25 No. 2 Sup (2012); 1-4Revista Brasileña en Promoción de la Salud; Vol. 25 Núm. 2 Sup (2012); 1-4Revista Brasileira em Promoção da Saúde; v. 25 n. 2 Sup (2012); 1-41806-1230reponame:Revista Brasileira em Promoção da Saúdeinstname:Universidade de Fortaleza (Unifor)instacron:UFORporenghttps://ojs.unifor.br/RBPS/article/view/2237/2462https://ojs.unifor.br/RBPS/article/view/2237/2463Aguiar, Andréa Sílvia Walter deMartins, Pollyannainfo:eu-repo/semantics/openAccess2012-11-28T11:07:07Zoai:ojs.ojs.unifor.br:article/2237Revistahttps://periodicos.unifor.br/RBPS/oai1806-12301806-1222opendoar:2012-11-28T11:07:07Revista Brasileira em Promoção da Saúde - Universidade de Fortaleza (Unifor)false
dc.title.none.fl_str_mv Essential attributes and qualifiers of primary health care - doi:10.5020/18061230.2012.p3
Atributos essenciais e qualificadores da atenção primária a saúde - doi:10.5020/18061230.2012.s1
title Essential attributes and qualifiers of primary health care - doi:10.5020/18061230.2012.p3
spellingShingle Essential attributes and qualifiers of primary health care - doi:10.5020/18061230.2012.p3
Aguiar, Andréa Sílvia Walter de
qualifiers of primary health care
atenção primária a saúde
title_short Essential attributes and qualifiers of primary health care - doi:10.5020/18061230.2012.p3
title_full Essential attributes and qualifiers of primary health care - doi:10.5020/18061230.2012.p3
title_fullStr Essential attributes and qualifiers of primary health care - doi:10.5020/18061230.2012.p3
title_full_unstemmed Essential attributes and qualifiers of primary health care - doi:10.5020/18061230.2012.p3
title_sort Essential attributes and qualifiers of primary health care - doi:10.5020/18061230.2012.p3
author Aguiar, Andréa Sílvia Walter de
author_facet Aguiar, Andréa Sílvia Walter de
Martins, Pollyanna
author_role author
author2 Martins, Pollyanna
author2_role author
dc.contributor.author.fl_str_mv Aguiar, Andréa Sílvia Walter de
Martins, Pollyanna
dc.subject.por.fl_str_mv qualifiers of primary health care
atenção primária a saúde
topic qualifiers of primary health care
atenção primária a saúde
description Historically, the primary health care (PHC) has been associated with the first level of care from a health system and characterized by the kind of professional that in it operates, where is expected a predominance of specialists in this area. However, the major limitation for this type of characterization is that the profile of professionals engaged in this service may vary from country to country. Several theoretical and conceptual landmarks proposed approaches and indicators to assess and characterize the APS. In 1978, the American Institute of Medicine suggested an approach in which listed its attributes such as accessibility, integrality, coordination, continuity and responsibility. This was an important landmark in an attempt to outline a normative approach to measure it. However, most indicators and specific definition was not suggested. The selected indicators required a high level of performance, were difficult to be achieved, and focused on the capacity of services and not in its concrete realization(1).A 1996 report, from the same institution, defined PHC as the provision of integrated services and accessible by clinicians who are responsible for attending a large majority of personal care needs, developing a continued partnership with patients and working within family and community. This definition does not include the first contact and focuses on individual attention.The Canadian Medical Association, in 1996, considered the APS as a front door of the health system and community interventions included in the definition of the functions of APS. In the same year was published a Charter for General Practice / Family Medicine in Europe (Letter to General Practice / Family Medicinein Europe), which describes 12 characteristics: general, accessible, integrated,continuous, as a team, holistic, personalized, targeted for the family and the community, coordinated, confidential and protectress(2).Donabedian(3) systematized a group of important variables that can assess the quality of a system or health service and rated according to their characteristics in structure, process and outcome. The evaluation of the process includes the quality of services provided by health professionals individually or in groups and refer to professional qualifications, organization and coordination of the work process of teams. The evaluation of the structure includes environmental conditions and equipment in which the services are provided and the results are evaluated starting from the verification of changes in health status of a population that can be attributed to the care process. Among the theoretical and conceptual landmarks of the PHC highlights the publication “Primary Care: Balancing Health Needs, Services, and Technology”, by Professor Barbara Starfield, in 1998, translated into Portuguese and published in Brazil in 2002. The book provides evidence on the role of PHC in health systems, evidence of its impact on population health, and compares the cost-effectiveness between countries with different forms and different degrees of implementation of this strategy, and propose a structure for measure it and set its attributes(1). The views of PHC, centered in the individual and in the population, provided the normative basis for evaluating it in a health system and contributed to the construction of the evaluation framework proposed by Starfield(1).The author also proposed a framework for evaluating the PHC which considered the concepts of the essential attributes and derivative measures of structure (capacity) and process (performance).The essential and exclusive attributes of the PHC include: access / care on first contact, longitudinality, integrality and coordination of care. A high level of reach of essential attributes of the PHC results in three additional aspects, denominated derivatives, which qualify the actions and services at this level of care(1,4).The aspects qualifiers are: centered on the family, cultural competence and community orientation. In most countries, nor centered on the family nor the community orientation are systems focus. The community orientation is an ideal rather than a reality(1,4).The National Primary Care Policy points out, in its guidelines, the universal and continuing access to health care quality and resolute, featuring primary care as the entry door and preferred care network. This care network should embrace users and promote linking and co-responsibility for the attention to their health needs(5). In the current issue of Brazilian Journal of Health Promotion, the reader can look into the User of the Family Health Strategy: knowledge and satisfaction with embracement, which contains important information that demonstrate mechanisms to ensure accessibility and embracement, from the comprehension of the user. Among the strategies for the development of integrality and coordinated care, now are exalted communities of practice, in which groups are formed around the practice of profession, linked from the need to share experiences so that knowledge can be collective(6). Articles “Community of practice as way of collective learning” and “Development of practices and knowledge in the Family Health Strategy: theoretical study” emphasize the learning derived from the exchange of experiences, sharing of meanings, observations, reflections on PHC.
publishDate 2012
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publisher.none.fl_str_mv Universidade de Fortaleza
dc.source.none.fl_str_mv Brazilian Journal in Health Promotion; Vol. 25 No. 2 Sup (2012); 1-4
Revista Brasileña en Promoción de la Salud; Vol. 25 Núm. 2 Sup (2012); 1-4
Revista Brasileira em Promoção da Saúde; v. 25 n. 2 Sup (2012); 1-4
1806-1230
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