Avaliação da atenção à saúde da pessoa idosa e ao envelhecimento em serviços de Atenção Primária
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Data
2018-02-23
Autores
Ramos, Nádia Placideli
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A Atenção Primária à Saúde (APS) possui papel essencial na promoção do envelhecimento ativo e gestão da saúde da pessoa idosa, conforme apontado na literatura nacional e internacional. Apesar do papel de destaque atribuído à APS, poucos trabalhos analisam como as ações que abordam o envelhecimento e a saúde dos idosos são desenvolvidas nesse nível de atenção. A presente pesquisa tem como objetivo geral avaliar a organização da atenção à saúde da pessoa idosa e ao envelhecimento em serviços de Atenção Primária à Saúde, e como objetivos específicos: avaliar a implementação e o desempenho de ações dirigidas à saúde da pessoa idosa e ao envelhecimento em serviços de APS de municípios do centro oeste paulista e verificar a associação entre o desempenho de serviços de APS na atenção à pessoa idosa e ao envelhecimento e indicadores de planejamento e avaliação em saúde. Trata-se de uma pesquisa avaliativa, quantitativa, transversal, de serviços de APS da Rede Regional de Atenção à Saúde 09, situada no centro-oeste paulista, a partir da aplicação do instrumento “Questionário de Avaliação da Qualidade de Serviços de Aten¬ção Básica” – QualiAB, em 2014. Baseado nas principais políticas públicas e diretrizes vigentes no país sobre atenção ao envelhecimento e à pessoa idosa foi construído um modelo teórico lógico operacional, que orienta a análise e discussão do material empírico. A partir do instrumento QualiAB foram definidos 155 indicadores relacionados a atenção à saúde da pessoa idosa e ao envelhecimento, agrupados em três domínios: Atenção à Saúde para o Envelhecimento Ativo; Organização para Atenção às Doenças Crônicas Não Transmissíveis (DCNT) e Estrutura e Rede de Apoio na Atenção ao Envelhecimento. As frequências dos indicadores selecionados foram processadas pelo Programa SPSS versão 20.0. Para análise dos domínios, foi aplicado o teste de k-médias (Programa Statistic Base) com a identificação (previamente) de cinco clusters para cada domínio; e o teste de Regressão Logística Múltipla (Programa SAS) para verificação das associações, utilizando-se como variáveis independentes indicadores de planejamento e avaliação em saúde do próprio QualiAB. Os resultados são apresentados na forma de três artigos. Uma avaliação descritiva para identificar a adequação e implementação de ações dirigidas à saúde da pessoa idosa e ao envelhecimento pelos serviços de APS (artigo 1); uma avaliação do desempenho dos serviços na atenção à saúde da pessoa idosa e ao envelhecimento em diferentes grupos de qualidade a partir dos domínios propostos (artigo 2). E a análise de associações entre os grupos de qualidade na atenção à saúde da pessoa idosa e indicadores de planejamento e avaliação em saúde dos serviços de APS (artigo 3). Como resultados gerais destaca-se a incipiência da incorporação de ações dirigidas à promoção do envelhecimento ativo e à gestão da saúde da pessoa idosa em serviços de APS no contexto estudado, e a importância das ações de planejamento e avaliação para a melhoria da qualidade. Recomenda-se a ampliação e diversificação das práticas de cuidado da saúde da pessoa idosa, preventivas e de promoção para o envelhecimento ativo, de modo integrado as redes intersetoriais de atenção à saúde
The Primary Health Care (PHC) plays an essential role in the promotion of active aging and in the health management of elderly, according to national and international literature. Despite the notable role attributed to the PHC, few studies have analyzed how the actions that approach the aging and health of the elderly are developed based on this type of healthcare. The general objective of this study is to evaluate the organization of elderly healthcare and aging in PHC services. The specific objectives are: to evaluate the implementation and development of actions directed to the health of elderly in PHC services in the central-west region of São Paulo state as well as to verify the association between the development of PHC services for the elderly and indicators of health planning and evaluation. This is an evaluative, quantitative and cross-sectional study, based on the 09 Healthcare Regional Network services, localized in the central-west of São Paulo state. The data were collected through the “Questionnaire for the Evaluation of Quality of Primary Health Care Services” – QualiAB, in 2014. Based on the main public policies and regulations in Brazil related to aging and healthcare of elderly, an operational, logical and theoretical model was developed in order to guide the analyses and discussion of the empirical material. Through the QualiAB instrument, 155 indicators were defined concerning the aging and healthcare of elderly, grouped into three domains: Healthcare for Active Aging, Organization in the Healthcare for Chronic Non-Communicable Diseases (CNCD); and Structure and Support Network for Aging Healthcare. The frequency of the selected indicators was processed by the SPSS software, version 20.0. For the analyses of domains, the K-means test was applied (Statistic Base software) with previous identification of five clusters for each domain. The Multiple Logistic Regression test (SAS software) was used to verify associations, considering the indicators of health planning and evaluation from the QualiAB as independent variables. The results are presented in three papers: a) A descriptive evaluation to identify the adequacy and implementation of actions directed to the healthcare and aging of elderly offered by the PHC services (paper 1); b-) an evaluation of the development in the services for the healthcare and aging of elderly from three different groups of quality according to the purposed domains (paper 2); c-) the analyses of association among the groups of quality in the healthcare of elderly and the indicators of planning and evaluation of PHC services (paper 3). As general results, the insipience as for the incorporation of actions directed to the promotion of active aging and elderly health management in PHC services considering the approached context must be emphasized, as well as the importance of planning and evaluation actions to improve quality. It is recommended the amplification and diversification of healthcare practices directed to the elderly, which may be preventive or promote an active aging, integrated into intersectoral healthcare networks.
The Primary Health Care (PHC) plays an essential role in the promotion of active aging and in the health management of elderly, according to national and international literature. Despite the notable role attributed to the PHC, few studies have analyzed how the actions that approach the aging and health of the elderly are developed based on this type of healthcare. The general objective of this study is to evaluate the organization of elderly healthcare and aging in PHC services. The specific objectives are: to evaluate the implementation and development of actions directed to the health of elderly in PHC services in the central-west region of São Paulo state as well as to verify the association between the development of PHC services for the elderly and indicators of health planning and evaluation. This is an evaluative, quantitative and cross-sectional study, based on the 09 Healthcare Regional Network services, localized in the central-west of São Paulo state. The data were collected through the “Questionnaire for the Evaluation of Quality of Primary Health Care Services” – QualiAB, in 2014. Based on the main public policies and regulations in Brazil related to aging and healthcare of elderly, an operational, logical and theoretical model was developed in order to guide the analyses and discussion of the empirical material. Through the QualiAB instrument, 155 indicators were defined concerning the aging and healthcare of elderly, grouped into three domains: Healthcare for Active Aging, Organization in the Healthcare for Chronic Non-Communicable Diseases (CNCD); and Structure and Support Network for Aging Healthcare. The frequency of the selected indicators was processed by the SPSS software, version 20.0. For the analyses of domains, the K-means test was applied (Statistic Base software) with previous identification of five clusters for each domain. The Multiple Logistic Regression test (SAS software) was used to verify associations, considering the indicators of health planning and evaluation from the QualiAB as independent variables. The results are presented in three papers: a) A descriptive evaluation to identify the adequacy and implementation of actions directed to the healthcare and aging of elderly offered by the PHC services (paper 1); b-) an evaluation of the development in the services for the healthcare and aging of elderly from three different groups of quality according to the purposed domains (paper 2); c-) the analyses of association among the groups of quality in the healthcare of elderly and the indicators of planning and evaluation of PHC services (paper 3). As general results, the insipience as for the incorporation of actions directed to the promotion of active aging and elderly health management in PHC services considering the approached context must be emphasized, as well as the importance of planning and evaluation actions to improve quality. It is recommended the amplification and diversification of healthcare practices directed to the elderly, which may be preventive or promote an active aging, integrated into intersectoral healthcare networks.
Descrição
Palavras-chave
Atenção Primária à Saúde, Envellhecimento, Pessoa Idosa, Avaliação de serviços de Saúde, Primary Health Care, Aging, Elderly, Health services evaluation