Desenvolvimento de um modelo de avaliação da atenção à deficiência em serviços de atenção primária à saúde
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Data
2020-02-27
Autores
Zarili, Thais Fernanda Tortorelli [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A Atenção Primária à Saúde (APS) é componente da Rede de Cuidados à Pessoa com Deficiência (RCPcD) e deve desenvolver ações de prevenção primária, que antecedem a instauração de condições de deficiência; secundária, relativas à redução ou recuperação de comorbidades que podem resultar em deficiência; diagnóstico precoce; e atenção integral às pessoas com deficiência, além de trabalhar em conjunto com os serviços especializados em ações de reabilitação. O presente estudo apresenta uma metodologia de avaliação de serviços de saúde pautada na construção teórica e aplicabilidade de um modelo de atenção à deficiência em serviços de APS. A construção teórica e metodológica se deu a partir de uma revisão integrativa da literatura acerca do tema e da construção de um modelo teórico-lógico de avaliação. Em seguida, o modelo construído foi aplicado no banco de dados do inquérito de avaliação de serviços de APS realizado no Estado de São Paulo entre 2017 e 2018 com o Questionário de Avaliação da Qualidade de Serviços de Atenção Básica (QualiAB). Os resultados são apresentados na forma de três artigos científicos a serem aplicados em periódicos indexados. Artigo 1: Revisão integrativa realizada a partir das bases Bireme, Scopus e Pubmed. Foram selecionados inicialmente 2644 artigos e 49 fizeram parte da amostra final a partir da análise e aplicação dos critérios de inclusão e exclusão. Como resultado obteve-se uma concentração de artigos científicos acerca da prevenção da deficiência na saúde do idoso e da criança e do acesso e acessibilidade à PcD. As ações de atenção à PcD não são valorizadas como objeto de investigação pela literatura científica, denotando sua baixa visibilidade e incorporação nas ações dos serviços de APS. Artigo 2: Apresenta o modelo de avaliação da atenção à deficiência na APS e a proposição de indicadores a partir da análise das políticas nacionais, de literatura científica em relação à deficiência, e com base em variáveis presentes no instrumento QualiAB. A dimensão avaliativa elaborada Atenção à Deficiência em Serviços de Atenção Primária à Saúde é composta por cinco domínios: “Estrutura (Insumos e Recursos Humanos)” (15 indicadores), “Qualificação da Atenção ao Pré-natal” (24 indicadores), “Qualificação da Atenção à Saúde da Criança” (32 indicadores), “Prevenção de incapacidades relacionadas a condições crônicas” (32 indicadores) e “Atenção à Pessoa com Deficiência e ao Cuidador” (23 indicadores). Foram realizadas análises para avaliar a correlação entre os domínios e a dimensão, e avaliação da confiabilidade das respostas, com base nos resultados do inquérito QualiAB. O modelo proposto apresenta potencial capacidade de avaliar as ações dos serviços para prevenção, diagnóstico e assistência à deficiência e pode ser replicado em diferentes contextos. Artigo 3: Aplicação do modelo de avaliação da Atenção à Deficiência em Serviços de Atenção Primária à Saúde em 2739 serviços, a partir do banco de dados do inquérito QualiAB. As características institucionais dos serviços foram definidas a partir das questões descritivas, foram analisadas as medidas de desempenho e testes de associações com variáveis independentes extraídas do instrumento. Os serviços de APS participantes denotam fragilidades para a dimensão avaliada. As principais variáveis independentes associadas ao melhor desempenho foram: ser Estratégia de Saúde da Família, possuir equipes multiprofissionais de apoio matricial, ter participado de processos de avaliação e a partir destes realizar planejamento das ações nos serviços. Como resultado geral, este trabalho apresenta um modelo de avaliação de serviços da APS sobre a atenção à deficiência replicável e fomenta a discussão sobre práticas avaliativas que possam contribuir para a qualificação dos serviços e consolidação da implantação da RCPcD.
Primary Health Care (PHC) is part of the Care Network for People with Disabilities (CPCP) and must develop primary prevention actions, which precede the establishment of conditions of disability; secondary, related to the reduction or recovery of comorbidities that can result in disability; early diagnosis; and comprehensive care for people with disabilities, in addition to working together with services specialized in rehabilitation actions. The present study presents a methodology for the evaluation of health services based on the theoretical construction and applicability of a model of care to disability in PHC services. The theoretical and methodological construction took place from a integrative literature review on the topic and the construction of a theoretical-logical model of evaluation. Then, the model built was applied to the survey database of PHC services assessment carried out in the State of São Paulo between 2017 and 2018 with the Primary Care Services Quality Assessment Questionnaire (QualiAB). The results are presented in the form of three scientific articles to be applied in indexed journals. Article 1: Integrative review based on the Bireme, Scopus and Pubmed databases. 2644 articles were initially selected and 49 were part of the final sample based on the analysis and application of the inclusion and exclusion criteria. As The result was a concentration of scientific articles on the prevention of deficiency in the health of the elderly and the child and access and accessibility to PwD. PwD care actions are not valued as an object of investigation by the scientific literature, denoting its low visibility and incorporation in the actions of PHC services. Article 2: Presents the model for assessing disability care in PHC and proposing indicators based on the analysis of national policies, scientific literature in relation to disability, and based on variables present in the QualiAB instrument. The evaluative dimension elaborated Attention to Deficiency in Primary Health Care Services is composed of five domains: “Structure (Inputs and Human Resources)” (15 indicators), “Qualification of Prenatal Care” (24 indicators), “Qualification of Child Health Care ”(32 indicators),“ Prevention of disabilities related to chronic conditions ”(32 indicators) and“ Care for People with Disabilities and Caregivers ”(23 indicators). Analyzes were carried out to assess the correlation between the domains and the dimension, and to assess the reliability of the responses, based on the results of the QualiAB survey. The proposed model has the potential to evaluate the actions of services for the prevention, diagnosis and assistance of disability and can be replicated in different contexts. Article 3: Application of the Disability Care Services assessment model Primary Health Care in 2739 services, from the QualiAB survey database. The institutional characteristics of the services were defined based on descriptive questions, performance measures and tests of associations with independent variables extracted from the instrument. The participating PHC services show weaknesses for the assessed dimension. The main independent variables associated with the best performance were: being a Family Health Strategy, having multiprofessional matrix support teams, having participated in evaluation processes and from there carrying out planning of actions in the services. As a general result, this work presents a PHC service evaluation model on care for replicable disability and encourages discussion on evaluative practices that can contribute to the qualification of services and consolidation of the implementation of CNPwD.
Primary Health Care (PHC) is part of the Care Network for People with Disabilities (CPCP) and must develop primary prevention actions, which precede the establishment of conditions of disability; secondary, related to the reduction or recovery of comorbidities that can result in disability; early diagnosis; and comprehensive care for people with disabilities, in addition to working together with services specialized in rehabilitation actions. The present study presents a methodology for the evaluation of health services based on the theoretical construction and applicability of a model of care to disability in PHC services. The theoretical and methodological construction took place from a integrative literature review on the topic and the construction of a theoretical-logical model of evaluation. Then, the model built was applied to the survey database of PHC services assessment carried out in the State of São Paulo between 2017 and 2018 with the Primary Care Services Quality Assessment Questionnaire (QualiAB). The results are presented in the form of three scientific articles to be applied in indexed journals. Article 1: Integrative review based on the Bireme, Scopus and Pubmed databases. 2644 articles were initially selected and 49 were part of the final sample based on the analysis and application of the inclusion and exclusion criteria. As The result was a concentration of scientific articles on the prevention of deficiency in the health of the elderly and the child and access and accessibility to PwD. PwD care actions are not valued as an object of investigation by the scientific literature, denoting its low visibility and incorporation in the actions of PHC services. Article 2: Presents the model for assessing disability care in PHC and proposing indicators based on the analysis of national policies, scientific literature in relation to disability, and based on variables present in the QualiAB instrument. The evaluative dimension elaborated Attention to Deficiency in Primary Health Care Services is composed of five domains: “Structure (Inputs and Human Resources)” (15 indicators), “Qualification of Prenatal Care” (24 indicators), “Qualification of Child Health Care ”(32 indicators),“ Prevention of disabilities related to chronic conditions ”(32 indicators) and“ Care for People with Disabilities and Caregivers ”(23 indicators). Analyzes were carried out to assess the correlation between the domains and the dimension, and to assess the reliability of the responses, based on the results of the QualiAB survey. The proposed model has the potential to evaluate the actions of services for the prevention, diagnosis and assistance of disability and can be replicated in different contexts. Article 3: Application of the Disability Care Services assessment model Primary Health Care in 2739 services, from the QualiAB survey database. The institutional characteristics of the services were defined based on descriptive questions, performance measures and tests of associations with independent variables extracted from the instrument. The participating PHC services show weaknesses for the assessed dimension. The main independent variables associated with the best performance were: being a Family Health Strategy, having multiprofessional matrix support teams, having participated in evaluation processes and from there carrying out planning of actions in the services. As a general result, this work presents a PHC service evaluation model on care for replicable disability and encourages discussion on evaluative practices that can contribute to the qualification of services and consolidation of the implementation of CNPwD.
Descrição
Palavras-chave
Avaliação em saúde, Atenção Primária à Saúde, Serviços de saúde, Pessoas com deficiência