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[巴西初级医疗保健中产前服务的质量:指标与社会不平等]

[Quality of prenatal services in primary healthcare in Brazil: indicators and social inequalities].

作者信息

Tomasi Elaine, Fernandes Pedro Agner Aguiar, Fischer Talita, Siqueira Fernando Carlos Vinholes, Silveira Denise Silva da, Thumé Elaine, Duro Suele Manjourany Silva, Saes Mirelle de Oliveira, Nunes Bruno Pereira, Fassa Anaclaudia Gastal, Facchini Luiz Augusto

机构信息

Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, Brasil.

Escola Superior de Educação Física, Universidade Federal de Pelotas, Pelotas, Brasil.

出版信息

Cad Saude Publica. 2017 Apr 3;33(3):e00195815. doi: 10.1590/0102-311X00195815.

Abstract

The aim of this study was to describe quality indicators for prenatal care in Brazil as part of the Program for the Improvement of Access and Quality (PMAQ-AB). The study analyzed number of prenatal visits, vaccination status, prescription of ferrous sulfate, physical examination, orientation, and laboratory tests, based on which a summary quality indicator was constructed. Data were collected in 2012-2013 during interviews conducted by External Evaluators of the PMAQ-AB, with 6,125 users who had done their last prenatal follow-up in Family Health units. During prenatal follow-up, 89% reported six or more visits, more than 95% received a tetanus booster and prescription of ferrous sulfate, 24% reported having received all the procedures in the physical examination, 60% received all the orientation, and 69% had all the recommended laboratory tests. Only 15% of interviewees had received adequate prenatal care, including all the recommended measures, and there was a significantly higher proportion of "complete" care in pregnant women that were older, with higher income, in the Southeast region of Brazil, in municipalities with more than 300,000 inhabitants, and in those with (HDI) in the upper quartile. There are persist social and individual inequalities that can be targeted by measures to upgrade the teams' work processes.

摘要

本研究旨在描述巴西作为改善医疗服务可及性与质量计划(PMAQ-AB)一部分的产前保健质量指标。该研究分析了产前检查次数、疫苗接种状况、硫酸亚铁处方、体格检查、指导以及实验室检查情况,并据此构建了一个综合质量指标。数据于2012年至2013年期间收集,由PMAQ-AB的外部评估人员对6125名在家庭健康单位完成最后一次产前随访的用户进行访谈。在产前随访期间,89%的人报告进行了六次或更多次检查,超过95%的人接受了破伤风加强免疫和硫酸亚铁处方,24%的人报告接受了所有体格检查项目,60%的人接受了所有指导,69%的人进行了所有推荐的实验室检查。只有15%的受访者接受了充分的产前保健,包括所有推荐措施,并且在年龄较大、收入较高、位于巴西东南部地区、居民超过30万的城市以及人类发展指数(HDI)处于上四分位数的孕妇中,“完整”保健的比例显著更高。仍然存在社会和个体不平等现象,可通过改进团队工作流程的措施加以解决。

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