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[初级保健在医疗网络中的整合:PMAQ-AB外部评估中的组成部分分析]

[Integration of primary care in the healthcare network: analysis of the components in the external evaluation of the PMAQ-AB].

作者信息

Chaves Lenir Aparecida, Jorge Alzira de Oliveira, Cherchiglia Mariangela Leal, Reis Ilka Afonso, Santos Marcos Antônio da Cunha, Santos Alaneir de Fátima, Machado Antônio Thomaz Gonzaga da Matta, Andrade Eli Iola Gurgel

机构信息

Universidade Federal de Minas Gerais, Belo Horizonte, Brasil.

出版信息

Cad Saude Publica. 2018 Feb 19;34(2):e00201515. doi: 10.1590/0102-311X00201515.

Abstract

This cross-sectional study examined the integration of primary care in the healthcare network of the Brazilian Unified National Health System (SUS), using the Gradual Response Model of Item Response Theory. Based on data from 17,202 teams that participated in the National Program for Access and Quality Improvement in Primary Care (PMAQ-AB, 2012), we measured gradients of integration to identify the teams' profile by level of integration. The results show that the items pertaining to matrix support measures (medical consultations, case discussions, shared clinical action, joint elaboration of therapeutic projects, permanent educational activities, work process discussions, interventions in the territory, and visits with primary care professionals) improved the performance of primary care teams. Communications devices between teams reinforced this understanding. Still, the approximately 50% of answers associated with the worst scenario for some study items evidenced the need to upgrade the integration between primary care activities and specialized care for the consolidation of comprehensive primary healthcare.

摘要

这项横断面研究采用项目反应理论的渐进反应模型,考察了巴西统一国家卫生系统(SUS)医疗网络中初级保健的整合情况。基于参与2012年国家初级保健获取与质量改善计划(PMAQ-AB)的17202个团队的数据,我们测量了整合梯度,以按整合水平确定各团队的概况。结果表明,与矩阵支持措施相关的项目(医疗会诊、病例讨论、共享临床行动、联合制定治疗方案、永久性教育活动、工作流程讨论、地区干预以及与初级保健专业人员的走访)提高了初级保健团队的绩效。团队之间的通讯设备强化了这种认识。然而,某些研究项目中约50%与最差情况相关的回答表明,有必要提升初级保健活动与专科护理之间的整合程度,以巩固全面的初级卫生保健。

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