在家庭健康战略高覆盖率背景下对慢性病初级保健的评估。
Evaluation of the primary care for chronic diseases in the high coverage context of the Family Health Strategy.
作者信息
Alves Kelly Cristina Gomes, Guimarães Rafael Alves, de Souza Marta Rovery, de Morais Neto Otaliba Libânio
机构信息
Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil.
Department of Medicine, Federal University of Tocantins, Palmas, Brazil.
出版信息
BMC Health Serv Res. 2019 Nov 29;19(1):913. doi: 10.1186/s12913-019-4737-2.
BACKGROUND
This cross-sectional study evaluated the adequacy of the Family Health Strategy for the primary care model for chronic noncommunicable diseases and the changes that occurred between the two cycles of external evaluations of the National Program for Improving Access and Quality of Primary Care, which took place in 2012 and 2014, in the higher coverage context of the Family Health Strategy of Brazil, in the state of Tocantins, Brazil.
METHODS
The data source contained information on the infrastructure of the 233 Primary Health Units and on the work process of 266 health teams. The Principal Component Analysis for Categorical Data technique and the McNemar chi-squared statistical test for comparing paired samples were used, and a significance level of 5% with a 95% Confidence Interval was used.
RESULTS
The analysis identified a low proportion of dispensing of medications for the treatment of chronic disease in both cycles. There was a significant increase in seasonal influenza vaccination, in the number of sterilization, procedure, dressings and inhalation rooms. There was a small but significant reduction in the materials for cervical cancer screening, although they are available in almost 90.0% of the PHUs. More than 70.0% of the health teams carried out additional health education activities, encouraged physical activity, registered schoolchildren with health needs for monitoring, evaluated user satisfaction and user referral.
CONCLUSIONS
The findings of this study highlighted the improvement of the structure of the Primary Health Units, but identified a low provision of medicines to treat chronic diseases. The health promotion was performed as the main work process tool of family health teams, but it was little focused on intersectoral actions and on actions with the population in the area or on the empowerment of users through self-management support for chronic diseases. Furthermore, it is critical that the Family Health Strategy in Tocantins be organized and focused on the care of chronic diseases to improve and adapt itself to a primary chronic care model.
背景
本横断面研究评估了家庭健康战略在慢性非传染性疾病初级保健模式中的适用性，以及在巴西托坎廷斯州家庭健康战略覆盖率较高的背景下，2012年和2014年进行的两轮初级保健改善可及性和质量国家计划外部评估之间所发生的变化。
方法
数据来源包含233个初级卫生保健单位的基础设施信息以及266个卫生团队的工作流程信息。使用了分类数据的主成分分析技术和用于比较配对样本的麦克尼马尔卡方统计检验，显著性水平为5%，置信区间为95%。
结果
分析发现两个周期中用于治疗慢性病的药物配给比例都很低。季节性流感疫苗接种、消毒、手术、换药和吸入室的数量有显著增加。宫颈癌筛查材料略有但显著减少，尽管在近90.0%的初级卫生保健单位都有提供。超过70.0%的卫生团队开展了额外的健康教育活动，鼓励体育锻炼，登记有健康需求的学童进行监测，评估用户满意度和用户转诊情况。
结论
本研究结果突出了初级卫生保健单位结构的改善，但发现治疗慢性病的药物供应不足。健康促进作为家庭健康团队的主要工作流程工具得以开展，但很少关注部门间行动以及与该地区人群相关的行动，或通过对慢性病的自我管理支持来增强用户权能。此外，至关重要的是，托坎廷斯州的家庭健康战略应进行组织并专注于慢性病护理，以改进并适应初级慢性病护理模式。
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