Moreira Diane Costa, Bispo Júnior José Patrício, Nery Adriana Alves, Cardoso Jefferson Paixão
Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brasil.
Universidade Estadual do Sudoeste da Bahia, Jequié, Brasil.
Cad Saude Publica. 2021 Jan 11;36(12):e00031420. doi: 10.1590/0102-311X00031420. eCollection 2021.
The study aimed to evaluate the work by the Expanded Family Health and Basic Healthcare Centers (NASF-AB), from the users' perspective, based on the attributes of comprehensive primary healthcare (PHC). This was a qualitative multiple case study conducted in six municipalities (counties) in the state of Bahia, Brazil. The theoretical and methodological frame of reference was an evaluative matrix based on the following attributes: access, longitudinality, and comprehensiveness. The matrix also considered the assumption of Inter-Consultation Support and the guidelines of the Family Health Strategy. Data and information were obtained from 44 interviews with users of the NASF-AB and observation of the centers' activities and routine work in the health units. The study showed that users have limited access to the NASF-ABs' activities. The availability of clinical care was insufficient, access was facilitated by home visits, and the acceptability was jeopardized by frustrations from unmet expectations. Longitudinal care has not been prioritized in the centers' work, with limited involvement by supporters in developing continuing care. Group activities showed the potential for forming bonds. In the attribute of comprehensiveness, the presence of NASF-ABs helped increase activities and case-resolution capacity, but the linkage with the healthcare network was negligible. In conclusion, the work by the NASF-AB displayed limitations for the development of comprehensive PHC. The results also suggest potentialities with the capacity to strengthen primary care that have not been fully explored.
该研究旨在从用户角度，基于全面初级卫生保健（PHC）的属性，评估扩展家庭健康与基本医疗保健中心（NASF - AB）的工作。这是一项在巴西巴伊亚州六个市（县）开展的定性多案例研究。理论和方法参照框架是一个基于以下属性的评估矩阵：可及性、连贯性和全面性。该矩阵还考虑了会诊间支持的假设以及家庭健康战略的指导方针。数据和信息通过对NASF - AB用户进行44次访谈以及观察卫生单位的中心活动和日常工作获得。研究表明，用户参与NASF - AB活动的机会有限。临床护理的可及性不足，家访有助于提高可及性，而未满足期望所带来的挫折感则危及了可接受性。中心工作未将连贯性护理作为优先事项，支持者在发展持续护理方面的参与有限。小组活动显示出建立联系的潜力。在全面性属性方面，NASF - AB的存在有助于增加活动和病例解决能力，但与医疗网络的联系微不足道。总之，NASF - AB的工作在全面初级卫生保健的发展方面存在局限性。研究结果还表明，加强初级保健的潜力尚未得到充分挖掘。
