Analysis of an instrument for primary health care monitoring

Qualitative, descriptive, and analytic research that consisted in the application of the instrument in 442 Basic Health Units - PCC from São Paulo city with the participation of local managers in its elaboration; the instrument is composed of 47 aspects that contemplated indicators of Structure, Process, and Result and we organized them in six thematic blocks: I - welcoming technical reception – WTR (reception); II - nursing work; III - medical work; IV - assistance organization and team integration; V - vaccination and program coverage; VI - management and participation. For the statistical analysis, we utilized the SPSS 25.0 program.

Results

The average and median scores obtained by the 414 evaluated Primary Care Centers (total of 470 possible points) were 356 and 380, respectively. Through the multivariate modeling, nine aspects of Structure and Processes stood out, when analyzed concerning the aspects of the Result, presenting statistical association (p<0.05): WTR carried out in every period of Primary Care Centers; specific training for the care in WTR; nurse clinical performance; systematized medical rearguard for WTR; complete oral health team; reserved time for team meeting; group appointment carried out systematically; health promotion actions; adequate physical accommodations.

Conclusion

The instrument presented the capacity to capture different stages of the organization and the results of the participant units of this study, and, besides a global evaluation, it revealed critical questions of the services related to the intended changes. As an evaluative tool for the services, it may contribute to the monitoring and the support to the everyday techno-management decision making.

Primary health care; Health services research; Health services accessibility; User embracement; Integrality in health

Ord.	Evaluated aspect	Type*	Nº of answers	Points obtained	%
I. Reception (Welcoming Technical Reception - WTR) – Total			2854	21505	75.4
1	WTR is in an exclusive place and the service is individualized	P	412	2480	60.2
2	Vacancy occupation one day after the WTR evaluation	P	412	3555	86.3
3	Scheduling after the evaluation of WTR	P	411	3450	83.9
4	WTR works during all the periods of PCC	P	410	3670	89.5
5	Waiting time for WTR < 40 minutes	R	386	2850	73.8
6	Presence of records of appointments in the WTR (reason and decision)	P	410	3255	79.4
7	Presence of specific training for the service in the WTR	P	413	2245	54.4
II. Nursing work – Total			1656	15290	92.3
8	Systematic presence of nurse in the unit	E	414	3930	94.9
9	The nurse carries out the appointment systematically	P	414	3680	88.9
10	The nurse appointment relies on formal protocols	P	414	4040	97.6
11	Active nursing in the WTR	P	414	3640	87.9
III. Medical work – Total			2825	21665	76.7
12	Medical presence in the PCC (10 = all the periods; 5 = 8 or 9 periods)	E	413	3335	80.8
13	Waiting time - child ≥ 2 years old (10: ≤ 30 days; 5: >30 ≤45; 0: >45)	R	413	3360	81.4
14	Follows the child care schedule < 2 years old	R	381	3245	85.2
15	Waiting time - adult appointment - (10: ≤30 days; 5: >30 ≤45; 0: >45)	R	413	2015	48.8
16	Waiting time - woman appointment (10: ≤30 days; 5: >30 ≤45; 0: >45)	R	412	2685	65.2
17	Waiting time - pregnant woman appointment (10: ≤30 days; 5: >30 ≤45; 0: >45)	R	381	3695	97.0
18	Presence of medical rearguard to support WTR	P	412	3330	80.8
IV. Assistance organization and team integration – Total			6106	47295	77.5
19	Assistance activities planned in multi-professional meetings	P	414	3550	85.7
20	Systematic multi-professional meetings for discussion of cases	P	414	3440	83.1
21	Scheduling is continuous without periodic closing	P	414	3840	92.8
22	Scheduling is carried out during all working day	P	414	3975	96.0
23	Agenda with reservation of vacancies for the demand of the day	P	414	3070	74.2
24	Papanicolaou integrated to the appointment (without separate scheduling)	P	406	3240	79.8
25	Papanicolaou with open routine (without pre-scheduling)	P	407	2930	72.0
26	RN with increase in maternity with scheduled appointment in PCC	P	408	3720	91.2
27	Complete oral health team **	E	406	2285	56.3
28	Complete mental health team***	E	407	1075	26.4
29	Group appointment carried out systematically	P	407	3440	84.5
30	Hold regular visits to defaulting	P	408	2300	56.4
31	Reference system with formal systematic	P	375	3490	93.1
32	Regular health promotion actions – community	P	406	3645	89.8
33	Regular health promotion actions – intersectoral	P	406	3295	81.2
V. Vaccination and program coverage – Total			2576	18655	72.4
34	Penta Vaccination coverage: 10: ≥90%; 5: <90% and ≥80%	R	369	2805	76.0
35	Triple Viral Coverage: 10: ≥90%; 5: <90% and ≥80%	R	371	2865	77.2
36	Papanicolaou rate: 10: ≥20%; 5: <20% and ≥15%	R	366	2685	73.4
37	Pregnant coverage: 10: ≥70%; 5: <70% and ≥50%	R	374	3190	85.3
38	Live births with 7 or + consultations: 10: ≥50%; 5: <50% and ≥30%	R	358	3025	84.5
39	Hypertensive coverage: 10: ≥30%; 5: <30% and ≥20%	R	369	2015	54.6
40	Diabetic coverage: 10: ≥20%; 5: <20% and ≥15%	R	369	2070	56.1
VI. Management and participation – Total			2726	22800	83.6
41	Accommodation: no lines, with water dispenser, good cleaning	E	389	3130	80.5
42	Presence preventive maintenance of equipments	P	389	2470	63.5
43	Public identification of the team: uniform, badge	P	390	2820	72.3
44	Respect to the user: no grid at the reception, no threatening poster	P	390	3810	97.7
45	Handbooks are separated in advance to the treatment	P	390	3620	92.8
46	Team meeting scheduled in advance	P	389	3350	86.1
47	Presence of Local Council or other mechanisms of participation	P	389	3600	92.5
All Questions – Total			18743	147210	78.5

Structure and process aspect	Average of the values of the result aspects		p-value*
Structure and process aspect	No or Parcial (0 ou 5)	Yes (10)	p-value*
WTR is in an exclusive place and the service is individualized	68.3±19.4	78.4±15.6	< 0.001
Vacancy occupation one day after the WTR evaluation	58.8±18.0	78.5±15.5	< 0.001
Scheduling after the evaluation of WTR	57.0±18.9	77.5±15.8	< 0.001
WTR works during all the periods of PCC	53.6±19.2	77.7±15.4	< 0.001
Presence of records of appointments in the WTR (reason and decision)	65.4±19.6	77.9±16.0	< 0.001
Presence of specific training for the service in the WTR	67.9±19,2	82.1±12.5	< 0.001
Systematic presence of nurse in the unit	57.8±19.9	76.1±16.9	< 0.001
The nurse carries out the appointment systematically	56.3±18.4	78.4±15.1	< 0.001
The nurse appointment relies on formal protocols	60.3±15.3	74.9±17.8	0.021
Active nursing in the WTR	58.2±21.7	77.5±15.4	< 0.001
Medical presence in the PCC (10 = all the periods; 5 = 8 or 9 periods)	68.8±18.9	77.5±16.6	< 0.001
Presence of medical rearguard to support WTR	61.6±17.4	80.2±14.8	< 0.001
Assistance activities planned in multi-professional meetings	57.0±17.5	77.3±16.3	< 0.001
Systematic multi-professional meetings for discussion of cases	56.8±18.8	77.8±15.7	< 0.001
Scheduling is continuous without periodic closing	61.3±19.1	76.2±17.0	< 0.001
Scheduling is carried out during all working day	62.8±17.1	75.4±17.6	0.022
Agenda with reservation of vacancies for the demand of the day	62.7±17.0	78.5±16.4	< 0.001
Papanicolaou integrated to the appointment (without separate scheduling)	68.7±20.4	75.9±16.9	0.005
Papanicolaou with open routine (without pre-scheduling)	62.9±19.1	78.7±15.5	< 0.001
RN with increase in maternity with scheduled appointment in PCC	64.4±20.5	76.0±17.0	< 0.001
Complete oral health team **	71.9±17.8	82.0±16.0	< 0.001
Complete mental health team***	74.7±17.7	73.5±19.1	0.724
Group appointment carried out systematically	61.9±18.5	78.4±15.8	< 0.001
Hold regular visits to defaulting	69.5±18.8	82.7±12.5	< 0.001
Reference system with formal systematic	63.6±22.6	75.4±17.2	0.003
Regular health promotion actions – community	55.9±17.5	77.4±16.1	< 0.001
Regular health promotion actions – intersectoral	66.1±17.8	77.7±16.8	< 0.001
Accommodation: no lines, with water dispenser, good cleaning	70.7±17.9	77.3±17.4	0.001
Presence of preventive maintenance of equipments	73.2±18.2	75.5±17.7	0.274
Public identification of the team: uniform, badge	60.4±19.5	79.5±14.4	< 0.001
Respect to the user: no grid at the reception, no threatening poster	67.8±17.9	74.8±17.9	0.347
Handbooks are separated in advance to the treatment	72.5±20.8	74.8±17.6	0.570
Team meeting scheduled in advance	56.1±16.1	77.4±16.4	< 0.001
Presence of Local Council or other mechanisms of participation	71.8±18.5	74.9±17.8	.429

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding Author: Paulo de Tarso Puccini E-mail: paulopuccini@gmail.com