Quality of Primary Health Care in Brazil: patients'view

To describe the evaluation of patients that participated in the National Program for Improving the Access and Quality in Primary Health Care (Programa Nacional de Melhoria do Acesso e da Qualidade na Atenção Básica) for the comprehensive healthcare, the bond and the coordination of care in the country's macro-regions.

Method:

A descriptive, transversal study, from interviews with 65,391 patients of Primary Health Care, in 3,944 municipalities regarding the use of health services.

Results:

The professionals seek to solve the patients' problems in their unit (73.1%) but focused mainly on the scope of the appointment (65.6%) and offering care away from the population's reality (69.4%). Difficulties in the rescue of clinical history were referred (50.3%) and in the care performed in other health services (29.2%).

Conclusion:

The comprehensive health care, the bond and the coordination of care remain challenges to the Primary Health Care in the country, requiring reflections on the implementation of national policies, especially considering the regional diversities in Brazil.

Descriptors:
Primary Health Care; Health Care Quality; Access, and Evaluation; Health Policy; Public Health; Health Services Research

Variable	Brazil n (%)	95%CI
Gender^* * number of interviewed patients = 65,391;
Male	14,600 (22.3)	22 - 22.6
Female	50,791 (77.7)	77.4 - 78
Age (average in years)^* * number of interviewed patients = 65,391;	49,3	49.1 - 49.5
Family monthly income (R$)^* * number of interviewed patients = 65,391;	1,163.1	1159.4 - 1166.7
Race/color^ patients who did not know/did not answer = 599. Patients who answered regarding race/color = 64,792.
White	25,164 (38.8)	38.5 - 39.2
Black	7,966 (12.3)	12 - 12.5
Yellow	1,735 (2.7)	2.6 - 2.8
Brown/mixed	29,311 (45.2)	44.9 - 45.6
Indigenous	616 (1)	0.9 - 1

Variable	North n (%) [95%CI]	Northeast n (%) [95%CI]	Southeast n (%) [95%CI]	South n (%) [95%CI]	Central-West n (%) [95%CI]	Brazil n (%) [95%CI]
When you are treated in this health unit, do you think that the team tries to solve your needs/problems in the health unit itself?^* * N = 64,857 (99.2% of the interviewed patients);
Yes	2,556 (69.3) [67.8 - 70.8]	15,077 (70.5) [69.9 - 71.1]	18,783 (74.5) [74 - 75.1]	7,914 (77) [76.2 - 77.9]	3,061 (71.2) [69.8 - 72.5]	47,391 (73.1) [72.7 - 73.4]
Yes, sometimes	786 (21.3) [20 - 22.6]	4,947 (23.1) [22.6 - 23.7]	4,714 (18.7) [18.2 - 19.2]	1,945 (18.9) [18.2 - 19.7]	908 (21.1) [19.9 - 22.3]	13,300 (20.5) [20.2 - 20.8]
Never	346 (9.4) [8.4 - 10.3]	1,371 (6.4) [6.1 - 6.7]	1,702 (6.8) [6.4 - 7.1]	414 (4) [3.6 - 4.4]	333 (7.7) [6.9 - 8.5]	4,166 (6.4) [6.2 - 6.6]
Do the health professionals ask questions about other health needs that you have or may have beyond those related to the reason for your appointment?^ N = 64,378 (98.5% of the interviewed patients);
Always/Usually	2,103 (57.6) [56.0 - 59.2]	13,459 (63.4) [62.7 - 64.0]	17,620 (70.3) [69.8 - 70.9]	6,458 (63.3) [62.4 - 64.2]	2,615 (61.6) [60.1 - 63.1]	42,255 (65.6) [65.3 - 66.0]
Hardly ever/Never	1,546 (42.4) [40.8 - 44.0]	7,770 (36.6) [36.0 - 37.3]	7,433 (29.7) [29.1 - 30.2]	3,744 (36.7) [35.8 - 37.6]	1,630 (38.4) [36.9 - 39.9]	22,123 (34.4) [34.0 - 34.7]
In your opinion, during the appointments, do the professionals of this team suggest solutions that are adequate to your reality?^* ***** N = 63,164 (96.6% of the interviewed patients).
Always/Usually	2,119 (60.1) [58.5 - 61.8]	13,892 (66.6) [66.0 - 67.3]	17,778 (72.4) [71.8 - 72.9]	7,328 (73.1) [72.2 - 74.0]	2,691 (64.0) [62.5 - 65.4]	43,808 (69.4) [69.0 - 69.7]
Hardly ever/Never	1,404 (39.9) [38.2 - 41.5]	6,957 (33.4) [32.7 - 34.0]	6,785 (27.6) [27.1 - 28.2]	2,694 (26.9) [26.0 - 27.8]	1,516 (36.0) [34.6 - 37.5]	19,356 (30.6) [30.3 - 31.0]

Variable	North n (%) [95%CI]	Northeast n (%) [95%CI]	Southeast n (%) [95%CI]	South n (%) [95%CI]	Central-West n (%) [95%CI]	Brazil n (%) [95%CI]
In this unit, are you treated by the same doctor?^* * N = 64,658 (98.9% of the interviewed patients);
Always/Usually	2,707 (73.0) [71.6 - 74.4]	17,656 (83.6) [83.1 - 84.1]	21,373 (84.7) [84.3 - 85.2]	8,387 (81.4) [80.6 - 82.1]	3,635 (84.5) [83.4 - 85.5.]	53,758 (83.1) [82.9 - 83.4]
Hardly ever/Never	1,000 (27.0) [25.6- 28.4]	3,460 (16.4) [15.9 - 16.9]	3,855 (15.3) [14.8 - 15.7]	1,917 (18.6) [17.9 - 19.4]	668 (15.5) [14.5 - 16.6]	10,900 (16.9) [16.6 - 17.1]
In this unit, are you assisted by the same nurse?^ N = 61,532 (94.1% of the interviewed patients);
Always/Usually	2,765 (76.2) [74.8 - 77.6]	17,640 (87.8) [87.3 - 88.3]	18,450 (77.2) [76.6 - 77.7]	7,047 (71.4) [70.5 - 72.3]	3,327 (82.4) [81.2 - 83.5]	49,229 (80.0) [79.7 - 80.3]
Hardly ever/Never	862 (23.8) [22.4 - 25.2]	2,449 (12.2) [11.7 - 12.7]	5,455 (22.8) [22.3 - 23.4]	2,826 (28.6) [27.7 -29.5]	711 (17.6) [16.5 - 18.8]	12,303 (20.0) [19.7 - 20.3]
Do the professionals remember what happened in your last appointments?
Yes	1,600 (44.2) [42.6 - 45.8]	9,781 (47.5) [46.8 - 48.2]	13,200 (54.3) [53.7 - 54.9]	4,949 (50.2) [49.2 - 51.2]	1,918 (46.4) [44.9 - 47.9]	31,448 (50.3) [49.9 - 50.7]
Yes, sometimes	518 (14.3) [13.2 - 15.5]	3,535 (17.2) [16.7 - 17.7]	3,869 (15.9) [15.5 - 16.4]	1,836 (18.6) [17.9 - 19.4]	596 (14.4) [13.3 - 15.5]	10,354 (16.6) [16.3 - 16.9]
No	1,501 (41.5) [39.9 - 43.1]	7,270 (35.3) [34.7 - 36]	7,230 (29.8) [29.2 - 30.3]	3,073 (31.2) [30.3 - 32.1]	1,622 (39.2) [37.7 - 40.7]	20,696 (33.1) [32.7 - 33.5]
When you need to ask questions after the appointment, is it easy to talk to the professionals that assisted you?^** ****** N = 64,895 (99.2% of the interviewed patients).
Always/Usually	1,395 (38) [36.4 - 39.5]	9,939 (46.4) [45.8 - 47.1]	12,115 (48) [47.4 - 48.6]	4,790 (46.5) [45.5 - 47.5]	1,673 (38.9) [37.4 - 40.4]	29,912 (46.1) [45.7 - 46.5]
Never	461 (12.5) [11.5 - 13.6]	1,973 (9.2) [8.8 - 9.6]	2,270 (9) [8.6 - 9.4]	956 (9.3) [8.7 - 9.8]	388 (9) [8.2 - 9.9]	6,048 (9.3) [9.1 - 9.5]
Did not have to ask questions	1,044 (28.4) [27 - 29.9]	5,828 (27.2) [26.6 - 27.8]	6,557 (26) [25.5 - 26.5]	2,659 (25.8) [25 - 26.7]	1,540 (35.8) [34.4 - 37.2]	17,628 (27.2) [26.8 - 27.5]

Variable	North n (%) [95%CI]	Northeast n (%) [95%CI]	Southeast n (%) [95%CI]	South n (%) [95%CI]	Central-West n (%) [95%CI]	Brazil n (%) [95%CI]
After you were treated by other professionals outside this health unit, did the team talked to you about this treatment?^* * N = 47,443 (72.6% of the interviewed patients) Does not know/Did not answer = 17,792 (27.2% of the interviewed patients);
Yes	796 (21.4) [20.1 - 22.7]	5,560 (25.9) [25.3 - 26.4]	8,341 (32.9) [32.3 - 33.5]	3,375 (32.7) [31.8 - 33.6]	1,006 (23.3) [22 - 24.5]	19,078 (29.2) [28.9 - 29.6]
Yes, sometimes	310 (8.3) [7.4 - 9.2]	1,983 (9.2) [8.8 - 9.6]	2,380 (9.4) [9 - 9.7]	1,208 (11.7) [11.1 - 12.3]	318 (7.4) [6.6 - 8.1]	6,199 (9.5) [9.3 - 9.7]
Never	1,309 (35.2) [33.6 - 36.7]	7,202 (33.5) [32.9 - 34.1]	8,645 (34.1) [33.5 - 34.7]	3,578 (34.6) [33.7 - 35.5]	1,432 (33.1) [31.7 - 34.5]	22,166 (34) [33.6 - 34.3]
Do you think it is easy to access your test results that arrive at this health unit?^ N = 65,229 (99.8% of the interviewed patients).
Yes	2,200 (59.1) [57.5 - 60.7]	12,399 (57.7) [57 - 58.3]	18,095 (71.4) [70.8 - 71.9]	7,393 (71.5) [70.7 - 72.4]	2,852 (66) [64.5 - 67.4]	42,939 (65.8) [65.5 - 66.2]
Yes, sometimes	576 (15.5) [14.3 - 16.6]	3,988 (18.6) [18 - 19.1]	3,400 (13.4) [13 - 13.8]	1,449 (14) [13.4 - 14.7]	643 (14.9) [13.8 - 15.9]	10,056 (15.4) [15.1 - 15.7]
Never	946 (25.4) [24 - 26.8]	5,111 (23.8) [23.2 - 24.3]	3,857 (15.2) [14.8 - 15.7]	1,491 (14.4) [13.8 - 15.1]	829 (19.2) [18 - 20.3]	12,234 (18.8) [18.5 - 19.1]

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] CORRESPONDING AUTHOR Helena Eri Shimizu E-mail: shimizu@unb.br