Family Health Support Center: health promotion, physical activity, and chronic diseases in Brazil - national PMAQ survey 2013

Seus, Thamires Lorenzet Cunha; Silveira, Denise Silva da; Tomasi, Elaine; Thumé, Elaine; Facchini, Luiz Augusto; Siqueira, Fernando Vinholes

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Epidemiologia e Serviços de Saúde

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 28 (2) • 2019 • https://doi.org/10.5123/S1679-49742019000200009 copy

Family Health Support Center: health promotion, physical activity, and chronic diseases in Brazil - national PMAQ survey 2013^* * Article derived from the doctoral dissertation entitled “The Family Health Support Center and the physical education professional”, defended by Thamires Lorenzet Cunha Seus at the Federal University of Pelotas (UFPel) Postgraduate Physical Education Program in 2018. Source of funding for this study: Primary Health Care Department of the Health Ministry’s Primary Health Care Secretariat (DAB/SAS/MS): Process No. 25000.187078/2011-11.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to describe reported health promotion actions directed towards chronic non-communicable disease (CNCD) patients, the support of physical education professionals (PEP) and the implementation of actions to promote body practices and physical activity (BPPA) by the Family Health Support Center (FHSC) teams, according to Brazilian municipality context variables.

Methods:

this was a cross-sectional study, forming part of the 2013/2014 National Primary Health Care Access and Quality Improvement Program (PMAQ), by means of interviews with FHSC professionals.

Results:

the action most reported by the teams was evaluation and rehabilitation of psychosocial conditions (90.8%); promotion of BPPA was the sixth most performed action, and was more prevalent in the Brazilian Southeast region (89.6%), in medium-sized municipalities (88.7%), with medium human development index (HDI) (86.7%); PEP provided support to 87% of the teams.

Conclusion:

FHSC were found to make an important contribution to BPPA.

Keywords:
Primary Health Care; Health Evaluation; Health Promotion; Chronic Disease

Context variables	FHSC teams (n=1,773)
Context variables	n	%
State
Acre	9	0.6
Alagoas	54	3.0
Amazonas	29	1.5
Amapá	17	1.0
Bahia	170	9.6
Ceará	141	7.9
Espírito Santo	5	0.3
Goiás	60	3.4
Maranhão	44	2.5
Minas Gerais	295	16.6
Mato Grosso do Sul	38	2.1
Mato Grosso	17	1.0
Pará	38	2.1
Paraíba	116	6.5
Pernambuco	141	7.9
Piauí	86	4.8
Paraná	76	4.3
Rio de Janeiro	71	4.0
Rio Grande do Norte	57	3.2
Rondônia	9	0.5
Roraima	4	0.2
Rio Grande do Sul	31	1.7
Santa Catarina	82	4.6
Sergipe	12	0.7
São Paulo	149	8.4
Tocantins	20	1.1
Region
North	126	7.1
Northeast	821	46.3
Midwest	117	6.6
Southeast	520	29.3
South	186	10.7
Municipality size^a
Very small	151	8.5
Small	566	31.9
Medium	462	26.1
Large	219	12.3
Very large	375	21.2
HDI^b
Very low	5	0.3
Low	350	19.7
Medium	659	37.2
High	547	30.8
Very high	212	12
FHS coverage^b
Low	31	1.7
Medium	384	26.7
High	1,358	76.6

Context variables	FHSC teams	Body practices and physical activity
Context variables	FHSC teams	%	n	P-value
Region (n=1,690)				p<0.001
North	110	79.1	87
Northeast	785	81.7	641
Midwest	112	89.3	100
Southeast	502	89.6	450
South	181	84	152
Municipality size^a (n=1,690)				p=0.005
Very small	141	84.4	119
Small	525	80.2	421
Medium	443	88.7	393
Large	216	83.8	181
Very large	365	86.6	316
HDI^b (n=1,690)				p=0,002
Very low	5	80	4
Low	325	77.2	251
Medium	623	86.7	540
High	528	86	454
Very high	209	86.6	181
FHS coverage^c (n=1,690)				p=0.668
Low	25	84	21
Medium	374	83.2	311
High	1,291	85	1,098
Total	84.6	1,430

Context variables	Health promotion actions
	FHSC teams (n=1,690)	A	B	C	D	E	F	G	H
		Evaluation and rehabilitation of psychosocial conditions	Treatment and rehabilitation of conditions related to food and nutrition	Evaluation and rehabilitation of motor function	Qualification of referrals to other health care centers	Harm reduction guidelines	Evaluation and rehabilitation of cardiorespiratory function	Strategies for pharmacotherapeutic treatment access	Monitoring of users in other health facilities
		% (n)	% (n)	% (n)	% (n)	% (n)	% (n)	% (n)	% (n)
State (n=1,690)
AC	8	100.0 (8)	62.5 (5)	87.5 (7)	87.5 (7)	62.5 (5)	50.0 (4)	50.0 (4)	75.0 (6)
AL	46	89.1 (41)	89.1 (41)	91.3 (42)	80.4 (37)	89.1 (41)	69.6 (32)	45.7 (21)	53.7 (22)
AM	24	87.5 (21)	91.7 (22)	91.7 (22)	75.0 (18)	66.7 (16)	79.2 (19)	50.0 (12)	61.9 (13)
AP	17	88.2 (15)	100.0 (17)	88.2 (15)	76.5 (13)	88.2 (15)	88.5 (15)	58.8 (10)	86.7 (13)
BA	164	87.2 (143)	89 (146)	83.5 (137)	89.6 (147)	90.2 (148)	59.1 (97)	63.4 (104)	72.7 (104)
CE	135	90.4 (122)	89.6 (121)	95.6 (129)	90.4 (122)	85.2 (115)	78.5 (106)	52.6 (71)	67.2 (82)
DF	1	100.0 (1)	100.0 (1)	100.0 (1)	100.0 (1)	100.0 (1)	0.0	100.0 (1)	100.0 (1)
ES	4	100.0 (4)	75.0 (3)	100.0 (4)	75.0 (3)	100.0 (4)	50.0 (2)	100.0 (4)	0.0
GO	59	88.1 (52)	84.7 (50)	91.5 (54)	83.1 (49)	93.2 (55)	62.7 (37)	66.1 (39)	73.1 (38)
MA	42	90.5 (38)	92.9 (39)	92.9 (39)	83.3 (35)	83.3 (35)	71.4 (30)	59.5 (25)	71.1 (27)
MG	286	94.1 (269)	93.4 (267)	91.3 (261)	91.3 (261)	87.4 (30)	75.2 (215)	80.1 (229)	72.1 (194)
MS	36	88.9 (32)	80.6 (29)	80.6 (29)	80.6 (29)	83.3 (35)	63.9 (23)	63.9 (23)	62.5 (20)
MT	16	87.5 (14)	87.5 (14)	62.5 (10)	37.5 (6)	68.8 (11)	50.0 (8)	68.8 (11)	28.6 (4)
PA	34	88.2 (30)	94.1 (32)	85.3 (29)	76.5 (26)	88.2 (30)	67.6 (23)	41.2 (14)	53.3 (16)
PB	112	88.4 (99)	88.4 (99)	91.1 (102)	91.1 (102)	85.7 (96)	74.1 (83)	54.5 (61)	56.6 (56)
PE	137	93.4 (128)	87.6 (120)	91.2 (125)	88.3 (121)	87.6 (120)	62.8 (86)	69.3 (95)	74.2 (95)
PI	83	84.3 (70)	90.4 (75)	89.2 (74)	86.7 (72)	80.7 (67)	72.3 (60)	49.4 (41)	67.1 (47)
PR	70	92.9 (65)	94.3 (66)	91.4 (64)	87.1 (61)	88.6 (62)	71.4 (50)	72.9 (51)	66.2 (43)
RJ	69	89.9 (62)	89.9 (62)	89.9 (62)	92.8 (64)	89.9 (62)	68.1 (47)	69.6 (48)	67.7 (42)
RN	56	98.2 (55)	96.4 (54)	92.9 (52)	91.1 (51)	87.5 (49)	71.4 (40)	67.9 (38)	65.5 (36)
RO	5	80.0 (4)	40.0 (2)	80.0 (4)	40.0 (2)	60.0 (3)	40.0 (2)	60.0 (3)	50.0 (2)
RR	4	100.0 (4)	100.0 (4)	100.0 (4)	75.0 (3)	100.0 (4)	50.0 (2)	75.0 (3)	100.0 (4)
RS	30	90.0 (27)	86.7 (26)	63.3 (19)	76.7 (23)	83.3 (25)	53.3 (16)	63.3 (19)	70.4 (19)
SC	81	95.1 (77)	90.1 (73)	88.9 (72)	82.7 (67)	84.0 (68)	69.1 (56)	85.2 (69)	63.6 (49)
SE	10	100.0 (10)	100.0 (10)	90.0 (9)	90.0 (9)	90.0 (9)	70.0 (7)	40.0 (4)	80.0 (8)
SP	143	90.2 (129)	83.2 (119)	86.0 (123)	87.4 (125)	90.2 (129)	65.0 (93)	71.3 (102)	86.8 (112)
TO	18	83.3 (15)	83.3 (15)	88.9 (16)	72.2 (13)	77.8 (14)	77.8 (14)	83.3 (15)	60.0 (9)
P-value		0.53	0.008	0.001	<0.001	0.136	0.017	<0.001	<0.001
Region (n=1,690)
North	110	88.2 (97)	88.2 (97)	88.2 (97)	74.5 (82)	79.1 (87)	71.8 (79)	55.4 (61)	57.3 (63)
Northeast	785	89.9 (706)	89.8 (705)	90.3 (709)	88.7 (696)	86.6 (680)	68.9 (541)	58.7 (461)	60.7 (477)
Midwest	112	88.4 (99)	83.9 (94)	83.9 (94)	75.9 (85)	86.6 (97)	60.7 (68)	66.1 (74)	56.2 (63)
Southeast	502	92.4 (464)	89.8 (451)	89.6 (450)	90.2 (453)	88.6 (445)	71.1 (357)	76.3 (383)	69.3 (348)
South	181	93.4 (169)	91.2 (165)	85.6 (155)	83.4 (151)	85.6 (155)	67.4 (122)	76.8 (139)	61.3 (111)
P-value		0.24	0.33	0.15	<0.001	0.12	0.26	<0.001	<0.001
Municipality size^a (n=1,690)
Very small	141	84.4 (126)	89.4 (126)	90.8 (128)	85.8 (121)	83.7 (118)	70.9 (100)	63.8 (90)	62.4 (88)
Small	525	91.0 (478)	89.1 (468)	89.3 (469)	82.3 (432)	83.4 (438)	67.6 (355)	60.7 (319)	58.5 (307)
Medium	443	92.3 (409)	92.1 (408)	90.5 (401)	87.8 (389)	88.3 (391)	70.2 (311)	61.6 (273)	59.4 (263)
Large	216	91.2 (197)	88.0 (190)	83.3 (180)	88.0 (190)	82.9 (179)	69.4 (150)	70.8 (153)	59.3 (128)
Very large	365	89.0 (325)	87.7 (320)	89.6 (327)	91.8 (335)	92.6 (338)	68.8 (251)	77.5 (283)	75.6 (276)
P-value		0.55	0.27	0.06	0.001	<0.001	0.9	<0.001	<0.001
HDI^b (n=1,690)
Very low	5	100.0 (5)	100.0 (5)	100.0 (5)	100.0 (5)	100.0 (5)	60.0 (3)	60.0 (3)	40.0 (2)
Low	325	90.7 (295)	89.0 (289)	91.4 (297)	85.8 (279)	85.2 (277)	71.4 (232)	56.0 (182)	56.6 (184)
Medium	623	91.5 (570)	91.5 (570)	90.2 (562)	87.2 (543)	83.3 (519)	69.3 (432)	60.5 (377)	60.7 (378)
High	528	89.4 (472)	87.1 (460)	84.8 (448)	84.1 (444)	88.4 (467)	65.5 (346)	71.9 (380)	60.6 (320)
Very high	209	92.3 (193)	89.9 (188)	92.3 (193)	93.8 (196)	93.8 (196)	73.7 (154)	84.2 (176)	85.2 (178)
P-value		0.60	0.162	0.004	0.01	0.001	0.18	<0.001	<0.001
FHS coverage^c (n=1,690)
Low	25	92.0 (23)	92.0 (23)	84.0 (21)	92.0 (23)	96.0 (24)	64.0 (16)	56.0 (14)	48.0 (12)
Average	374	90.6 (339)	88.2 (330)	85.8 (321)	86.4 (323)	88.8 (332)	63.6 (238)	71.9 (269)	69.8 (261)
High	1,291	90.8 (1,173)	89.8 (1,159)	90.1 (1,163)	86.8 (1,121)	85.2 (1,108)	70.7 (913)	64.7 (835)	61.1 (789)
P-value		0.97	0.63	0.048	0.721	0.129	0.029	0.019	0.003
Total		90.8 (1,535)	89.5 (1,512)	89.1 (1,505)	86.8 (1,467)	86.6 (1,464)	69.1 (1,167)	66.2 (1,118)	62.8 (1,062)

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[1] Correspondence: Thamires Lorenzet Seus - Rua Luís de Camões, No. 625, Pelotas, RS, Brazil. Postcode: 96055-630 E-mail: seustl@gmail.com