Integrality, conditions of service delivery and work process of Family Health Teams in Belo Horizonte

Ferreira Neto, João Leite; Oliveira, Graziella Lage; Viana, Natália de Oliveira; Duarte, Luiz Guilherme Mafle Ferreira

doi:10.1590/0103-1104201611114

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ORIGINAL ARTICLE • Saúde debate 40 (111) • Oct-Dec 2016 • https://doi.org/10.1590/0103-1104201611114 copy

Integrality, conditions of service delivery and work process of Family Health Teams in Belo Horizonte

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The aim was to analyze the relation between integrality interventions and conditions of service delivery, in addition to the work process of Family Health Teams, in health centers in a district of the city of Belo Horizonte (MG). It is a cross-sectional study with self-administered questionnaire. Descriptive and comparative analyses were carried out through Pearson's chi-square, using p=0.05 value to verify the statistical significance. Both service delivery conditions and the work process showed association with the accomplishment of integrality interventions, and planning proved to be the most important tool for the accomplishment of such activities.

KEYWORDS
Integrality in health; Family Health Strategy; Health promotion; Primary Health Care; Working conditions

Variables	n	%
When does reception happen at the unit?
During entire opening time	279	53,3
At hours defined by the team	184	35,2
Varies according to the team	60	11,5
Which professionals participate in the reception?
Nurses	495	92,2
Nurse auxiliaries	517	96,3
Physicians	193	36
Community Health Agents	76	14,2
What is the average amount of time spent in each reception?
Maximum 5 minutes	64	17
More than 5 minutes	313	83
What happens during reception?
Listening to user’s need	525	97,6
User referral	463	86,2
Providing information/guidance	448	83,3
Risk classification	255	47,4
Delivery of examination results	188	34,9
How many patients have their demands met at reception?
Few or none	24	6
Half	28	6,7
Most	365	87,3
What happens during examination (only physicians and nurses: n=138)?
Guidance	137	99,3
Medical history of user’s health treatment	120	87
Medical history of user’s other health practices	93	67,4
Prescription of medicaments	94	69,6
Guidance on how to use the medicaments	116	84,7
Prescription of diet/food guidance	82	60,3
Prescription of physical activity	81	59,6
Other guidance on life habits	102	74,5
Listening to the user on resistance to prescriptions	87	64,4
Internal referral – medical support , mental health, Nasf	56	41,5
External referral – specializations, hospitalization, Emergency Unit (UPA), Social Assistance Reference Center (Cras)	37	27,4
Group activities with users at the unit	31	23
Referral to prevention/promotion activities	94	68,6
Prevention/promotion activities to which users are referred:
Leisure activities	75	54
Community activities	70	50,4
Walking	95	68,3
Lian Gong	120	87
Town academy	114	82
Health groups	77	55,4
Nasf	113	81,3
How long after referral does the user get access to urgency/emergency services?
Same day	124	97,6
More than 1 day	5	2,4
Has the heath professional received permanent education in the last 12 months?
Yes	333	62,8
No	197	37,2
Tools used by ESF for territory analysis:
Family register	406	83,2
Health at the Territory Project	66	13,5
Health at School Program	234	48
Vulnerability index	200	41
Epidemiological data	252	51,6
Professional reports	371	76
Territory characteristics	137	28,1

Variables related to integrality	Variables related to conditions of services delivery (n=538)
	Risk classification (%)			Differentiated delivery (%)			Relation between nr. of ESF and population (%)
	High	Medium	Value p	Yes	No	Value p	2400-2800	2800-3400	> 3400	Value p
Provide information during reception:			0,548			0,015				0,211
Yes	161 (97)	364 (97,8)		262 (80)	186 (88,2)		106 (78,5)	190 (85,6)	152 (84)
No	5 (3)	8 (2,2)		65 (20)	25 (11,8)		29 (21,5)	32 (14,4)	29 (16)
Referral to promotion/ prevention/ activities during consultation:			0,006			0,448				0,191
Yes	22 (52,4)	72 (75,8)		61 (71)	33 (64,7)		19 (57,6)	44 (75,9)	31 (67,4)
No	20 (47,6)	23 (24,2)		25 (29)	18 (35,3)		14 (42,4)	14 (24,1)	15 (32,6)
Prescription of physical activities during consultation:			0,083			0,024				0,281
Yes	21 (48,8)	60 (64,5)		58 (66,7)	23 (46,9)		20 (58,8)	38 (66,7)	23 (51)
No	22 (51,2)	33 (35,5)		29 (33,3)	26 (53,1)		14 (41,2)	19 (33,3)	22 (49)
Guidance onlife habits duringconsultation:			0,203			0,003				0,025
Yes	29 (67,4)	73 (77,7)		72 (82,8)	30 (60)		24 (70,6)	49 (86)	29 (63)
No	14 (32,6)	21 (22,3)		15 (17,2)	20 (40)		10 (29,4)	8 (14)	17 (37)
Referral togroup activities during consultation:			0,037			0,676				0,125
Yes	5 (12,2)	26 (27,7)		19 (21,8)	12 (25)		4 (11,8)	17 (30,4)	10 (22,2)
No	36 (87,8)	68 (72,3)		68 (78,2)	36 (75)		30 (88,2)	39 (69,6)	35 (77,8)
Invitation for activities at Basic Health Unit duringhome visit:			0,608			0,039				0,015
Yes	100 (64,5)	236 (66,9)		197 (62,7)	139 (71,6)		70 (55,6)	149 (69,6)	117 (69,6)
No	55 (35,5)	117 (33,1)		117 (37,3)	55 (28,4)		56 (44,4)	65 (30,4)	51 (30,4)

Variables related to integrality	Variables related to Work Process in services (n=538)
	Assessment of teamworkin meetings%			Assessment of interventions on the population%			Planning%^* * Planning: 1=little; 2=some, 3=satisfactory.
	Always	Little/Never	Value p	Yes	No	Value p	1	2	3	Value p
Provide information at reception:			0,008		0,917					0,258
Yes	81,7	92,4		84,1	84,6		81,2	82	879,3
No	18,3	7,6		15,9	15,4		18,8	18	12,7
Prescription of diet/consultation:			0,003			0,213				0,210
Yes	61,1	33,3		61,8	50		54,1	55,1	70
No	33,9	66,7		38,2	50		45,9	44,9	30
Internalreferral to consultation:			0,984			0,718				0,004
Yes	41,4	41,7		41,3	45,5		31,4	30	60
No	58,6	58,3		58,7	54,5		68,6	70	40
Externalreferral to consultation:			0,771			0,546				0,028
Yes	27,9	25		27,3	28,6		17,1	21,6	40,8
No	72,1	75		72,7	71,4		82,9	78,4	59,2
Invitation for activities at UBS, during home visit:			0,294			0,001				0
Yes	65,4	71		69	45,8		51,4	74,7	73,5
No	34,6	29		31	54,2		46,6	25,3	26,5
Assessment of health condition, duringhome visit:			0,455			0,744				0
Yes	72,3	76		73	70,8		56,4	79,3	80,5
No	27,7	24		27	29,2		43,6	20,7	19,5
Does ESF use family register?			0,014			0				0
Yes	85,3	74,7		85,9	61,5		74	86,3	90
No	14,7	25,3		14,1	38,5		26	13,7	10
Does ESF use vulnerability index?			0,001			0,031				0
Yes	45,4	27,4		43,4	25,6		33,1	35,1	56,3
No	54,6	72,6		56,6	74,7		66,9	64,9	43,7
Does ESF use professional reports?			0,855			0,113				0,001
Yes	77	79,9		77,8	66,7		65,7	81,5	85,5
No	23	22,1		22,2	33,3		34,3	18,5	18,5
Are there group activitiesoutside Basic Health Unit?			0,776			0				0,024
Yes	77,4	76		79	21		68,2	79,6	78,8
No	22,6	24		42	58		31,8	20,4	21,2

Variables related to integrality	Variables related to conditions of service delivery (n=538)
	Risk classification (high)		Differentiated delivery		Relation between nr. of ESF and population
	OR	CI 95%	OR	CI 95%	OR [CI 95%]	OR [CI 95%]	OR [CI 95%]
	OR	CI 95%	OR	CI 95%	2400-2800	2800-3400	>3400
Provide information at reception:			0,54	[0,33-0,89]
Referral to promotion/prevention activities during consultation:	0,35	[0,16-0,76]
Prescription of physical activities during consultation:			2,26	[1,10-4,63]
Guidance on life habits during consultation:			3,20	[1,45-7,07]	1	2,55 [0,89-7,29]^* * Despite value p <0.05, confidence intervals (CI 95%) do not show to be significant.	0,71 [0,27-1,84]^* * Despite value p <0.05, confidence intervals (CI 95%) do not show to be significant.
Invitation for activities at Basic Health Units during home visit:			0,67	[0,45-0,98]	1	1,83 [1,16-2,89]	1,83 [1,13-2,97]

Variables related to integrality	Variables related to work process in services (n=538)
	Assessment of teamwork in meetings		Assessment of interventions on population		Planning
	OR	CI 95%	OR	CI 95%	OR [CI 95%]	OR [CI 95%]	OR [CI 95%]
	OR	CI 95%	OR	CI 95%	Little	Some	Much
Provide information at reception:	0,37	[0,17-0,79]
Prescription of diet during consultation:	3,89	[1,53-9,91]
Internal referral during consultation:					1	0,93 [0,37-2,40]^* * Despite value p <0.05, confidence intervals (CI 95%) do not show to be significant.	3,27 [1,32-8,14]
External referral during consultation:					1	1,33 [0,44-4,01]^* * Despite value p <0.05, confidence intervals (CI 95%) do not show to be significant.	3,33 [1,17-9,50]
Invitation for activities at Basic Health Units during home visit:			2,62	[1,44-4,80]	1	2,79 [1,78-4,38]	2,63 [1,66-4,17]
Assessment of health condition, duringhome visit:					1	2,96 [1,85-4,74]	3,19 [1,94-5,24]
ESF uses family register for territory analysis:	1,96	[1,14-3,39]	3,81	[1,89-7,67]	1	2,22 [1,27-3,88]	3,19 [1,69-6,02]
ESF uses vulnerability index for territory analysis:	2,61	[1,58-4,30]	2,22	[1,06-4,68]	1	1,09 [0,69-1,71]*	2,60 [1,65-4,09]
ESF uses professional reports for territory analysis:					1	2,31 [1,40-3,82]	2,29 [1,37-3,86]
Conducting group activities outside Basic Health Unit:			5,20	[2,83-9,55]	1	1,82 [1,12-2,98]	1,73 [1,05-2,87]

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[1] Conflict of interests: non-existent