Performance patterns of primary health care in the face of COVID-19 in Brazil: characteristics and contrasts

The adequate fight against pandemics requires effective coordination between primary health care (PHC) and health surveillance, guaranteed attention to acute and chronic demands, and a bond with the community dimension in the scope of basic health units (UBS, acronym in Portuguese). This study aims to contrast two extreme standards of PHC performance in the fight against COVID-19 in Brazil, comparing them with the profiles of the corresponding municipalities and characteristics of the organization of services. Based on the results of a cross-sectional national survey with a representative sample of UBSs, we created a synthetic index to evaluate how PHC performs against COVID-19 called CPI, composed of axes of health surveillance and social support (collective dimension) and of COVID-19 care and continuity of care (individual dimension). Of the 907 surveyed UBSs, 120 were selected, half of which had the highest indexes (complete standard) and the other half, the lowest ones (restricted standard). The municipalities of the UBSs with a complete standard are predominantly rural, have low Municipal Health Development Index (MHDI), high Family Health Strategy (FHS) coverage, and stand out in the collective dimension, whereas the UBSs in urban municipalities with this same standard have high MHDI, low FHS coverage, and an emphasis on the individual dimension. In the restricted standard, we highlight community health workers' reduced work in the territory. In the Brazilian Northeast, UBSs with complete standard predominate, whereas, in its Southeast, UBSs with restricted standard predominate. The study poses questions that refer to the role and organization of PHC in the health care network under situations that require prompt response to health issues and indicates the greater potential capacity of the FHS program in such situations.

Community health workers perspective on the COVID-19 impact on primary health care in Northeastern Brazil

This article evaluates the COVID-19 pandemic impacts on the Family Health Strategy (FHS) team's work routines across a range of northeast Brazilian cities as perceived by community health workers (CHW). Data on COVID-19, CHW activities, and FHS teams were collected in 2021 by a structured questionnaire. A total of 1,935 CHWs from four state capitals (Fortaleza - Ceará State, João Pessoa - Paraíba State, Recife - Pernambuco State, Teresina - Piauí State) and four hinterland cities (Crato, Juazeiro do Norte, Barbalha, Sobral - Ceará State) participated in the study. Most CHWs were women (82.42%), with mean age 46.25±8.54 years. Many (39.92%) were infected with COVID-19, of which 70.78% believed they were infected in the workplace. A total of 77.82% defined their role as frontline in the fight against COVID-19, 16.07% reported receiving training for COVID-19, and 13.74% had access to sufficient protective equipment. Most (90.27%) believed their work routines were modified by the pandemic, either strengthening (41.46%) or weakening (44.41%) the team spirit. Home visits (60.55%), health promotion actions in schools (75.66%) and in specific community groups (93.96%), and other on-site community services (66.01%) showed a reduction in frequency. The sampled cities revealed a significant heterogeneity regarding responses to the COVID-19 pandemic, possibly associated with a lack of coordination by the Federal Government. Regardless of context, the pandemic led to a reconfiguration of local health systems, workflows, and primary care protocols for FHS teams. The importance of the Brazilian Unified National Health System (SUS) and its potential for reorganization during crisis should be acknowledged while preserving the headway made thus far.

Professional burnout and patient safety culture in Primary Health Care

OBJECTIVES

to analyze the association between the risk of occupational exhaustion (burnout) and safety culture in Primary Health Care.

METHODS

ross-sectional study conducted in 18 Primary Health Care Units in the Northeast of Brazil. Three questionnaires were used: sociodemographic, Maslach Burnout Inventory, and the Medical Office Survey on Patient Safety Culture. The study was approved by the Research Ethics Committee.

RESULTS

seventy-eight healthcare workers participated, of which 64.1% presented a reduced risk of burnout; and 11.5%, a high risk (p=0.000). The following were identified as weakened dimensions of safety culture: Work pressure and pace; Owner, managing partners, leadership support; Overall ratings on quality; and Overall rating on patient safety.

CONCLUSIONS

an association was found between low risk of developing burnout syndrome and positive evaluation of safety culture.

Risk of depression during pregnancy in usual risk antenatal care

OBJECTIVE

to identify the risk of depression during pregnancy among pregnant women receiving routine prenatal care and the associated factors.

METHOD

a cross-sectional study, carried out with 201 pregnant women, in a routine prenatal clinic of a university maternity hospital. Data were collected using an electronic form containing a characterization instrument and the Escala de Risco de Depressão na Gravidez (Depression during Pregnancy Scale). The dependent variable was the risk of depression during pregnancy. Statistical analysis was performed by calculating the Odds Ratio and using the Chi-square and Fischer's Exact tests.

RESULTS

among the participants, 68.2% had a higher risk of depression during pregnancy. There was a statistically significant association between a higher risk of depression during pregnancy and occupation (p=0.04), that is, unemployment (OR=2.00) doubled the risk of depression.

CONCLUSION

the high prevalence of the risk of depression during pregnancy indicates the necessity of planning, prioritizing, and integrating mental health into prenatal health services, especially in the primary healthcare environment, by health managers and policymakers.

[Obesity and intersectionality: critical analysis of narratives within public health policies in Brazil (2004-2021)]

This study aimed to critically analyze the narrative of Brazilian public health policies in obesity care based on an intersectional approach. This is a qualitative exploratory, documentary, and analytical study based on the "What's the problem represented to be?" approach (WPR). This approach constitutes a methodological instrument for critical analysis of public policies based on six guiding questions. A total of ten documents were selected, published from 2004 to 2021 by the Brazilian government. The critical analysis resulted in three categories: (i) obesity causes and the dominant narrative: what problems are represented?; (ii) dominant narrative and health care: what are the effects for people with obesity?; (iii) obesity and intersectionality: where are silences? The consumption of food and sedentary lifestyle were the dominant narrative as causes of obesity. Intersectionality, mediated by the categories of gender/sex, race/skin-color, and social class, was identified as silenced in the narrative of public health policies, not being associated as linked causes of obesity, nor effectively included in the proposed actions of the policies. The silences found in the study highlight the need to include intersectionality in the elaboration and execution of public health policies and in the care of people with obesity. Considering the intersections of gender/sex, race/skin-color, and social class and their forms of oppression in the emergence and aggravation of obesity, critical analyses of simplistic narratives in public health policies are extremely relevant to problematize gaps affect the care of users with obesity.

Telenursing in mental health: effect on anxiety symptoms and alcohol consumption during the COVID-19 pandemic

OBJECTIVE

(1) A remote intervention with a positive impact on reducing anxiety and alcohol use. (2) Nursing as a protagonist of preventive care in mental health (3) A low-cost intervention that covers several population groups. (4) Telenursing in mental health as a care strategy during COVID-19. to investigate the effect of a remote intervention on anxiety symptoms and alcohol use in users of the Primary Health Care service.

METHOD

a quasi-experimental study conducted with 1,270 participants who answered the Alcohol Use Disorders Identification Test and the State-Trait Anxiety Inventory-6. Of these, 1,033 interviewees scored for moderate/severe anxiety symptoms (STAI-6 > 3) and moderate/severe risk alcohol use (AUDIT-C > 3), and received the interventions via telephone calls with follow-up periods lasting seven and 180 days. For data analysis, a mixed-effects regression model was used.

RESULTS

the effect of the intervention performed was positive in reducing anxiety symptoms between T0 and T1 (µ=1.6, p<0.001) and in reducing the alcohol use pattern between T1 and T3 (µ=1.57, p<0.001).

CONCLUSION

the follow-up results suggest a positive effect of the intervention in reducing anxiety and the alcohol use pattern, which tends to be maintained over time. There is diverse evidence that the intervention proposed can be an alternative for preventive care in mental health, in situations where accessibility of the user or the professional is compromised.

Educational intervention performed by nurses for blood pressure control: a systematic review with meta-analysis

to assess the effect of an educational intervention performed by nurses for blood pressure control in people with arterial hypertension, when compared to usual care. a systematic review with meta-analysis of randomized clinical trials, conducted in six databases. The studies included were those in which an educational intervention was performed by nurses on people with arterial hypertension. The risk of bias was assessed by means of the Risk of Bias Tool, the meta-analysis was performed in the Review Manager software and certainty of the evidence was calculated in the Grading of Recommendations Assessment, Development and Evaluation system. a total of 1,692 studies were found, which were peer-reviewed, including eight of them in the meta-analysis. The meta-analysis was calculated for the "systolic blood pressure" and diastolic blood pressure" outcomes, in subgroups by time and by intervention performance type. For the in-person educational intervention, performed individually combined with a group activity, the effect estimate was -12.41 mmHg (95% Confidence Interval: from -16.91 to -7.91, p<0,00001) for systolic pressure and -5.40 mmHg (95% Confidence Interval: from -7.98 to -2.82, p<0,00001) for diastolic pressure, with high certainty of evidence. the educational intervention performed by nurses, individually and combined with a group activity, presents a statistically significant clinical effect. PROSPERO registration No.: CRD42021282707.

The pandemic changes daily life and ways of living: technosociality and user/families experiences

OBJECTIVES

understand the changes imposed by the COVID-19 pandemic in the daily lives of users of Primary Health Care and their families and its impact on self-care and health promotion.

METHODS

this is a holistic-qualitative multiple case study, based on the Comprehensive Sociology of Everyday Life, in which 61 users participated.

RESULTS

experiencing a new daily life in COVID-19 pandemic times, users express their feelings, adaptation to new habits and ways of living. Health technologies and virtual social networks stand out in helping with everyday tasks, in communicating with loved ones and health professionals, and in validating dubious information. Faith and spirituality arise in the face of uncertainty and suffering.

FINAL CONSIDERATIONS

it is imperative to pay close attention to the changes in daily life caused by the COVID-19 pandemic, in order to offer care directed to the singular and collective needs.

Development and validation of an instrument for the evaluation of HIV care in Primary Health Care

OBJECTIVE

To develop and validate an instrument to evaluate the decentralization process of care for People Living with HIV in Primary Health Care.

METHOD

Methodological study, developed in four stages: elaboration of the logical model based on the triad Structure-Process-Outcomes; development of the instrument; content validation by expert judges and technical reviewers; and semantic validation. Online questionnaires were used, and the Kappa index was used for analysis.

RESULTS

The instrument with 68 items and 8 factors was submitted to validation by expert judges who recommended the exclusion of 3 items and the alteration of 2 factors. In the validation by technical reviewers, 2 items were excluded and 6 factors were highlighted; the agreement index was ≥0.75. In the semantic validation, 87.3% of the judges answered "totally agree" for the items presented.

CONCLUSION

The instrument is validated for its content, has 63 items and has the potential to assess the care provided for people living with HIV in Primary Health Care.

Prevalence of characteristics associated with sarcopenia in elders: a cross-sectional study

Objectives:

to identify the prevalence and characteristics associated with sarcopenia in elders in Primary Health Care Units.

Methods:

cross-sectional study with 384 elders. To evaluate sarcopenia, we measured: strength and muscle mass, and physical performance. The elderly were classified as having: probable sarcopenia; sarcopenia; or severe sarcopenia. The chi-squared test and the multinomial logistic regression method were used.

Results:

the prevalence of probable sarcopenia was 25.52%; of sarcopenia, 11.98%; and of severe sarcopenia, 9.90%. Probable sarcopenia is 1.75 times more prevalent in men; osteoporosis is 2.16 times more prevalent in people with severe sarcopenia; polypharmacy is 1.57 times more likely in individuals with probable sarcopenia; and calf circumference below 31 cm is 2.24 times more likely in patients with sarcopenia and 2.19 times more likely in patients with severe sarcopenia.

Conclusions:

the highest prevalence was of probable sarcopenia, and the characteristics associated with sarcopenia were sex, osteoporosis, polypharmacy, overweight, obesity, and calf circumference.

Educational interventions in child development and health literacy assumptions: an integrative review

OBJECTIVES

to analyze scientific evidence in the literature that addresses educational interventions conducted by health professionals on early childhood development in a community context and to identify which health literacy assumptions are present during the implementation of interventions.

METHOD

an integrative review in PubMed, CINAHL and Web of Science databases. Of 300 studies found, we selected 11 for the sample.

RESULTS

health professionals are trained to implement interventions with parents/caregivers to promote child development in community settings. Parents are encouraged to develop an environment that is encouraging and conducive to the development of their children. The main dimensions of health literacy found were access and apply.

CONCLUSION

it confirms the importance of training health professionals, with skills and communicative skills to guide parents/caregivers to encourage the development of their children in their family environment with playful and interactive activities.

Elderly Mortality due to Ambulatory Care Sensitive Conditions and Primary Health Care Coverage in the Federal District

OBJECTIVES

To describe the mortality coefficients of elderly due to primary care sensitive conditions, from 2008 to 2018, and determine its association with the coverage of the Primary Health Care (Family Health Strategy and Basic Care models) in the Federal District.

METHODS

Ecological time series of mortality in Federal District elderly, from 2008 to 2018. The Poisson regression model was applied, considering as significant those with p<0.05, with a CI of 95%.

RESULTS

There were 70,503 deaths. There was a decrease in the risk of death of elders due to cardiovascular diseases and diabetes. Higher primary care coverage decreased the chance of death by sensitive conditions, both in Basic Care (OR: 0.994, CI: 0.990-0.998) and in the Family Health Strategy (OR: 0.997, CI: 0.995-0.999).

CONCLUSIONS

Primary Care coverage was associated with a lower chance of death of the elderly due to Ambulatory Care Sensitive Conditions, especially in Basic Care.

Nursing protocol in chronic kidney disease prevention in older adults in primary care

OBJECTIVES

to develop a protocol for Nursing Process operationalization in approaching older adults with vulnerability to chronic kidney disease in Primary Health Care, based on Neuman's stressors.

METHODS

a methodological study, carried out in two stages: 1) synthesis of evidence using an inductive strategy (mixed method study) and 2) protocol development to support the nursing process operationalization with older adults enrolled in a Basic Health Unit, using a deductive strategy (Neuman's stressor concepts, NANDA, NIC, and NOC taxonomies, Risner's line of reasoning, and cross-mapping), described according to A Step-by-Step Guide to Developing Protocols.

RESULTS

102 older adults participated, and 17 diagnoses, 34 interventions and 26 nursing outcomes were identified.

CONCLUSIONS

the protocol developed is a technology that makes it possible to operationalize the Nursing Process, based on Neuman's stressors and on taxonomy, conceptual and care frameworks, guiding care and nursing records.

El sentido de coherencia y las habilidades para la vida como factores protectores en personas con prediabetes

OBJETIVO

analizar el sentido de coherencia y las habilidades para la vida y su relación con el cumplimiento del estilo de vida saludable.

MÉTODO

estudio observacional transversal en personas con prediabetes atendidas en atención primaria, quienes respondieron a un cuestionario con variables sociodemográficas y hábitos saludables y a los cuestionarios de sentido de coherencia y habilidades para la vida. Se realizó un análisis descriptivo, bivariante y un modelo de regresión múltiple.

RESULTADOS

los y las participantes con mayor sentido de coherencia son quienes presentan mayores habilidades para la vida (Pearson = 0.470; p ⩽ 0.001) y mantienen un estilo de vida más saludable (B:1.24; p = 0.001). Una mayor puntuación de las habilidades de la vida se relaciona con un estilo de vida saludable (Pearson = 0.355, p < 0.001). El sentido de coherencia predice el estilo de vida saludable (BB = 0.21, p = 0.001).

CONCLUSIÓN

las personas con prediabetes con un mayor sentido de coherencia y más habilidades para la vida realizan conductas más saludables con relación a la dieta, al ejercicio físico y al hábito tabáquico. Las personas con mayor sentido de coherencia tienen mayor probabilidad de seguir el estilo de vida saludable.

Association between Metabolic Syndrome and professional category: a cross-sectional study with Nursing professionals

OBJECTIVE

to evaluate the association of Metabolic Syndrome and its components among Primary Health Care Nursing professionals in the state of Bahia, Brazil, according to professional category.

METHOD

a cross-sectional, population-based and multicenter study conducted with 1,125 Nursing professionals. The independent variable was the professional category, dichotomized into technical and higher education levels. The outcome was Metabolic Syndrome following criteria from the National Cholesterol Education Program Adult Treatment Panel III based on anthropometric measurements and blood samples. The statistical analysis was performed by calculating the prevalence ratios and using Pearson's Chi-square test.

RESULTS

the prevalence of Metabolic Syndrome was higher in the technical level category (PR=1.64; CI=1.29 - 2.06; p≤0.01). When compared to Nurses, these professionals were older, had lower incomes, worked more on duty and performed less physical activity on a regular basis. Among the Nurses, the most prevalent component was altered cholesterol (40.5%) and among the Nursing Technicians/Assistants, it was abdominal obesity (47.3%).

CONCLUSION

the association between the Nursing category and Metabolic Syndrome was evident, with higher occurrence among technical level professionals.

Multiprofessional family health residency as a setting for education and interprofessional practices

OBJECTIVE

to know the experiences lived during the residency by graduates of a Multiprofessional Residency Program in Family Health that could contribute to the development of Interprofessional Education and/or Collaborative Practice.

METHOD

a qualitative study with residents who entered a Multiprofessional Residency Program of a Brazilian public university in 2017, a period in which the theme of interprofessionality was implemented in the activities of the residency. Data was collected using an electronic form built from the theoretical framework of interprofessional education. Content analysis was used to process the data.

RESULTS

nine residents participated, distributed among the professions of Physical Education, Nursing, Nutrition, Dentistry, Psychology and Social Work, five of whom were female and with a mean age of 28.4. Two categories emerged: the Residency as a setting for learning from the other, and the Residency as a setting for understanding the role of the other. Interprofessional education and practice provided opportunities for the development of collaborative skills, enhancing teamwork and interprofessional work.

CONCLUSION

the multiprofessional logic was evidenced in the resident's practice; and the gradual insertion of activities such as case discussions, shared services and inter-sectoral actions aligned with the theoretical-methodological framework of interprofessionality favored an approach to interprofessional work.

Knowledge about the intrauterine device and interest in using it among women users of primary care services

OBJECTIVE

to analyze the level of knowledge about the intrauterine device, the interest in using it and the relationship between these events among women in reproductive age.

METHOD

cross-sectional study conducted with 1858 women between 18 and 49 years old, attending Primary Health Care Facilities. Data were obtained in face-to-face interviews. The level of knowledge was evaluated by items with answers options "agree", "disagree" and "I don't know". Knowledge was categorized as below/equal and above the median. Chi-square and multiple logistic regression were used in Stata 14.2 (95% confidence level).

RESULTS

intrauterine device current use was not frequent (1.7%; n=32) and the level of knowledge was higher among women between 25 and 34 years old, white, living in Aracaju (Sergipe), who were more educated, and who were currently using or had already used the intrauterine device. Interest in using the intrauterine device (38.0%; n=634) was higher among younger women, single, more educated, had health insurance, no children and with higher level of knowledge about the intrauterine device.

CONCLUSION

the level of knowledge about the intrauterine device was associated with the interest in using it.

The role of social support in the psychological illness of women

OBJECTIVE

to analyze the relationship between perception of social support and emotional and physical symptoms associated with psychiatric conditions among women.

METHOD

a cross-sectional, quantitative study was carried out with a randomized random sample of 141 women attended at a Family Health Unit of the city of Ribeirão Preto/SP. A sociodemographic questionnaire, the Social Support Questionnaire and the Self-Report Questionnaire were used.

RESULTS

there was no association between sociodemographic characteristics and mental disorder, but between aspects such as low income and schooling. The exercise of professions culturally considered as of low prestige gave rise to some reflections related to gender inequality. There was a significant difference in the satisfaction scores between the women who reported or not the symptoms of tiredness and sadness and the number of supporters among those who reported or not the symptom of fatigue. Spouses and children were the most mentioned supporters, and having mental disorder was significantly associated with having no friends in the support network.

CONCLUSION

issues related to gender equity and satisfaction with social support are important aspects of care. For the promotion of mental health, efforts must be made to make women feel more connected and supported by the supporters available in their social environment.

Availability and use of healthcare resources in prisons according to the transference model: a comparative study in Spain

OBJECTIVE

In most European countries, correctional healthcare provision is under strain or in the process of change regarding its management model and the implications that such modifications may entail for the improvement of inmates' health. This paper compares the functioning and the results of health management in a facility whose healthcare service is integrated within an autonomic health system and others which depend on the department of corrections.

MATERIALS AND METHODS

Cross-sectional study where the study unit is the facility itself. From the data collected from the record of Monthly Health Statistics of Penitentiary Institutions we have constructed a series of indicators according to the recommendations of the National Health System.

RESULTS

The physician to nurse ratio per inmate is higher in the transferred facility. Only the transferred establishment has telemedicine resources. Attendance to primary health services is higher that in all non-transferred establishments, while the mean attendance to specialized consultation in the transferred facility doubles that of the remaining centers.

DISCUSSION

We have observed greater access to specialized care in the correctional facility managed by the community health system when compared to that of the facilities managed by Penitentiary Institutions. This statement is based on a series of effectivity indicators and results that have provided significantly improved outcome in the transferred facility.

[Would the Screening of Common Mental Disorders in Primary-Care Health Services Hyper-Frequent Patients Be Useful?]

Hyper-frequentation in health services is a problem for patients, their families and the institutions. This study is aimed at determining the frequency and characteristics of common mental disorders in hyper-frequent patients showing vague symptoms and signs at a primary healthcare service during the year 2007 in the city of Cali (Colombia).

METHODOLOGY

Cross sectional. The most frequent mental disorders in hyper-frequent patients were detected through a telephone interview which included several modules of the PRIME MD instrument.

RESULTS

In general, healthcare service hyper-frequenters are working women, 38,7-year old in average. Basically, the consultation is due to cephalalgia but they also exhibit a high prevalence of common mental disorders (somatization, depression and anxiety) not easily diagnosed by physicians in primary care. Expenses for additional health activities generated by these patients are attributed basically to medical consultation and required procedures.

CONCLUSION

Considering hyper-frequenters in health care services as a risk group in terms of common mental disorders involves screening as an efficient strategy to prevent abuse in service use and to improve satisfaction with the attention received.

Female breast symptoms in patients attended in the family medicine practice

BACKGROUND

there are few studies on breast symptoms (BS) in patients attended at primary care units in Mexico. The aim was to determine the frequency and types of BS overall and by age-group and establish which BS were related to diagnosis of breast cancer.

METHODS

data from all female patients with a breast-disease-related diagnosis, attended from 2006 to 2010, at the Family Medicine Unit 38, were collected. The frequencies of BS were determined by four age-groups (< 19, 20-49, 50-69, > 70 years) and likelihood ratios for breast cancer for each breast-related symptom patient, with a 95 % confidence interval (CI).

RESULTS

the most frequent BS in the study population were lump/mass (71.7 %) and breast pain (67.7 %) of all breast complaints, and they were more noted in women age group of 20-49 years. Overall, 120 women had breast cancer diagnosed with a median age of 53.51 + 12.7 years. Breast lump/mass had positive likelihood ratios for breast cancer 4.53 (95 % CI = 2.51-8.17) and breast pain had increased negative LR = 1.08 (95 % CI = 1.05-1.11).

CONCLUSIONS

breast lump/mass was the predominant presenting complaint among females with breast symptoms in our primary care unit, and it was associated with elevated positive likelihood of breast cancer.

[Reliability of a questionnaire used in the long-term follow up of the opinion and perceptions of family medicine by medical students of the University of Zaragoza (Spain)]

AIM

Family medicine deals with certain aspects and perspectives that are often left behind in the training of other levels of care, thus the need for medical students to make contact with Primary Care is of increasing importance. The aim of this study is to evaluate the reliability of the questionnaire of the UNIMEDIFAM group (FIS PI070975) for the long-term outcome of expectations and knowledge about family medicine.

DESIGN

Reliability of a questionnaire.

SETTING

University of Zaragoza.

PARTICIPANTS

371 students from the 1st, 3rd, 5th, and 6th years.

METHOD

The internal consistency of the questionnaire was determined using Cronbach's alpha coefficient, and the stability using the test-retest.

RESULTS

On scale A of the questionnaire we found that three of 19 items were unstable, in 8 of 26 on scale B, and 3 of 38 items on scale C. The Cronbach's alpha value of scale A was 0.722, 0.861 on scale B, and 0,663 on scale C.

CONCLUSIONS

The 3 scales are within the appropriate values, except scale C, which is very close. The findings of this validation process can serve as a reference that may be extrapolated to the UNIMEDIFAM national questionnaire.

Restless legs syndrome: literature review

Restless legs syndrome is a distressing condition, with negative effects on sleep and daytime activities that affect personal, family and occupational life. The overall impact of restless legs syndrome on quality of life is comparable to that of chronic and frustrating conditions such as depression and diabetes. Misdiagnosis and inappropriate treatment may increase patients' suffering in terms of uncertainty, overuse or misuse of care services and lack of trust. Presenting a synthesis of the main topics in the literature on restless legs syndrome facilitates for a better understanding and its management in primary care settings.

[Is streptococcal pharyngitis diagnosis possible?]

OBJECTIVE

To determine the validity of the Centor score (cervical adenopathy, tonsillar exudate, fever, and absence of catarrh symptoms) in diagnosing streptococcal pharyngitis (gold standard: throat swab).

DESIGN

Descriptive study.

SETTING

San Fernando 2 Health Centre, Madrid (outer urban area), Spain.

PARTICIPANTS

On hundred forty patients over 14 years old who had a "sore throat" as main symptom and attended clinic between 14 February and 12 May, 2005.

MAIN MEASUREMENTS

Sensitivity, specificity, positive and negative predictive values, and the probability quotients of the Centor score were determined. Pharyngeal throat culture was used as the reference method.

RESULTS

Thirty four patients had positive throat culture (24.3%; 95% CI, 17.6%-32.4%). Finding the 4 criteria in the Centor score had a positive predictive value (PPV) of 48.1% (95% CI, 30.7%-66.0%) and a negative predictive value (NPV) of 81.4% (95% CI, 73.3%-87.5%); although only fever (OR, 3.64; 95% CI, 1.40-9.49) and tonsillar exudate (OR, 6.18; 95% CI, 2.08-18.35) were linked to streptococcal aetiology.

CONCLUSIONS

The high NPV and specificity of the clinical score makes the diagnosis of non-streptococcal pharyngitis very accurate. However, the PPV is low: a high Centor score (3 or 4 criteria) does not mean streptococcal pharyngitis with certainty. What approach to take with patients suspected of streptococcal pharyngitis is not yet resolved (microbiological test, early antibiotic, or postponed antibiotic).