O TRABALHO NA ESTRATÉGIA SAÚDE DA FAMÍLIA E A PERSISTÊNCIA DAS PRÁTICAS CURATIVISTAS

Physiotherapy work process in primary health care in a Brazilian municipality: qualitative study

OBJECTIVE

The aim of this study was to analyze the work process of physiotherapists in primary health care (PHC) and the repercussions of work management practices.

METHODS

A qualitative study that used semi-structured interviews with nineteen physiotherapists, two management physiotherapists and a coordinator of PHC in municipality in Southern Brazil. Data were analyzed using the methodological framework of discourse analysis.

RESULTS

Through the analyzed speeches, the work routine of physiotherapists working in basic health units in the municipality studied mainly involves individual care, group activities and home visits. The diversity of this routine is influenced by management, work teams, the characteristics of the assisted population and the professional profile of the physiotherapist. Measures that enhanced work effectiveness were the increase in the number of physiotherapists in the city over the years, effective interprofessional relationships, the possibility of working in a single health unit, and monthly meetings for continuing education. Among the weaknesses presented were the low effectiveness of the orthopedics protocol adopted in the municipality, poor access to secondary care, lack of knowledge about the physiotherapist's functions in PHC and limitations in infrastructure and financial resources.

CONCLUSION

Physiotherapy in primary care has been consolidated in the studied city, with effective management actions and increased access to professional, having a positive impact on resolving health conditions sensitive to this level of care.

Physiotherapy practices in primary health care

Abstract Introduction: Physiotherapy was included in primary health care (PHC) in order to expand access and provide comprehensive care to the population. Objective: To understand the routine and tools used by physiotherapists in primary health care and analyze the determining factors in providing care in a municipality where every basic health unit (BHU) has a physiotherapist. Methods: This is a qualitative study of nineteen physiotherapists conducted in a city of Southern Brazil, using a semistructured interview and a methodological framework for discourse analysis. Results: The main tools routinely used in the physiotherapy service are individual appointments, home visits and group work. Physiotherapy practices are influenced by public health, municipal management and BHU policies, physiotherapy profile in addition to the characteristics of the coverage area and the population being treated. Introducing health promotion measures and implementing relational technologies are the main challenges for physiotherapists, and many of these professionals already recognize their importance in promoting comprehensive care. Conclusion: Physio-therapy practices and the tools used are in line with the Primary Care Family Health Support Center (NASF-AB) model of action recommended by public policies and have been effective for many health conditions. Knowing the routine of PHC physiotherapy services may help professional training and service management, with a view to producing physiotherapy care aimed at the principle of comprehensiveness and consolidating the role of physiotherapists at this level of care.

Vigilância do desenvolvimento de crianças em creche: um estudo sobre o olhar materno

Resumo Objetivo Compreender a percepção materna acerca da vigilância do desenvolvimento de crianças menores de três anos que frequentam creche. Método Estudo qualitativo com nove mães de crianças menores de três anos, matriculadas em uma creche do município de João Pessoa-PB, vinculada a uma Unidade de Saúde da Família. Os dados foram coletados por meio de entrevistas semiestruturadas e submetidos à análise temática. Resultados A vigilância do desenvolvimento de crianças que frequentam creche encontra-se fragilizada, visto que a maioria das mães não costumam levar a criança para a unidade de saúde, para o acompanhamento do crescimento e desenvolvimento, e a inserção dos profissionais de saúde na creche ainda é limitada. Entretanto, as mães reconhecem a creche como cenário ideal para a promoção do desenvolvimento infantil e a importância da atuação dos profissionais de saúde nesse cenário. Conclusão e implicações para prática São necessárias ações conjuntas da creche com a Unidade de Saúde da Família para a atenção integral e vigilância do desenvolvimento infantil.

Scale for evaluating food and nutrition education practices in Primary Health Care

ABSTRACT Objective To develop, validate and analyse intra- and inter-raters’ agreement and reliability of a scale for the evaluation of food and nutrition education practices in primary health care. Methods Three theoretical references were used for the development of items with answers on a 4-point scale (not observed, partially/satisfactorily/fully observed): the Brazilian Dietary Guidelines, the Interprofessional Collaborative Practice and the Family Health Strategy as models for organizing primary health care. The scale was submitted for content and face panel validation and it was further reevaluated online. Thirty specialists used the scale for the rating of 4 videos produced for the study showing food and nutrition education practices in primary health care settings. Intra- and inter-raters agreement and reliability were analyzed by test at one time point and retest 30 days later. Results The scale initially included 72 items but was reduced to 17 items after content and face validation, together with a fill-out manual that was reviewed by experts. In the re-evaluation, all 17 items were maintained, and content adjustments were made in the manual. Thirty raters applied the scale to the videos in the test, and 28 in the retest. All videos obtained combined kappa values of >0.4. In the test-retest, 19 raters showed >80% agreement; in the inter-rater evaluation, 14 raters generated kappa values >0.75. Conclusion The scale underwent content and face validation and showed to be useful to diagnose the absence and the full addressing of the Brazilian Dietary Guidelines content with good intra- and inter-rater agreement and reliability in different settings of Primary Health Care.