Aplicativo para sistematizar informações no planejamento de ações de saúde pública

Development of an application for mobile devices to identify the frailty phenotype among the elderly

Abstract Objective: to develop a mobile app to quickly and safely identify frailty syndrome features among the elderly. Method: a cross-sectional study was conducted. The application was developed for the Android platform in the Java programming language and XML markup. The study instrument was based on five frailty phenotype criteria. The tests were conducted with 20 elderly persons living in a long-term care facility. Results: the twenty elderly persons had a mean age of 76.55 (±9.5) years. Thirteen were identified as frail, five were pre-frail and two were non-frail. The comparison of the results of the instruments of analysis coincided in the general evaluation of frailty and in the individual identification of the five criteria. Conclusion: the data suggests that the use of the application for the evaluation of frailty among the elderly was performed safely, with the advantage of quick access to allow the monitoring of the clinical status and prognosis of the patient.

Primary health care assessment tools: a literature review and metasynthesis

This study comprises a systematic review and metasynthesis of qualitative literature on national and international databases to identify the main tools used to assess Primary Health Care (PHC). A total of 3,048 results were returned for literature written in Portuguese, Spanish and English published between 1979 and 2013. Thirty-three articles/studies were selected after thorough reading and analysis. Eight of these studies addressed the use of one or more of the following validated PHC assessment tools: the WHO Primary Care Assessment Tool (PCET); the ADHD Questionnaire for Primary Care Providers (AQ-PCP); the General Practice Assessment Questionnaire (GPAQ), PACOTAPS (primary health care software); and the PCAT (Primary Care Assessment Tool). The study showed that the majority of these tools were used internationally. The PCAT and EUROPEP were used in Brazil and the most commonly used tool in this country was the PCAT. The results show that the use of research tools to assess PHC may assist in the creation of new proposals to improve family healthcare and that PCAT is the most adequate tool for this purpose.

Características da utilização de serviços de atenção básica à saúde nas regiões Sul e Nordeste do Brasil: diferenças por modelo de atenção

Considerando o destaque da atenção básica para o sistema de saúde e a consolidação da Estratégia da Saúde da Família, é importante que as informações sobre a demanda atendida sejam atualizadas para apoiar a gestão do SUS. O estudo comparou o perfil da demanda atendida em unidades básicas de saúde (UBS) de dois modelos de atenção (tradicional e saúde da família [PSF]) em 240 UBS de sete estados do Sul e Nordeste. Coletados em formulário próprio, todos os atendimentos de um dia de trabalho foram processados com o aplicativo PACOTAPS. Foram registrados 26.019 atendimentos, 52% no Sul e 48% no Nordeste; um terço em UBS Tradicionais e 67% em UBS do PSF. A maior proporção de atendimentos foi para mulheres entre 15 e 49 anos (36%), com diferenças significativas entre os modelos, sendo maior nas UBS do PSF. A segunda maior proporção foi de pessoas com 50 anos ou mais de idade (30%), significativamente maior nas UBS Tradicionais. Os procedimentos mais registrados foram os atendimentos básicos de enfermagem (33%), com maior proporção nas UBS Tradicionais. A proporção de consultas médicas foi de 22%, sendo duas vezes maior nas UBS Tradicionais. O perfil da demanda refletiu as diferenças entre os modelos de atenção no país e pode subsidiar a organização dos processos de trabalho em atenção básica.

[Management of work, education, information, and communication in primary healthcare in cities in Southern and Northeastern Brazil]

Decentralization in Brazil's Unified National Health System is challenging the management capability at the local level. Municipalities are required to operate health teams, provide infrastructure, technology, and supplies for the health services, and organize the work process. An epidemiological survey assessed the management of work, education, information, and communication in primary care services in 41 municipalities with more than 100,000 inhabitants each in the Northeast and South of the country. Health professionals and administrators were insufficiently trained for their daily responsibilities, and the infrastructure and management tools were deficient. Precarious work contracts (lack of formal job stability) for health workers is a serious problem in Brazil's primary care system. The work supervision was weakly linked to health care and planning. Continuing education for the health team was limited, and health information focused only on collection of data to send to the State and Federal management levels. Thus far health communication has been ineffective as a tool to connect primary care managers and professionals to the population and society.

[Impact of immunization measures by the Family Health Program on infant mortality from preventable diseases in Olinda, Pernambuco State, Brazil]

This article analyzes the impact of the Family Health Program (FHP) on infant health in Olinda, Pernambuco State, Brazil, evaluating immunization and infant mortality from vaccine-preventable diseases. A time-series study was conducted with data from the principal health information systems, analyzing indicators before and after implementation of the FHP in 1995. The independent variable was year of birth, related to degree of population coverage by the FHP. Three periods were analyzed: 1990-1994 (prior), 1995-1996 (implementation phase: 0 to 30% coverage), and 1997-2002 (intervention: coverage of 38.6% to 54%). Trends in the indicators were analyzed by simple linear regression, testing significance with the t test. During the implementation period there was an increase in all the vaccination coverage rates (176% BCG, 223% polio, 52% DPT, 61% measures) and a decrease in infant mortality from preventable diseases (12.7 deaths/year), even without a decrease in absolute poverty in the municipality or an increase in either coverage by the public health care system or the sewage system. Improvement in the indicators demonstrates the effectiveness of FHP actions in the municipality.

[Architectonic barriers for elderly and physically disabled people: an epidemiological study of the physical structure of health service units in seven Brazilian states]

This cross-sectional study, carried out in 41 Brazilian cities, describes the conditions of the basic health units (UBS) in relation to architectural barriers. A sample of 240 UBS with different modalities of basic attention was selected at random. The professionals working in the UBS answered a standardized questionnaire about architectonic barriers in their units.Approximately 60% of the UBS were classified as inadequate in relation to easy access for the elderly and subjects with disabilities. The existence of steps, the lack of railings, the inexistence of slopes, the lack of bathrooms adapted for the users of wheelchairs, and the inadequate waiting rooms were a constant in the studied UBS. The conclusion is that many architectural barriers make the access to the health services difficult. The population aging and the consequent increasing demand for healthcare by the elderly, the increase of chronic diseases and use of UBS by disabled persons make an urgent institutional intervention for improving the physical the structure of the UBS indispensable.

Desempenho do PSF no Sul e no Nordeste do Brasil: avaliação institucional e epidemiológica da Atenção Básica à Saúde

A pesquisa, desenvolvida dentro dos Estudos de Linha de Base do Proesf analisou o desempenho do Programa Saúde da Família (PSF) em 41 municípios dos Estados de Alagoas, Paraíba, Pernambuco, Piauí, Rio Grande do Norte, Rio Grande do Sul e Santa Catarina. Utilizou delineamento transversal, com grupo de comparação externo (atenção básica tradicional). Entrevistou 41 presidentes de Conselhos Municipais de Saúde, 29 secretários municipais de Saúde e 32 coordenadores de Atenção Básica. Foram caracterizados a estrutura e o processo de trabalho em 234 Unidades Básicas de Saúde (UBS), incluindo 4.749 trabalhadores de saúde; 4.079 crianças; 3.945 mulheres; 4.060 adultos e 4.006 idosos. O controle de qualidade alcançou 6% dos domicílios amostrados. A cobertura do PSF de 1999 a 2004 cresceu mais no Nordeste do que no Sul. Menos da metade dos trabalhadores ingressaram por concurso público e o trabalho precário foi maior no PSF do que em UBS tradicionais. Os achados sugerem um desempenho da Atenção Básica à Saúde (ABS) ainda distante das prescrições do SUS. Menos da metade da demanda potencial utilizou a UBS de sua área de abrangência. A oferta de ações de saúde, a sua utilização e o contato por ações programáticas foram mais adequados no PSF.