Avaliação do acesso de primeiro contato na Atenção Primária à Saúde na perspectiva do enfermeiro

Abstract

Introduction: The evaluation of Primary Health Care (PHC) in Brazil is a priority for the Ministry of Health, which develops strategies to measure and evaluate results regarding the organization and quality of services, in view of the accelerated increase in the number of Family Health teams (FHt) throughout the country. Objective: To analyze the access to first contact attribute and associated factors from the perspective of PHC nursing professionals in the city of Montes Claros, MG, Brazil. Method: Analytical, quantitative cross-sectional study, developed in the PHC of the city of Montes Claros/MG, from November to December of 2021. The universe is made up of 163 professional nurses working in the city's PHC in 2021. Of these, 142 from the eSF, 12 institutional supporters, eight preceptors from the Multidisciplinary Family Health Residency Program (RMSF) and one from the Primary Care team (eAP). The inclusion criteria were: active professionals who agreed to participate in the research and who signed this Free and Informed Consent Form (FICF) with a minimum of six months' experience in the eSF. Professionals on leave for any reason longer than 30 days were excluded from the study. Of the total, 52 professionals did not meet the inclusion criteria, with the participating population consisting of 111 subjects. The study was approved by the Unimontes Research Ethics Committee - Report nº. 3,650,670/2019, respecting the ethical principles that guide research involving human beings, described and established by Resolution 466/2012. After the consent of the municipal managers, through official documents, contact was made with the professionals for clarifications about the research and the online sending of the invitation and ICF. The interviews with the 111 participants took place via remote access platforms, due to the Covid-19 pandemic. Data were collected using an instrument composed of two parts: a Google form, which included sociodemographic and professional characteristics, independent variables (gender, age group, marital status, family nucleus, monthly income, training time, postgraduate degree, participation in some management training in PHC, total working time in PHC, working time in the current FHt, total working hours and institutional link). The second part corresponded to the evaluation of the APS “access to first contact” attribute (dependent variable), using the PCATool instrument - professional version. The instrument consists of nine items, according to each answer option, the values assigned define scores. The components are calculated by adding all scores divided by the total number of items, totaling nine. The result indicates the classification of each attribute, with values ≤ 6.6 being considered low. Initially, descriptive analyzes were carried out on all variables, using simple and relative frequencies. Then, bivariate analysis was performed, adopting the Poisson Regression model with robust variance, estimating crude and adjusted Prevalence Ratios (PR) with their respective 95% confidence intervals. The variables that presented a p-value ≤ 0.25 in the bivariate analysis were selected for multiple analysis, with the final model being considered a p-value < 0.05. To evaluate the quality of the model fit, the Deviance Aprovação 004 (75984715) SEI 2310.01.0014430/2023-04 / pg. 6 test was used. Results: 111 professional nurses participated in the study, the majority of whom were female (85.6%); age group over 30 years old (73.9%). In relation to the professional profile, 73.9% had a training period of up to 12 years. The average score assigned in the accessibility dimension was 5.08 (SD = 1.3; minimum value = 2.22; maximum value = 8.15). It was observed that 83.8% (n = 93) consider access to first contact to health services in PHC to be low. An association was observed between the outcome of first contact with institutional employment (p = 0.018) and another employment relationship (p = 0.013). Low value of first contact access to health services in PHC was 1.16 times (16% higher) among public servants/contractors and 1.16 times (16% higher) among those who did not have another employment relationship. Conclusions: The low score for the first contact access attribute suggests the fragility of the Family Health Strategy as a gateway to the Unified Health System.