Atenção à saúde para pessoas com deficiência no contexto da Atenção Primária em Saúde: avaliação da qualidade e representações sociais de médicos da Estratégia Saúde da Família

Abstract

This study aimed to evaluate the quality of health care for people with disabilities (PwD) in the context of Primary Health Care (PHC) and to analyze the social representations of physicians who work in Family Health Strategy teams regarding the health care they provide toPwD. This is a multifaceted investigation, which included three distinct studies. The first studywas an integrative literature review, addressing the quality of health care for PwD in thecontextof PHC. The search for articles was performed in the Virtual Health Library and Pubmed databases, in August 2019, including works published between 2015 and 2019. After reading and analyzing the titles and abstracts, 33 articles remained for review. In general, there was a very small number of publications addressing the topic. A good part of the selected articles emphasized, among others, the barrier to access as a major barrier in the care of PwD. The results emphasize that PHC team professionals are not adequately trained for PwD health care.The second study was a population-based survey to identify the distribution of PwD in the community and assess the attributes of the PHC services they use. Forty urban census tracts inthe city were drawn, approaching 20 households in each tract, and applying a sociodemographicquestionnaire and the Primary Care Assessment Tool (PCATool). In the 800 households visited,2680 people were found, of which 50 were PwD, according to the families' records, 45 adults and five children. The main deficiencies recorded were mental/intellectual (40.0%) and physical (34.0%). In relation to adults, the highest PCATool scores were for First Contact Access/Use, Longitudinality and Coordination/Information System. The other attributes showed values below 6.6, with critical values for the First Contact Access/Accessibility attributes (4.38) and available services (3.58). Among children, the lowest values were for First Contact Access/Accessibility (3.56) and Coordination/Information Systems (4.67). The third study analyzed the Social Representations of physicians who work in PHC teams on health care for people with disabilities, based on the Theory of Social Representations, with a structural approach from the Central Nucleus Theory. The study was conducted using the word evocation technique. EVOC® and IRAMUTEC® software were used for data analysis. A total of 109 physicians participated in the study, with a predominance of young female professionals, with less than five years of experience in the services. Data analysis suggests that care for PwD in primary care is guided by a truncated practice, permeated by fear and difficulties for doctors and patients. The results pointed the urgent need to reorganize services to improve care for PwDin primary care. There is a difficulty expressed in the training process and in the current care model that do not ensure quality and dignity to PwD in the context of health care in PHC.