The challenges of teamwork in the family health strategy

Disparities in the protagonism of oral health teams in the work process of Primary Healthcare

OBJECTIVE

Evaluate and compare the protagonism of Oral Health teams (OHt) in the teamwork process in Primary Healthcare (PHC) over five years and estimate the magnitude of disparities between Brazilian macro-regions.

METHODS

Ecological study that used secondary data extracted from the Sistema de Informação em Saúde para a Atenção Básica (SISAB - Health Information System for Primary Healthcare) from 2018 to 2022. Indicators were selected from a previously validated evaluative matrix, calculated from records in the Collective Activity Form on the degree of OHt's protagonism in team meetings and its degree of organization concerning the meeting agendas. A descriptive and amplitude analysis of the indicators' variation over time was carried out, and the disparity index was also calculated to estimate and compare the magnitude of differences between macro-regions in 2022.

RESULTS

In Brazil, between 3.06% and 4.04% of team meetings were led by OHt professionals. The Northeast and South regions had the highest (3.71% to 4.88%) and lowest proportions (1.21% to 2.48%), respectively. From 2018 to 2022, there was a reduction in the indicator of the "degree of protagonism of the OHt" in Brazil and macro-regions. The most frequent topics in meetings under OHt's responsibility were the work process (54.71% to 70.64%) and diagnosis and monitoring of the territory (33.49% to 54.48%). The most significant disparities between regions were observed for the indicator "degree of organization of the OHt concerning case discussion and singular therapeutic projects".

CONCLUSIONS

The protagonism of the OHt in the teamwork process in PHC is incipient and presents regional disparities, which challenges managers and OHt to break isolation and lack of integration, aiming to offer comprehensive and quality healthcare to the user of the Unified Health System (SUS).

A percepção do usuário idoso sobre o acesso e a qualidade da Atenção Primária à Saúde

Introdução: O envelhecimento populacional brasileiro já repercute na Atenção Primária à Saúde. Objetivo: Avaliar a percepção dos idosos quanto ao acesso e à qualidade da atenção em Bambuí, Minas Gerais. Métodos: Esta pesquisa tem abordagem qualitativa. O modelo dos signos, significados e ações foi utilizado na coleta e análise dos dados. Foram realizadas entrevistas nos domicílios, cuja escolha baseou-se em critérios para garantir a heterogeneidade dos participantes. Resultados: A análise fundamentou-se na perspectiva êmica. Nela, emergiram elementos que compõem a percepção do usuário idoso acerca da implantação e da consolidação do Sistema Único de Saúde e da Estratégia Saúde da Família local na categoria ― Desafios da Atenção Primária à Saúde na percepção do usuário idoso. Observou-se na percepção dos idosos, o serviço público evoluiu para melhor, porém ainda persistem dificuldades de acesso e a insatisfação de alguns com a qualidade do serviço, o que os leva à busca pela atenção secundária, pela urgência e pela medicina privada. Conclusões: Os achados demonstram que na percepção dos idosos a implantação da Estratégia Saúde da Família foi positiva, porém a atenção primária em saúde ainda pode ser melhorada.

Prática colaborativa na Estratégia Saúde da Família

Objetivo: compreender a configuração da Prática Colaborativa no contexto da Estratégia Saúde da Família. Método: trata-se de um estudo de caso único, de natureza qualitativa, realizado com trinta e cinco profissionais das equipes de saúde da família. A coleta de dados ocorreu por meio de entrevistas, guiadas por roteiro semiestruturado e observação não participante. Os dados foram analisados por meio de Análise de Conteúdo Temática. Resultados: os resultados evidenciaram potencialidades da prática colaborativa para a qualificação das práticas profissionais e dos resultados de saúde, no contexto da ESF. Entretanto observou-se insuficiência de dispositivos organizacionais para apoiar o trabalho compartilhado na ESF, desafio a ser superado, inclusive no que tange às políticas públicas, revelando o chamamento para a educação interprofissional no contexto dos serviços de saúde para estimular a colaboração. Conclusão: a configuração da Prática Colaborativa interprofissional no contexto da Estratégica Saúde da Família é desafiadora e requer processos interacionais e da organização do trabalho.

Patient safety culture in primary health care: Medical office survey on patient safety culture in a Brazilian family health strategy setting

Study objectives

To assess the patient safety culture in Primary Health Care (PHC) setting after the transition to the Family Health Strategy (FHS) model in a Brazilian metropolitan area and compare the results between the categories of health care professionals.

Methods

A cross-sectional study including 246 workers from primary health care services in Federal District, Brazil. Data collection took place from October to December 2019 through the Medical Office Survey on Patient Safety Culture (MOSPSC) application. Patient safety culture was considered positive when the score was above 60%. For comparisons between the categories of health care professionals’, the ANOVA and Kruskal-Wallis test were used for composite percent positive scores, and Pearson’s chi-square or Fishers exact test for frequency and percentage of positive responses.

Results

The overall MOSPSC composite percent positive score was 49.9%. Among the 12 dimensions, only three showed a positive patient safety culture: Teamwork (73.1%), Organizational learning (62.9%), and Patient care tracking/follow-up (60.1%). The percentage of positive responses on overall quality assessment (78.1%) and overall patient safety assessment (78.0%) showed a positive evaluation. There was no significant difference in the composite percent positive score of overall MOSPSC (p = 0.135) and the percentage of positive responses on overall patient safety assessment (p = 0.156) between the categories of health care professionals. Overall quality assessment showed a significant difference between job roles (p < 0.001), in which nursing /health care technicians showed a significantly lower score than other job roles.

Conclusion

The patient safety culture assessment showed a weakness in the patient safety in the PHC services. The MOSPSC and nine of its dimensions presented a negative safety culture assessment, regardless of the high scores in the overall patient safety and quality assessments.

Implementation of the National Policy for Comprehensive Attention to Men's Health: challenges experienced by nurses

OBJECTIVE

To analyze the challenges experienced by nurses in the implementation of the National Policy for Comprehensive Attention to Men's Health.

METHOD

Descriptive, qualitative study, carried out with nurses working in Primary Health Care in a city in the state of Bahia, Brazil. Individual interviews were carried out and then analyzed using the Discourse of the Collective Subject, in the light of the guidelines of the National Policy for Comprehensive Attention to Men's Health.

RESULTS

A total of 40 nurses participated. The challenges for the implementation of the policy are related to the inoperability of government actions, weaknesses in municipal management, underfunding and discontinuity of actions.

CONCLUSION

Nurses face complex macro-management challenges in the implementation of the National Policy for Comprehensive Attention to Men's Health in Primary Health Care.

A Comparative Case Study: Does the Organization of Primary Health Care in Brazil and Turkey Contribute to Reducing Disparities in Access to Care?

Brazil and Turkey are among the few high-middle-income countries that explicitly chose to strengthen their primary health care (PHC) systems as the centerpiece of much broader health system reforms aiming to narrow inequities in access to care. This comparative case study reviews the organization of Brazil and Turkey's PHC systems to derive lessons that can apply to other countries that may consider reforming the organization of PHC systems as a way to address health inequities. The analysis uses the Flagship Framework to investigate how the organization of PHC delivery in Brazil and Turkey can lead to measurable improvements in access to care. It compares (1) the degree of decentralization in PHC service delivery responsibilities, (2) the use of multi-professional PHC teams, and (3) patient impanelment strategies. The comparative analysis offers three important lessons. First, changes in the organization of PHC systems can contribute to observable improvements in the level and distribution of health outcomes, but organizational strategies do not guarantee eliminating disparities in access. Second, PHC systems can operate in health systems with varying degrees of decentralization, but the level of decentralization may influence implementation. Third, relying on multi-professional PHC teams that serve geographically empaneled populations can improve equitable access to care, but course corrections may be needed to address evolving health demands.

Matrix support in children's mental health in Primary Health Care: institutional socio-clinical intervention research

OBJECTIVE

To analyze matrix support for Family Health Strategy teams in relation to Mental Health in Children and Adolescents.

METHOD

This is a research-intervention with a qualitative approach, based on the Institutional Analysis framework, Socio-clinic, carried out with eighteen health workers from two Family Health Strategy and Psychosocial Care Center teams of a small municipality in the countryside of the state of São Paulo, through eleven reflection meetings.

RESULTS

The following themes emerged: The dynamics of relations in the FHS territory; Matrix Support as a technological device: unveiling established practices. Subsequently, the results were discussed based on the principles of Institutional Socio-clinic.

CONCLUSION

Matrix support in children's mental health, based on Institutional Socio-clinic, favored the deterritorialization of professionals, revealing how mental health care is provided for children and adolescents, and the crossings that occur in the production of this care as well as possible paths to be followed to improve health actions.

Knowledge and practices of Primary Care professionals on diabetic neuropathy: study of social representations

OBJECTIVES

to analyze the knowledge and practices of Primary Health Care professionals about diabetic neuropathy through their social representations.

METHODS

a qualitative, descriptive study, anchored in the procedural aspect of the Theory of Social Representations. It was carried out in four Family Health Units in Belém-Pará, with 31 professionals from four health teams. Data were produced by individual semi-structured interviews, and the corpus was submitted to content analysis.

RESULTS

two thematic categories were defined, showing the participants' understanding and imagination about neuropathy, as well as the biopsychosocial repercussions of this complication in patients' daily lives. The multidisciplinary practices developed in the context of disease treatment/prevention and the consequences of this performance were also shown.

FINAL CONSIDERATIONS

professionals' representations are anchored in neuropathy occurrence due to the deficient standard of care for themselves by patients, which results in the team's surpassing care attitude as an alternative to illness' challenges.

Strategies used by nurses for conflict mediation

OBJECTIVE

to understand what are the strategies used by nurses to mediate conflicts.

METHOD

a qualitative and descriptive study that used oral history, carried out in the organ transplant unit of a university hospital located in the city of São Paulo, SP, Brazil. The population consisted of seven nurses with one year or more of experience in the unit. Data collection took place with semi-structured interviews. The reports were transcribed, and their content was analyzed according to Minayo's model.

RESULTS

three categories have emerged: Conflict-generating sources; Strategies for conflict mediation such as collaboration, dialogue, standardization, and expressive action by nurses to mediate conflicts; Consequences of conflicts.

CONCLUSION

there is a need to invest in the training of nurses to mediate conflicts, and it is important to develop skills such as interpersonal relationships and communication for the success of their professional performance.

Essential management competencies of nurses: actions and interactions in the context of the Family Health Strategy

OBJECTIVE

to understand the meanings attributed by the Family Health Strategy (FHS) nurses to the management competencies essential to the performance of their actions.

METHOD

explanatory, qualitative study, whose methodological framework was based on Grounded Theory. A total of 12 Family Health Strategy nurses from a municipality in southern Brazil participated through semi-structured interviews, between December 2018 and February 2019.

RESULTS

the experience was understood by the phenomenon "Lapidating management competencies daily to play the role of a nurse in the context of the Family Health Strategy". As action/interaction strategies, the following categories emerged: "Evidencing the management skills of Family Health Strategy nurses" and "Recognizing the need for strategies to work on specificities in the context of the Family Health Strategy".

FINAL CONSIDERATIONS

according to the meanings attributed by nurses, there are several essential management skills for the work in the Family Health Strategy, but they are still little worked and developed in this context, mainly because it is a complex health care scenario.

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.

Disclosure of difficult news in primary health care: aspects that hinder or facilitate communication from the perceptions of nurses

OBJECTIVE

To identify aspects that hinder or facilitate the work of nurses in primary health care when disclosing difficult news.

METHOD

Qualitative, descriptive and exploratory study addressing 15 nurses from ten primary health care units located in the south of Brazil. Data were collected from February to April 2017, using a semi-structured interview. Interviews were audio-recorded and analyzed based on discourse analysis.

RESULTS

The aspects that hinder communication include the demand for services; work organization; the characteristics of patients; and personal aspects. Facilitating aspects include privacy and being in the community. Also hindering or facilitating communication: the way the network functions and the staff; academic training; professional experience; personal aspects.

CONCLUSION

This topic is seldom addressed during academic training and this lack of preparedness is one of the main barriers hindering the disclosure of difficult news. Hence, it is essential that teaching institutions establish a discussion regarding this topic.

Adversities experienced by professionals in the Primary Healh Care: implications for the meanings of the work

Abstract Objective: To understand the experiences of adversity in the Primary Health Care and their implications for the meanings of the participant professionals' work. Methods: Single case study, of qualitative nature, with 62 professionals active in the Family Health Strategy, whose data were collected by means of semi-structured interview and comics technique and analyzed by the thematic content analysis, with aid of Atlas ti, version 7 software. Results: There emerged the categories: Experiences of adversities in the Family Health Strategy and Implications of the adversities for the meaning of the professionals' work. In these categories were pointed aspects related to inadequate conditions of work, to wage question, to excessive demands and interpersonal conflicts that provided negative implications for the meanings of the team's work, for satisfaction and usefulness of the work. Conclusion: it was possible to apprehend the experiences of adversities in the work environment and its implications on the meanings of the work that can impair the professionals' actions. Implications for practice: the study may subsidize the reflection on the strategies that enable the reduction of the adversities in the work environment, contributing to benefiting the worker's health and care of quality for the population.