Residência em Medicina de Família e Comunidade e qualidade da atenção primária à saúde do município de Palmas - Tocantins

Abstract

Introduction: Primary Health Care (PHC) is a strategy to organize health systems to enable universal access to services and comprehensive care over time. In Brazil, the strategy adopted to expand PHC is the Family Health Strategy (ESF). Financing for the expansion of the ESF has been growing, as has the number of teams deployed. Given this scenario, the PHC reform generated several needs to improve the network. One of them is the professional qualification of doctors to work at this level through the Residency Programs in Family and Community Medicine (PRMFC). Objective: To compare the quality of health care in PHC units with and without PRMFC. Methods: Cross-sectional study using a questionnaire applied to health professionals from Basic Health Units (UBS) with and without PRMFC in Palmas, Tocantins, between August 2020 and July 2021. The following instruments were applied: a sociodemographic questionnaire and the questionnaire of the QualiAB Assessment and Monitoring System for Primary Health Care. Results: 98 health professionals from 16 UBS were interviewed (eight with PRMFC and eight without PRMFC). UBS with PRMFC presented better evaluation compared to UBS without PRMFC, with 8 UBS with PRMFC being evaluated in the second-best quartile (Q2) (100.00%), while four UBS without PRMFC (50.00%) were evaluated in Q2 and four in Q3 (50.00%), p = 0.021. In the Management and Local Governance dimension, the UBS with PRMFC had a better evaluation compared to UBS without PRMFC, and, similarly to the general evaluation, eight UBS with PRMFC were evaluated in the second-best quartile (Q2) (100.00% ), while four UBS without PRMFC (50.00%) were evaluated in Q2 and four in Q3 (50.00%), p = 0.021. Regarding the Health Care Management dimension, the UBS with PRMFC also had a better evaluation than UBS without PRMFC, with one UBS with PRMFC being evaluated in the best quartile (Q1) (12.50%) and seven in Q2. while two UBS without PRMFC (25.00%) were evaluated in Q2, five UBS in Q3 (62.50%) and one UBS in Q4 (12.50%), p = 0.021. In the items of the Women's Health Care subdomain, UBS with PRMFC performed better than UBS without PRMFC in the quality of primary health care for women (median: 78.1; IQ25-75%: 74.3-82.3 versus median: 56.8; IQ25-75%: 48.5-65.6, p = 0.007). Similarly, UBS with PRMFC had better assessment of Child and Adolescent Health Care than UBS without PRMFC (median: 61.8; IQ25-75%: 33.4-71.0 versus median: 53.6; IQ25-75%: 27.2-60.8, p = 0.015) and Adult and Elderly Health Care (median: 70.8; IQ25-75%: 61.7-78.9 versus median: 56, 8; IQ25- 75%: 33.6-70.0, p<0.001). Conclusion: The development of Residency Programs in Family and Community Medicine in primary health care units may be associated with an improvement in the quality of Primary Health Care in Palmas. In our study, it was observed that UBS with residency programs had better ratings in the QualiAB questionnaire and its Management and Local Governance and Health Care Management dimensions than UBS without residency programs, as well as in the quality of primary health care to the different cycles of life: Child and Adolescent Health Care, Women's Health Care, and Adult and Elderly Health Care.