Evaluation of quality of the family health strategy in the Federal District

To evaluate quality of the Family Health Strategy (FHS) in the National Program for Improving Access and Quality of Primary Care in the Federal District (FD) from the perspective of users.

Methods:

Evaluative research carried out in 25 basic health units of the Federal District through a validated questionnaire assessing the following dimensions: access, gateway, bond, service range, coordination, family focus, community orientation, and health professionals.

Results:

Service provision, qualification of professionals, quality of professional-user relationship, and continuity of care were the best evaluated dimensions, while family approach, community approach, and access were the worst. Access to the FHS was found to be compromised, besides failing to establish itself as gateway to the FD health system.

Conclusion:

When they can access the local system, FD users do enjoy several services, but access is still a barrier, mainly because the very system is not prepared to meet users’ needs/preferences. The dimensions regarding family focus and community orientation are precarious, which reveals the need for reflection on the care model adopted in the Federal District.

Descriptors:
Primary Health Care; Health Services Research; Public Health Systems Research; Community Health Services; Surveys and Questionnaires

Variable	Unit Location
Variable	Urban (%)	Rural (%)
Age
Under 20 years	3.3	2.1
From 20 to 39 years	44.3	43.8
From 40 to 59 years	44.3	34.7
From 60 to 79 years	6.6	19
80 years and over	1.6	0.4
Sex
Male	18	23.1
Female	82	76.9
Schooling
Incomplete elementary	24.6	22.3
Complete elementary	13.1	9.5
Incomplete high school	21.3	14.9
Complete high school	31.2	34.3
Incomplete college	4.9	4.6
College degree	1.6	7
Postgraduate studies	-	1.2
No schooling	3.3	6.2
Income
Up to 1 minimum wage	42.6	45
2-4 minimum wages	47.5	42.2
Over 5 minimum wages	8.2	12.8
Occupation
Public server	1.6	4.6
Employee with a formal contract	9.8	28.9
Employee without salary	9.8	7
Unpaid family employee	14.8	24.4
Self-employed w/ establishment	6.6	3.3
Self-employed w/o establishment	3.3	6.6
Employer with fixed employees	1.6	0.4
Unemployed	18	11.2
Retired	6.6	8.3
Pensioner	3.3	2.5
Other	23	2.9
Time attending unit
Between 3 and 11 months	26.2	16.9
One to 4 years	32.8	23.6
Five to 10 years	23	18.2
More than 10 years	18	41.3

AR	Assigned score [95% CI]
AR	Access	Gateway	Bond	Service Range	Coordination	Family Focus	Community Orientation	Health professionals
Areal	1.73 [1.38-2.08]	3.20 [2.60-3.80]	4.51 [4.28-4.74]	4.59 [4.42-4.75]	4.27 [3.93-4.60]	5	3.06 [2.51-3.60]	4.31 [3.99-4.61]
Brazlândia	1.33 [0.95-1.70]	1.53 [0.83-2.21]	3.63 [3.20-4.06]	2.73 [2.42-3.04]	3.25 [2.70-3.78]	2.08 [1.13-3.03]	1.34 [0.81-1.86]	2.14 [1.59-2.67]
Ceilândia	1.98 [1.60-2.35]	2.39 [1.81-2.96]	3.55 [3.16-3.93]	3.85 [3.56-4.13]	3.60 [3.09-4.11]	2.83 [1.89-3.76]	2.42 [1.78-3.05]	3.83 [3.42-4.23]
Estrutural	2.86 [2.66-3.06]	3.83 [3.54-4.10]	4.05 [3.88-4.21]	4.50 [4.39-4.60]	4.00 [3.77-4.21]	2.59 [2.13-3.04]	1.87 [1.56-2.16]	4.05 [3.86-4.23]
Gama	2.23 [2.11-2.34]	3.64 [3.46-3.81]	3.99 [3.88-4.08]	4.54 [4.48-4.59]	4.05 [3.93-4.17]	2.43 [2.16-2.68]	2.43 [2.25-2.61]	4.15 [4.04-4.24]
Itapoã	2.19 [1.56-2.92]	3.39 [2.39-4.38]	4.40 [4.00-4.80]	4.99 [4.95-5]	4.32 [3.78-4.86]	1.91 [0.59-3.12]	0.81 [0.30-1.30]	4.77 [4.61-4.92]
Paranoá	1.86 [1.56-2.15]	4.02 [3.63-4.40]	4.28 [4.05-4.50]	4.55 [4.40-4.70]	4.32 [4.03-4.60]	2.76 [2.04-3.48]	2.87 [2.39-3.34]	4.63 [4.47-4.78]
Samambaia	1.91 [1.38-2.44]	4.19 [3.50-4.86]	4.39 [4.02-4.75]	4.72 [4.55-4.89]	4.55 [4.16-4.93]	3.89 [2.89-4.87]	2.29 [1.44-3.12]	4.38 [3.92-4.82]
São Sebastião	1.23 [0.90-1.55]	2.14 [1.55-2.72]	3.79 [3.42-4.14]	1.94 [1.67-2.21]	2.99 [2.48-3.48]	2.74 [1.84-3.63]	1.77 [1.32-2.22]	3.00 [2.58-3.41]
Sobradinho	1.98 [1.77-2.17]	2.61 [2.25-2.96]	3.88 [3.68-4.06]	3.51 [3.34-3.67	3.57 [3.31-3.81]	2.40 [1.94-2.84]	2.06 [1.75-2.35]	3.83 [3.62-4.03]
FD	2.17 [2.09-2.25]	3.35 [3.20-3.51]	3.98 [3.88-4.07]	4.26 [4.16-4.36]	3.92 [3.83-4.02]	2.64 [2.48-2.81]	2.18 [2.05-2.32]	3.99 [3.88-4.10]

Access	Score
Do you find it easy to get a medical consultation in this health care unit?	3.16
Do you think you can get a (non-urgent) medical consultation at this health facility within 24 hours?	1.29
Is this facility/center/unit open during the weekends?	0.53
Is this facility/center/unit open after 6 pm at least one day during the week?	0.63
During the regular operating period of this facility/center/unit, is there an available telephone number to make appointments or ask for information?	1.41
When this facility/center/unit is closed, is there an available telephone number to make appointments or ask for information?	0.78
Do you usually have to wait more than 30 minutes in this health unit before being seen by a health professional?	4.20

Services	Score
Vaccinations for children	4.44
Child care	4.83
Adult care	4.89
Elderly care	4.88
Prenatal control	4.93
Family planning services	4.62
Attention to sexually transmitted diseases (e.g. AIDS, syphilis)	4.30
Tuberculosis control program	4.08
Controls/treatment of epidemic diseases (e.g. dengue, malaria)	4.22
Counseling for chronic diseases (arthritis, asthma, heart disease)	4.21
Treatment/control of diabetes	4.72
Treatment/control of hypertension or high blood pressure	4.82
Treatment of minor injuries	4.31
Advice on alcohol and tobacco use	3.64
Mental health problems	2.37
Advice on diet or nutrition	3.74
Advice on physical activity	3.75
Education on hygienic preparation of water and food	3.24
Domestic violence education	1.81
Home accident education	2.00
Preventive dental education (tooth brushing, oral hygiene)	3.5
Dental care	3.4

Dimensions	Score
Gateway
In general, when you or your family needs some preventive health care (vaccinating, measuring blood pressure, routine tests), do you come to this facility/center/unit?	3.92
When you or your family has a health problem, do you usually come to this facility/center/unit?	3.16
Except in emergency cases, do you normally have to make an appointment at this facility/center/unit before consulting with a specialist?	2.95
Coordination
Do you receive the results of your laboratory tests?	4.13
Do you bring the results of your laboratory tests to this facility/center/unit?	4.63
Are you notified of the scheduling of your return visit to know the results of your lab tests?	3.37
When you come to this facility/center/unit, do you bring documents, medical records, test results or requests, immunization cards, etc.?	4.87
Does the professional of this facility/center/unit always have your medical records available when you are being seen or examined?	4.75
Do the professionals of this facility/center/unit allow you to see your medical record?	1.51
Family Focus
During the consultation, do the professionals of this unit usually ask about your living conditions and those of your family (unemployment, availability of drinking water, basic sanitation etc.)?	1.34
During the consultation do the professionals of this facility/center/unit usually ask for information on diseases of other family members?	3.95
Community Orientation
Are you or your family consulted to know if the services of this facility/center/ unit meet your health problems?	0.95
Do you think that the professionals of this facility/center/unit know about the most important health problems in your community?	3.18
Does this facility/center/unit offer services in schools?	2.5
How often do the professionals in this facility/center/unit make home visits?	2.78
Do you think this facility/center/unit works with others groups to carry out activities that improve the living conditions of your community?	2.19

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding Author: Helena Eri Shimizu E-mail: shimizu@unb.br