Desenvolvimento e validação de um questionário (QSPC-Q) para avaliação da qualidade e fortalecimento da atenção primária no Brasil

Sales, Mozart Júlio Tabosa; Goes, Paulo Sávio Angeiras de; Carvalho, Aline Priscila Rego de; Silva, Caio Cesar Arruda da; Silva Junior, José Roberto da; Abreu, Amanda Carolina Félix Cavalcanti de; Pazos, Carolina Thaiza Costa; Vidal, Suely Arruda

Mozart Júlio Tabosa Sales

conception

data collection and analysis

interpretation

writing

review of the manuscript

approved the final version and submission of the manuscript

Instituto de Medicina Integral Professor Fernando Figueira. R. dos Coelhos 300, Coelhos. 52060-050 Recife PE Brasil. mozart.sales@imip.org.br

Faculdade Pernambucana de Saúde. Recife PE Brasil.

https://orcid.org/0000-0001-6805-4636

Paulo Sávio Angeiras de Goes

conception

data collection and analysis

interpretation

writing

review of the manuscript

approved the final version and submission of the manuscript

Universidade Federal de Pernambuco. Recife PE Brasil.

Faculdade de Medicina de Olinda. Olinda PE Brasil.

https://orcid.org/0000-0002-6708-0450

Aline Priscila Rego de Carvalho

data analysis

interpretation

writing

review of the manuscript

approved the final version and submission of the manuscript

Secretaria Estadual de Saúde de Pernambuco. Recife PE Brasil.

https://orcid.org/0000-0002-4779-793X

Caio Cesar Arruda da Silva

data analysis

interpretation

writing

review of the manuscript

approved the final version and submission of the manuscript

Secretaria Estadual de Saúde de Pernambuco. Recife PE Brasil.

https://orcid.org/0000-0002-9612-4387

José Roberto da Silva Junior

data analysis

interpretation

writing

review of the manuscript

approved the final version and submission of the manuscript

Instituto de Medicina Integral Professor Fernando Figueira. R. dos Coelhos 300, Coelhos. 52060-050 Recife PE Brasil. mozart.sales@imip.org.br

Faculdade Pernambucana de Saúde. Recife PE Brasil.

https://orcid.org/0000-0003-3843-005X

Amanda Carolina Félix Cavalcanti de Abreu

data analysis

interpretation

writing

review of the manuscript

approved the final version and submission of the manuscript

Secretaria de Saúde do Recife. Recife PE Brasil

https://orcid.org/0000-0002-5803-0208

Carolina Thaiza Costa Pazos

conception

data collection and analysis

approved the final version and submission of the manuscript

Universidade Federal de Pernambuco. Recife PE Brasil.

https://orcid.org/0000-0002-0348-3461

Suely Arruda Vidal

conception

data collection and analysis

interpretation

writing

review of the manuscript

approved the final version and submission of the manuscript

Instituto de Medicina Integral Professor Fernando Figueira. R. dos Coelhos 300, Coelhos. 52060-050 Recife PE Brasil. mozart.sales@imip.org.br

https://orcid.org/0000-0002-4268-520X

Chief editors:

Maria Cecília de Souza Minayo, Romeu Gomes, Antônio Augusto Moura da Silva

Indicator	Consensus among responses in the first round	Consensus after in- person meeting
Attending scheduled and spontaneous demand	90%	100%
Reception, risk classification, health needs assessment, and vulnerability analysis	60%	100%
Priority attention to risk groups and patients with clinical or behavioral risk factors	60%	87.50%
Territorialization and mapping of the area where BHU teams operate	90%	100%
Adscription of patients, bonding, and accountability	80%	100%
Qualified listening	60%	87.50%
Follow-up of vulnerable patients or those with diseases or conditions sensitive to primary care	80%	100%
Prenatal and postpartum care	90%	100%
Consultation with identification and registration of all health and socio-environmental vulnerability issues	40%	87.50%
Referral to specialized care	60%	100%
Home care for patients with controlled or compensated health problems and physical difficulties or impossibilities	60%	100%
Educational activities for promotion and prevention in the FHU, households, and community.	70%	87.50%
Active surveillance	50%	87.50%
Patient and family registration in the food supplementation program	20%	-
Articulation between the team, traditional caregivers, FHSC, and other levels of care	50%	100%
Organization of medical records and agenda in the FHU.	90%	100%
Epidemiological diagnosis of the territory with the Municipal Health Department to identify problems and schedule consultations	30%	75%
Monitoring and analysis of health indicators and information	50%	100%
Planning meetings with the FHS to manage and organize the work process of the team (self-assessment)	80%	100%
Requirement of medical records and previous exams from patients	20%	100%
Permission for patients to consult their medical records	40%	37.50%
Monitoring of the written information exchanged between referral and counter-referral services	50%	87.50%
Holding meetings to discuss community health issues, monitoring of indicators, social control, satisfaction, and the communication channel with the leaders.	60%	75%
Orientation of conduct according to community needs and profile	90%	100%
Conduction of home visits to discuss health or family issues of the patient, discuss or question the family history, and plan the treatment	30%	87.50%
Knowledge and respect for the beliefs, customs, and traditions of communities, rural populations, settlers, quilombolas, and indigenous people	90%	100%

Variables	Average if the item is deleted	Variance if the item is deleted	Corrected item- total correlation	Cronbach’s alpha if the item is deleted
1. First-contact care
16. Frequency of participation in the reception	202.71	802.48	0.472	0.919
2. Longitudinality
19. Participation in mapping socio-environmental vulnerability issues of the community	203.03	805.70	0.547	0.919
24. Assessment of attendance in groups for hypertension and diabetes	202.10	812.93	0.382	0.920
26.Frequency of participation of the professional in groups for hypertension and diabetes	202.14	813.70	0.347	0.920
29. Professional participation in recognizing the importance of the BHU for the population	201.54	826.80	0.256	0.921
37. Classification of the impact of requesting medical records and previous exams on medical practice	202.07	825.88	0.220	0.921
3. Comprehensiveness
14. Percentage of time dedicated to procedures (other than medical consultations)	203.44	806.16	0.231	0.922
21. Analysis of the card for children under five years old (vaccine and growth curves)	202.32	803.59	0.459	0.919
23. Weight and blood pressure assessment in adults	202.10	817.39	0.233	0.921
27. Frequency of prenatal care	202.10	819.71	0.257	0.921
28. Average percentage of postpartum consultations in the last six months	203.88	784.60	0.567	0.918
34. Percentage of referrals to a specialist in the last six months	203.08	825.61	0.204	0.921
35. Percentage of patients who return from the specialist for follow-up at the Basic Health Unit	203.62	811.46	0.345	0.920
41. Frequency of home visits or consultations in the last six months	202.03	820.68	0.289	0.920
4. Coordination
20.1. Participation in the discussion of risk classification of micro areas in the last six months	202.82	789.34	0.653	0.917
20.2. Participation in team meetings to discuss community issues in the last six months	202.13	798.20	0.655	0.918
20.3. Participation in the creation of the diagnosis map in the last six months	203.18	777.58	0.743	0.916
20.4. Participation in the health situation room in the last six months	203.24	791.77	0.499	0.919
20.5. Participation in community discussions about health issues in the last six months	202.53	796.99	0.579	0.918
20.6. Participation in joint work with the secretariat to schedule specialized consultations in the last six months	202.90	800.46	0.389	0.920
20.7. Participation in the follow-up of deaths of children under one-year-old and maternal deaths in the last six months	203.54	805.20	0.316	0.921
20.8. Participation in the registration of micro areas in the last six months	204.11	792.33	0.539	0.918
20.9.Participation in the follow-up of preterm children and neonatal and maternal near-miss in the last six months	203.10	792.13	0.476	0.919
20.10. Participation in active surveillance activities in the last six months	202.62	795.33	0.545	0.918
36. Frequency of requesting medical records and previous exams in the last six months	202.27	822.92	0.244	0.921
38. Frequency of use of the form for referral to the specialist in the last six months	202.40	823.24	0.203	0.921
39. Frequency of counter-referral forms received in the last six months	204.39	823.25	0.224	0.921
44.1. Frequency of articulation activities with the team in the last six months	201.89	807.87	0.526	0.919
44.2. Frequency of articulation activities with traditional caregivers in the last six months	203.35	797.26	0.464	0.919
44.3. Frequency of articulation activities with Family Health Support Center professionals in the last six months	203.27	799.15	0.455	0.919
44.4. Frequency of articulation activities with professionals from other levels of care in the last six months	203.44	808.42	0.359	0.920
45. Frequency of epidemiological diagnosis of the territory with the Municipal Health Department in the last six months	203.97	797.59	0.523	0.919
47. Frequency of participation in planning meetings with the Family Health Strategy to manage and organize the work process in the last six months	203.09	799.40	0.505	0.919
48. Frequency of participation in self-assessment meetings in the last six months	203.59	805.05	0.399	0.920
5. Family and community orientation
32. Frequency of invitations to participate in local activities in the last six months	202.94	799.88	0.460	0.919
42. Frequency of participation in educational activities in schools, daycare centers, shelters, or churches in the last six months	203.07	823.24	0.203	0.921
43.1. Participation in external educational activities on family planning in the last six months	203.24	785.49	0.678	0.917
43.2. Participation in external educational activities on prevention of sexually transmitted diseases in the last six months	202.90	788.94	0.652	0.917
43.3. Participation in external educational activities on oral health in the last six months	203.81	791.01	0.550	0.918
43.4. Participation in external educational activities on nutrition in the last six months	203.23	786.86	0.617	0.918
49.1. Participation in meetings to discuss community health issues in the last six months	202.57	788.13	0.684	0.917
49.2. Participation in meetings for monitoring indicators in the last six months	203.10	779.42	0.739	0.916
49.3. Participation in social control activities in the last six months	203.53	779.26	0.716	0.917
49.4. Participation in dialogues with community leaders to assess satisfaction in the last six months	203.75	774.26	0.748	0.916
6. Cultural competence
51. Classification of the importance of incorporating knowledge about community beliefs and customs in medical practice	202.60	814.97	0.276	0.921

Attribute number*	Variables	1	2	3	4	5	6	7	8	9	10	11	12	13
4	20.10. Participation in active surveillance activities in the last six months	0.387
5	49.4. Participation in dialogues with community leaders to assess satisfaction in the last six months	0.449
5	49.3. Participation in social control activities in the last six months	0.457
5	49.2. Participation in meetings for monitoring indicators in the last six months	0.469
5	42. Frequency of participation in educational activities in schools, daycare centers, shelters, or churches in the last six months	0.554
5	43.1. Participation in external educational activities on family planning in the last six months	0.753
5	43.2. Participation in external educational activities on prevention of sexually transmitted diseases in the last six months	0.762
5	43.4. Participation in external educational activities on nutrition in the last six months	0.804
5	43.3. Participation in external educational activities on oral health in the last six months	0.807
4	20.2. Participation in team meetings to discuss community issues in the last six months		0.430
4	20.1. Participation in the discussion of risk classification of micro areas in the last six months		0.441
5	32. Frequency of invitations to participate in local activities in the last six months		0.444
4	44.1. Frequency of articulation activities with the team in the last six months		0.483
5	49.1. Participation in meetings to discuss community health issues in the last six months		0.511
1	16. Frequency of participation in the reception		0.662
4	20.6. Participation in joint work with the secretariat to schedule specialized consultations in the last six months			0.409
Attribute number*	Variables	1	2	3	4	5	6	7	8	9	10	11	12	13
4	45. Frequency of epidemiological diagnosis of the territory with the Municipal Health Department in the last six months			0.613
4	47. Frequency of participation in planning meetings with the Family Health Strategy to manage and organize the work process in the last six months			0.681
4	48. Frequency of participation in self-assessment meetings in the last six months			0.712
4	20.8. Participation in the registration of micro areas in the last six months				0.489
4	20.9. Participation in the follow-up of preterm children and neonatal and maternal near-miss in the last six months				0.745
4	20.7. Participation in the follow-up of deaths of children under one-year-old and maternal deaths in the last six months				0.807
3	23. Weight and blood pressure assessment in adults					0.414
2	29. Professional participation in recognizing the importance of the BHU for the population					0.501
2	26. Frequency of participation of the professional in groups for hypertension and diabetes					0.742
2	24. Assessment of attendance in groups for hypertension and diabetes					0.744
4	44.2. Frequency of articulation activities with traditional caregivers in the last six months						0.685
4	44.3. Frequency of articulation activities with Family Health Support Center professionals in the last six months						0.699
4	44.4. Frequency of articulation activities with professionals from other levels of care in the last six months						0.735
4	38. Frequency of use of the form for referral to the specialist in the last six months							0.388
2	19. Participation in mapping socio-environmental vulnerability issues of the community								0.467
Attribute number*	Variables	1	2	3	4	5	6	7	8	9	10	11	12	13
4	20.3. Participation in the creation of the diagnosis map in the last six months								0.546
4	20.4. Participation in the health situation room in the last six months								0.707
3	35. Percentage of patients who return from the specialist for follow-up at the Basic Health Unit									0.510
3	41. Frequency of home visits or consultations in the last six months									0.515
2	37. Classification of the impact of requesting medical records and previous exams on medical practice									0.677
4	36. Frequency of requesting medical records and previous exams in the last six months									0.788
4	20.5. Participation in community discussions about health issues in the last six months										0.352
3	34. Percentage of referrals to a specialist in the last six months										0.779
6	51. Classification of the importance of incorporating knowledge about community beliefs and customs in medical practice										0.746
3	28. Average percentage of postpartum consultations in the last six months											0.410
3	14. Percentage of time dedicated to procedures (other than medical consultations)											0.824
3	21. Analysis of the card for children under five years old (vaccine and growth curves)												0.445
3	27. Frequency of prenatal care												0.724
4	39. Frequency of counter-referral forms received in the last six months													0,785

[1] Chief editors:

Maria Cecília de Souza Minayo, Romeu Gomes, Antônio Augusto Moura da Silva

Brasil

Brasil

Desenvolvimento e validação de um questionário (QSPC-Q) para avaliação da qualidade e fortalecimento da atenção primária no Brasil

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