Qualification of Family Health Care Expanded Support Centers: analysis according to the Program for Improving Access and Quality of Primary Care cycles

Muller, Erildo Vicente; Stler, José Lucas Meira; Silva Junior, Manoelito Ferreira

doi:10.1590/0103-1104202113007

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Brasil

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ORIGINAL ARTICLE • Saúde debate 45 (130) • Jul-Sep 2021 • https://doi.org/10.1590/0103-1104202113007 copy

Qualification of Family Health Care Expanded Support Centers: analysis according to the Program for Improving Access and Quality of Primary Care cycles

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The aim of the study was to analyze the indicators related to the management and working process of the Family Health Care Expanded Support Centers according to the Primary Health Care and the Centers teams perspectives in Brazil. This is a cross-sectional study with historical series analysis, using secondary data from the External Evaluation of the Program for Improving Access and Quality of Primary Care. The data were obtained from modules II and module IV from the 2nd and 3rd cycles. Chisquare and the Mann-Witney test (p<0.05) were performed. The grades given by the Primary Health Care teams to the Centers were above 7 and increased 1 point in the 3rd cycle, beside, there was an upgrade in almost all items from the 2nd to the 3rd cycles, concerning to the meetings with the municipal management and the working process of the Primary Health Care and Centers teams in the planning of actions and its frequency. We came to the conclusion that there was an increase in most indicators related to management and working process from the perspective of Primary Health Care team and Family Health Care Expanded Support Centers in Brazil.

KEYWORDS
Primary Health Care; Unified Health System; Health evaluation; Health evaluation, access and evaluation; Quality improvement

Cycle	Question Code	Answer Category from PIAQ-PC	Study Category
AXIS 1: Manegement
debate between management and the PCt about the professionals who should make up the FHSC
2nd cycle	II.33.1	Yes (1); No (2); Does not apply (3); ‘Does not apply’ (998); Lost data (9,997)	Yes (1) or No (2)
3rd cycle	II.33.1	Yes (1); No (2); Does not apply (998); Does not know (999); ‘Excluded team’ (7); Lost data (9,997)	Yes (1) or No (2)
presence of a person in charge of the FHSC in municipal management
2nd cycle	IV.5.1	Yes (1); No (2); Lost data (9,997)	Yes (1) or No (2)
3rd cycle	IV.3.1	Yes (1); No (2); Lost Data (9,997)	Yes (1) or No (2)
frequency of meetings between FHSC professionals with the PCt
2nd cycle	IV.5.3	Weekly (1); Biweekly (2); Monthly (3); No frequency defined (4); Do not happen (5); Does not apply (998); Lost data (9,997)	Yes (1, 2 e 3) or No (4 e 5)
3rd cycle	IV.3.2	Yes (1); No (2); Does not apply (998); Lost data (9,997)	Yes (1) or No (2)
AXIS 2: FHSC work process, from the perspective of the PCt
PCt attended by matrix support in complex cases
2nd cycle	II.9.4	Yes (1); No (2); Does not know; Did not respond (999); Lost data (9,997)	Yes (1) or No (2)
3rd cycle	II.3.1	Yes (1); No (2); ‘Excluded team’ (7); Lost data (9,997)	Yes (1) or No (2)
FHCS professionals carry out matrix support
2nd cycle	II.9.5.1	Yes (1); No (2); Does not apply (998); Lost data (9,997)	Yes (1) or No (2)
3rd cycle	II.3.2.1	Yes (1); No (2); Does not apply (998); ‘Excluded team’ (7); Lost data (9,997)	Yes (1) or No (2)
PCt requests FHCS’s support with written referrals
2nd cycle	II.33.15.1	Yes (1); No (2); Does not apply (998); Lost data (9,997)	Yes (1) or No (2)
3rd cycle	II.34.1.1	Yes (1); No (2); Does not apply (998); ‘Excluded team’(7); Lost data (9,997)	Yes (1) or No (2)
PCt requests FHCS’s support with case discussions
2nd cycle	II.33.15.2	Yes (1); No (2); Does not apply (998); Lost data (9,997)	Yes (1) or No (2)
3rd cycle	II.34.1.2	Yes (1); No (2); Does not apply (998); ‘Excluded team’(7); Lost data (9,997)	Yes (1) or No (2)
PCt requests FHCS’s support with shared consultations
2nd cycle	II.33.15.3	Yes (1); No (2); Does not apply (998); Lost data (9,997)	Yes (1) or No (2)
3rd	II.34.1.3	Yes (1); No (2); Does not apply (998); ‘Excluded team’(7); Lost data (9,997)	Yes (1) or No (2)
PCt performs appointment scheduling directly in the FHSC professional's agenda
2nd cycle	II.33.15.4	Yes (1); No (2); Does not apply (998); Lost data (9,997)	Yes (1) or No (2)
3rd cycle	II.34.1.4	Yes (1); No (2); Does not apply (998); ‘Excluded team’ (7); Lost data (9,997)	Yes (1) or No (2)
the FHSC schedule is made with its PCt
2nd cycle	II.33.5	Yes (1); No (2); Does not apply (998); Does not know; Did not respond (999); Lost data (9,997)	Yes (1) or No (2)
3rd cycle	II.34.4	Yes (1); No (2); Does not apply (998); ‘Excluded team’ (7); Lost data (9,997)	Yes (1) or No (2)
you know the activities schedule of the FHSC with its PCt
2nd cycle	II.33.11	Yes (1); No (2); Does not apply (998); Lost data (9,997)	Yes (1) or No (2)
3rd cycle	II.34.5	Yes (1); No (2); Does not apply (998); ‘Excluded team’ (7); Lost data (9,997)	Yes (1) or No (2)
all professionals from FHSC have guaranteed periodic activities with the PCt
2nd cycle	II.33.12	Yes (1); No (2); Does not apply (998); Does not know; Did not respond (999); Lost data (9,997)	Yes (1) or No (2)
3rd cycle	II.34.6	Yes (1); No (2); Does not apply (998); Does not know; Did not respond (999); ‘Excluded team’ (7); Lost data (9,997)	Yes (1) or No (2)
PCt and FHSC have criteria for FHSC care and referrals to other care points
2nd cycle	II.33.14	Yes (1); No (2); Does not apply (998); Does not know; Did not respond (999); Lost data (9,997)	Yes (1) or No (2)
3rd cycle	II.34.7	Yes (1); No (2); Does not apply (998); Does not know; Did not respond (999); ‘Excluded team’ (7); Lost data (9,997)	Yes (1) or No (2)
there are criteria between your team and the FHSC to trigger support in unforeseen situations (out of schedule or urgency)
2nd cycle	II.33.16	Yes (1); No (2); Does not apply (998); Does not know; Did not respond (999); Lost data (9,997)	Yes (1) or No (2)
3rd cycle	II.34.8	Yes (1); No (2); Does not apply (998); Does not know; Did not respond (999); ‘Excluded team’ (7); Lost data (9,997)	Yes (1) or No (2)
in unforeseen situations, your team gets the support of the FHSC
2nd cycle	II.33.16.1	Yes (1); No (2); Does not apply (998); Lost data (9,997)	Yes (1) or No (2)
3rd cycle	II.34.9	Yes (1); No (2); Does not apply (998); ‘Excluded team’ (7); Lost data	Yes (1) or No (2)
shared consultations happen between PCt and FHSC
2nd cycle	II.33.17.1	Yes (1); No (2); Does not apply (998); Lost data (9,997)	Yes (1) or No (2)
3rd cycle	II.35.1.4	Yes (1); No (2); Does not apply (998); ‘Excluded team’ (7); Lost data	Yes (1) or No (2)
case discussion takes place between PCt and FHSC
2nd cycle	II.33.17.7	Yes (1); No (2); Does not apply (998); Lost data (9,997)	Yes (1) or No (2)
3rd cycle	II.35.1.1	Yes (1); No (2); Does not apply (998); ‘Excluded team’ (7); Lost data	Yes (1) or No (2)
management of referrals and/or waiting lists for specialists between the PCt and FHSC
2nd cycle	II.33.17.8	Yes (1); No (2); Does not apply (998); Lost data (9,997)	Yes (1) or No (2)
3rd cycle	II.35.1.14	Yes (1); No (2); Does not apply (998); ‘Excluded team’ (7); Lost data	Yes (1) or No (2)
the demand for individual care to be provided by FHSC professionals is organized
2nd cycle	II.33.17.9	Yes (1); No (2); Does not apply (998); Lost data (9,997)	Yes (1) or No (2)
3rd cycle	II.35.1.2	Yes (1); No (2); Does not apply (998); ‘Excluded team’ (7); Lost data	Yes (1) or No (2)
discussion of topics takes place/permanent education actions between PCt and FHSC
2nd cycle	II.33.17.10	Yes (1); No (2); Does not apply (998); Lost data (9,997)	Yes (1) or No (2)
3rd cycle	II.35.1.9	Yes (1); No (2); Does not apply (998); ‘Excluded team’ (7); Lost data	Yes (1) or No (2)
the definition of access criteria, prioritization of cases and assignments of each professional takes place between the PCt and the FHSC
2nd cycle	II.33.17.11	Yes (1); No (2); Does not apply (998); Lost data (9,997)	Yes (1) or No (2)
3rd cycle	II.35.1.15	Yes (1); No (2); Does not apply (998); ‘Excluded team’ (7); Lost data	Yes (1) or No (2)
monitoring and evaluation of results of shared care between PCt and FHSC take place
2nd cycle	II.33.17.12	Yes (1); No (2); Does not apply (998); Lost data (9,997)	Yes (1) or No (2)
3rd cycle	II.35.1.18	Yes (1); No (2); Does not apply (998); ‘Excluded team’ (7); Lost data	Yes (1) or No (2)
average time to respond to the PCt request by FHSC
2nd cycle	II.33.9	From 1 to 30 days: numeric from 1 to 30; Over 30 days: 31; Does not apply (998); Lost data (9,997)	Up to 1 day (1); From 2 to 7 days (2); From 8 to 15 days (3); From 16 to 30 days (4); Over 30 days (5)
3rd cycle	II.34.2	Up to 1 day (1); From 2 to 7 days (2); From 8 to 15 days (3); From 16 to 30 days (4); Over 30 days (5); Does not apply (998); ‘Excluded team’ (7); Lost data (9,997)
the FHSC responds to requests for support in a timely manner
2nd cycle	II.33.10	Always (1); Most of the time (2); Sometimes (3); Rarely (4); Never (5); Does not apply (998); Lost data (9,997)	Always (1); Most of the time (2); Sometimes (3); Rarely (4); Never (5)
3rd cycle	II.34.3	Always (1); Most of the time (2); Sometimes (3); Rarely (4); Never (5). Does not apply (998); ‘Excluded team’ (7); Lost data (9,997)
what is the frequency of meetings between FHSC professionals and PCt
2nd cycle	II.33.13.1 a II.33.13.5	Weekly (II.33.13.1); Biweekly (II.33.13.2); Monthly (II.33.13.3); No defined periodicity (II.33.13.4) Yes (1); No (2); Does not apply (998); Lost data (9,997)	Weekly (1); Biweekly (2); Monthly (3); No defined periodicity (5); In the case of more than one option, the highest frequency was considered
3rd cycle	II.35.2	Weekly (1); Biweekly (2); Monthly (3); Over 30 days (4); No defined periodicity (5); ‘Excluded team’ (7); Lost data (9,997)	Weekly (1); Biweekly (2); Monthly (3); Over 30 days (4); No defined periodicity (5)
how PCt assesses FHSC's contribution to solving user needs
2nd cycle	II.33.20.1	0; 1; 2; 3; 4; 5; 6; 7; 8; 9; 10; Does not apply (998); Lost data (9,997)	Numerical from 0 to 10
3rd cycle	II.36.2.1	0; 1; 2; 3; 4; 5; 6; 7; 8; 9; 10; Does not apply (998); ‘Excluded team’ (7); Lost data (9,997)	Numerical from 0 to 10
how PCt assesses FHSC's contribution to the reduc tion of unnecessary referrals to specialized care
2nd cycle	II.33.20.2	0; 1; 2; 3; 4; 5; 6; 7; 8; 9; 10; Does not apply (998); Lost data (9,997)	Numerical from 0 to 10
3rd cycle	II.36.2.2	0; 1; 2; 3; 4; 5; 6; 7; 8; 9; 10; Does not apply (998); ‘Excluded team’ (7); Lost data (9,997)	Numerical from 0 to 10
how PCt assesses the contribution of the FHSC in qualifying referrals
2nd cycle	II.33.20.3	0; 1; 2; 3; 4; 5; 6; 7; 8; 9; 10; Does not apply (998); Lost data (9,997)	Numerical from 0 to 10
3rd cycle	II.36.2.4	0; 1; 2; 3; 4; 5; 6; 7; 8; 9; 10; Does not apply (998); ‘Excluded team’ (7); Lost data (9,997)	Numerical from 0 to 10
how PCt assesses the FHSC's contribution to deal with problems considered difficult
2nd cycle	II.33.20.4	0; 1; 2; 3; 4; 5; 6; 7; 8; 9; 10; Does not apply (998); Lost data (9,997)	Numerical from 0 to 10
3rd cycle	II.36.2.5	0; 1; 2; 3; 4; 5; 6; 7; 8; 9; 10; Does not apply (998); ‘Excluded team’ (7); Lost data (9,997)	Numerical from 0 to 10
how PCt assesses the FHSC’s contribution to the improvement of health indicators for the population in the territory
2nd cycle	II.33.20.5	0; 1; 2; 3; 4; 5; 6; 7; 8; 9; 10; Does not apply (998); Lost data (9,997)	Numerical from 0 to 10
3rd cycle	II.36.2.8	0; 1; 2; 3; 4; 5; 6; 7; 8; 9; 10; Does not apply (998); ‘Excluded team’ (7); Lost data (9,997)	Numerical from 0 to 10
how PCt assesses the FHSC’s contribution in the improvement of the health situation of shared cases
2nd cycle	II.33.20.6	0; 1; 2; 3; 4; 5; 6; 7; 8; 9; 10; Does not apply (998); Lost data (9,997)	Numerical from 0 to 10
3rd cycle	II.36.2.6	0; 1; 2; 3; 4; 5; 6; 7; 8; 9; 10; Does not apply (998); ‘Excluded team’ (7); Lost data (9,997)	Numerical from 0 to 10
how the PCt assesses the FHSC’s contribution in expanding the actions offered at the Basic Health Unit and the population's access
2nd cycle	II.33.20.7	0; 1; 2; 3; 4; 5; 6; 7; 8; 9; 10; Does not apply (998); Lost data (9,997)	Numerical from 0 to 10
3rd cycle	II.36.2.9 e II.36.2.10	0; 1; 2; 3; 4; 5; 6; 7; 8; 9; 10; Does not apply (998); ‘Excluded team’ (7); Lost data (9,997)	It was calculated by the average of the questions with rounding of the scores. Numerical from 0 to 10
evaluation of the support your PCt receives from the FHSC
2nd cycle	II.33.21	0; 1; 2; 3; 4; 5; 6; 7; 8; 9; 10; Does not apply (998); Lost data (9,997)	Numerical from 0 to 10
3rd cycle	II.36.3	0; 1; 2; 3; 4; 5; 6; 7; 8; 9; 10; Does not apply (998); ‘Excluded team’ (7); Lost data (9,997)	Numerical from 0 to 10
AXIS 3: Work process in FHSC’s owns perspective
the FHSC identifies the main demands to support PCt
2nd cycle	IV.10.1	Yes (1); Sometimes (2); Não (3); Lost data (9,997)	Yes (1 or 2); No (3)
3rd cycle	IV.5.2	Yes (1); No (2); Lost data (9,997)	Yes (1); No (2)
FHSC actions articulated with the planning of the PCt
2nd cycle	IV.7.7	Yes (1); No (2); Lost data (9,997). Included in ‘No’ is the calculation of 68 teams who answered ‘no’ to question IV.7.5, about 'not carrying out planning', meaning ‘no’ in such question	Yes (1); No (2)
3rd cycle	IV.7.7	Sempre (1); Most times (2); Sometimes (3); Never (4); Lost data (9,997)	Yes (1, 2 or 3); No (4)
the FHSC monitors the indicators related to its work process
2nd cycle	IV.7.9	Yes (1); No (2); Lost data (9,997)	Yes (1); No (2)
3rd cycle	IV.7.4	Yes (1); No (2); Lost data (9,997)	Yes (1); No (2)
the FHSC carried out some self-assessment process in the last 12 months
2nd cycle	IV.7.10	Yes (1); No (2); Lost data (9,997)	Yes (1); No (2)
3rd cycle	IV.7.5	Yes (1); No (2); Lost data (9,997)	Yes (1); No (2)
the FHSC carries out shared consultations with the PCt
2nd cycle	IV.8.4.2	Yes (1); No (2); Lost data (9,997)	Yes (1); No (2)
3rd cycle	IV.7.7.1	Yes (1); No (2); Lost data (9,997)	Yes (1); No (2)
the FHSC conducts therapeutic groups
2nd cycle	IV.8.4.4	Yes (1); No (2); Lost data (9,997)	Yes (1); No (2)
3rd cycle	IV.7.7.2	Yes (1); No (2); Lost data (9,997)	Yes (1); No (2)
the FHSC carries out health education activities
2nd cycle	IV.8.4.5	Yes (1); No (2); Lost data (9,997)	Yes (1); No (2)
3rd cycle	IV.7.7.4	Yes (1); No (2); Lost data (9,997)	Yes (1); No (2)
the FHSC registers its actions in medical records common to PCt
2nd cycle	IV.11.1	Yes (1); No (2); Lost data (9,997)	Yes (1); No (2)
3rd cycle	IV.7.10	Yes (1); No (2); Lost data (9,997)	Yes (1); No (2)
continuing education is offered to FHSC professionals
2nd cycle	IV.6.4	Yes, for all professionals (1); Yes, for some professionals (2); No (3); Lost data (9,997)	Yes (1 or 2); No (3)
3rd cycle	IV.4.1	Yes (1); No (2); Lost data (9,997)	Yes (1); No (2)

Variables	2nd Cycle (2013-2014)		3rd Cycle (2015-2018)		p-value
Variables	n	%¹ 1 Percentual (rounding fractions to one decimal place): In reference to the total number of teams from each cycle.	n	%¹ 1 Percentual (rounding fractions to one decimal place): In reference to the total number of teams from each cycle.	p-value
The municipal manegement debated with the PCt² 2 PCt: Primary Care teams. about who should make up the FHSC³ 3 FHSC: Family Health Care Expanded Support Centers. Each variable comes with the ‘N’ equals to the sum of answering teams from 2nd and 3rd cycles: (N=40,500)⁴ 4 Variable answered by professional from PCt that receives support from the FHSC;
Sim	9,698	61.5	16,985	68.6	<0.001
There is a person in charge of the FHSC3 in municipal manegement (N=5,805)⁵ 5 Variable answered by professional from FHSC; and
Sim	1,642	92.6	3,755	93.2	0.415
Frequency of meetings between FHSC3 and the coordination (N=5,397)⁶ 6 Variable answered by professional from FHSC that said ‘Yes’ in the previous question.
Sim	1,349	82.2	3,560	94.8	<0.001

Variables	2nd Cycle (2013-2014)		3rd Cycle (2015-2018)		p-value
Variables	n	%¹ 1 Percentual (rounding fractions to one decimal place): In reference to the total number of teams from each cycle	n	%¹ 1 Percentual (rounding fractions to one decimal place): In reference to the total number of teams from each cycle	p-value
PCt² 2 PCt: Primary Care teams. attended by matrix support in complex cases (N=66,999)⁴ 4 Variable answered by the professional of all the PCt analyzed;
Yes	27,463	92.6	36,547	97.9	<0.001
FHCS³ 3 FHSC: Family Health Care Expanded Support Centers. Each variable comes with the ‘N’ equals to the sum of answering teams from 2nd and 3rd cycles: professionals carry out matrix support (N=64,010)⁵ 5 Variable answered by professional from PCt that receives matrix support;
Yes	17,157	62.5	27,213	74.5	<0.001
PCt requests FHCS’s support with written referrals (N=44,370)⁶ 6 Variable answered by professional from PCt that receives support from the FHSC; and
Yes	10,565	61.6	20,992	77.1	<0.001
PCt requests FHCS’s support with case discussions (N=44,370)⁶ 6 Variable answered by professional from PCt that receives support from the FHSC; and
Yes	11,680	68.1	22,505	82.7	<0.001
PCt requests FHCS’s support with shared consultations (N=44,370)⁶ 6 Variable answered by professional from PCt that receives support from the FHSC; and
Yes	7,759	45.2	20,477	75.2	<0.001
PCt performs appointment scheduling directly in the FHSC professional's agenda (N=44,370)⁶ 6 Variable answered by professional from PCt that receives support from the FHSC; and
Yes	9,510	55.4	19,849	72.9	<0.001
The FHSC schedule is made with its PCt (N=43,356)⁷ 7 Variable answered by the PCt professional that receives FHSC support (‘N’ lower than 44.370 because of the inclusion of ‘Does not apply’.
Yes	13,727	85	22,017	80.9	<0.001
You know the activities schedule of the FHSC with its PCt (N=44,370)⁶ 6 Variable answered by professional from PCt that receives support from the FHSC; and
Yes	14,256	83.1	24,336	89.4	<0.001
All professionals from FHSC have guaranteed periodic activities with the PCt (N=43,902)⁷ 7 Variable answered by the PCt professional that receives FHSC support (‘N’ lower than 44.370 because of the inclusion of ‘Does not apply’.
Yes	13,062	77.2	23,577	87.4	<0.001
PCt and FHSC have criteria for FHSC care and referrals to other care points (N=43,586)⁷ 7 Variable answered by the PCt professional that receives FHSC support (‘N’ lower than 44.370 because of the inclusion of ‘Does not apply’.
Yes	12,955	77.4	24,122	89.8	<0.001
There are criteria between your team and the FHSC to trigger support in unforeseen situations (out of schedule or urgency) (N=43,517)⁷ 7 Variable answered by the PCt professional that receives FHSC support (‘N’ lower than 44.370 because of the inclusion of ‘Does not apply’.
Yes	12,031	72	23,917	89.2	<0.001
In unforeseen situations, your team gets the support of the FHSC (N=39,244)⁷ 7 Variable answered by the PCt professional that receives FHSC support (‘N’ lower than 44.370 because of the inclusion of ‘Does not apply’.
Yes	11,912	99	26,305	96.7	<0.001
Shared consultations happen between PCt and FHSC (N=44,370)⁶ 6 Variable answered by professional from PCt that receives support from the FHSC; and
Yes	10,821	63.1	23,923	87.9	<0.001
Case discussion takes place between PCt and FHSC (N=44,370)⁶ 6 Variable answered by professional from PCt that receives support from the FHSC; and
Yes	11,867	69.2	25,429	93.4	<0.001
Management of referrals and/or waiting lists for specialists between the PCt and FHSC (N=44,370)⁶ 6 Variable answered by professional from PCt that receives support from the FHSC; and
Yes	9,376	54.6	18,415	67.7	<0.001
the demand for individual care to be provided by FHSC professionals is organized (N=44,370)⁶ 6 Variable answered by professional from PCt that receives support from the FHSC; and
Yes	12,304	71.7	24,412	89.7	<0.001
Discussion of topics takes place/permanent education actions between PCt and FHSC (N=44,370)⁶ 6 Variable answered by professional from PCt that receives support from the FHSC; and
Yes	11,824	68.9	21,904	80.5	<0.001
The definition of access criteria, prioritization of cases and assignments of each professional takes place between the PCt and the FHSC (N=44,370)⁶ 6 Variable answered by professional from PCt that receives support from the FHSC; and
Yes	11,165	65.1	21,901	80.5	<0.001
Monitoring and evaluation of results of shared care between PCt and FHSC take place (N=44,370)⁶ 6 Variable answered by professional from PCt that receives support from the FHSC; and
Yes	10,261	59.8	20,608	75.7	<0.001
On avarage, the FHSC respont to a PCt in how many days (N=44,370)⁶ 6 Variable answered by professional from PCt that receives support from the FHSC; and
1 day	1,729	10.1	3,302	12.1
2 a 7 days	9,123	53.2	16,156	59.4
8 a 15 days	4,200	24.5	5,271	19.4	<0.001
16 a 30 days	1,644	9.6	1,928	7.1
Over 30 days	461	2.7	556	2
The FHSC responds to requests for support in a timely manner (N=44,370)⁶ 6 Variable answered by professional from PCt that receives support from the FHSC; and
Always	7,414	43.2	14,148	52
Most of the times	6,985	40.7	9,983	36.7
Sometimes	2,185	12.7	2,514	9.2	<0.001
Rarely	421	2.5	439	1.6
Never	152	0.9	129	0.5
What is the frequency of meetings between FHSC professionals and PCt (N=44,369)⁷ 7 Variable answered by the PCt professional that receives FHSC support (‘N’ lower than 44.370 because of the inclusion of ‘Does not apply’.
Weekly	6,673	38.9	8,842	32.5
Biweekly	2,520	14.7	4,297	15.8
Monthly	4,210	24.5	9,503	34.9	<0.001
Over 30 days	-	-	816	3
No defined periodicity	3,753	21.9	3,755	13.8

	2nd Cycle (2013-2014) (N=17,157)¹ 1 ‘N’ common in the 2nd cycle of all the variables.					3rd Cycle (2015-2018) (N=27,213)² 2 ‘N’ common in the 3rd cycle of all the variables.
Variable	Average	SD	Median	IR25	IR75	Average	SD	Median	IR25	IR75
How PCt assesses FHSC's contribution to solving user needs (N=44,370)
Numerical	7.82	1.57	8	7	9	8.52	1.35	9	8	10	<0.001
How PCt assesses FHSC's contribution to the reduction of unnecessary referrals to specialized care (N=44,370)
Numerical	7.51	2.08	8	7	9	8.29	1.69	9	8	9	<0.001
How PCt assesses the contribution of the FHSC in qualifying referrals
Numerical	7.82	1.9	8	7	9	8.46	1.6	9	8	10	<0.001
How PCt assesses the FHSC's contribution to deal with problems considered difficult
Numerical	8.04	1.76	8	7	9	8.61	1.46	9	8	10	<0.001
How PCt assesses the FHSC’s contribution to the improvement of health indicators for the population in the territory
Numerical	7.68	1.91	8	7	9	8.34	1.61	9	8	9	<0.001
How PCt assesses the FHSC’s contribution in the improvement of the health situation of shared cases
Numerical	7.92	1.81	8	7	9	8.76	1.39	9	8	10	<0.001
How the PCt assesses the contribution of the FHSC in expanding the actions offered at the Basic Health Unit and the population's access
Numerical	7.84	1.86	8	7	9	8.59	1.49	9	8	10	<0.001
Evaluation of the support your PCt receives from the FHSC (N=44,370)
Numerical	8.13	1.72	8	7	9	8.76	1.42	9	8	10	<0.001

Variables	2nd Cycle (2013-2014)		3rd Cycle (2015-2018)		p-value
Variables	n	%¹ 1 Percentage (rounding fractions to one decimal place): relation referring to the total of teams in each cycle.	n	%¹ 1 Percentage (rounding fractions to one decimal place): relation referring to the total of teams in each cycle.	p-value
The FHSC² 2 FHSC: Family Health Care Expanded Support Centers identifies the main demands to support PCt³ 3 PCt: Primary Care team. (N=5,805)⁴ 4 N=5,805 (From the somatory of FHSC: 1,774 from 2nd cycle + 4,031 from 3rd cycle). Common to all the variables.
Yes	1,394	78.6	3,953	98.1	<0.001
FHSC² 2 FHSC: Family Health Care Expanded Support Centers actions articulated with the planning of the PCt³ 3 PCt: Primary Care team. (N=5,805)⁴ 4 N=5,805 (From the somatory of FHSC: 1,774 from 2nd cycle + 4,031 from 3rd cycle). Common to all the variables.
Yes	1,485	83.7	3,978	98.7	<0.001
The FHSC² 2 FHSC: Family Health Care Expanded Support Centers monitors the indicators related to its work process (N=5,805)⁴ 4 N=5,805 (From the somatory of FHSC: 1,774 from 2nd cycle + 4,031 from 3rd cycle). Common to all the variables.
Yes	1,293	72.9	3,245	80.5	<0.001
^The FHSC² 2 FHSC: Family Health Care Expanded Support Centers carried out some self-assessment process in the last 12 months (N=5,805)⁴ 4 N=5,805 (From the somatory of FHSC: 1,774 from 2nd cycle + 4,031 from 3rd cycle). Common to all the variables.
Yes	1,494	84.2	3,629	90	<0.001
The FHSC² 2 FHSC: Family Health Care Expanded Support Centers carries out shared consultations with the PCt³ 3 PCt: Primary Care team. (N=5,805)⁴ 4 N=5,805 (From the somatory of FHSC: 1,774 from 2nd cycle + 4,031 from 3rd cycle). Common to all the variables.
Yes	1,609	90.7	3,819	94.7	<0.001
The FHSC² 2 FHSC: Family Health Care Expanded Support Centers conducts therapeutic groups (N=5,805)⁴ 4 N=5,805 (From the somatory of FHSC: 1,774 from 2nd cycle + 4,031 from 3rd cycle). Common to all the variables.
Yes	1,617	91.1	3,722	92.3	0.126
The FHSC² 2 FHSC: Family Health Care Expanded Support Centers carries out health education activities (N=5,805)⁴ 4 N=5,805 (From the somatory of FHSC: 1,774 from 2nd cycle + 4,031 from 3rd cycle). Common to all the variables.
Yes	1,725	97.2	3,891	96.5	0.160
The FHSC² 2 FHSC: Family Health Care Expanded Support Centers registers its actions in medical records common to PCt³ 3 PCt: Primary Care team. (N=5,805)⁴ 4 N=5,805 (From the somatory of FHSC: 1,774 from 2nd cycle + 4,031 from 3rd cycle). Common to all the variables.
Yes	1,472	83	3,593	89.1	<0.001
Continuing education is offered to FHSC² 2 FHSC: Family Health Care Expanded Support Centers professionals (N=5,805)⁴ 4 N=5,805 (From the somatory of FHSC: 1,774 from 2nd cycle + 4,031 from 3rd cycle). Common to all the variables.
Yes	1,196	67.4	3,775	93.6	<0.001

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