Primary Healthcare Efficiency Indicators for Analysis and Decision-Making Support for Managers

This study aimed to analyze the scientific literature on the aspects and/or positive and negative impacts of Primary Health Care (PHC) in Brazil. There was conducted a literature search on the Lilacs database, finding nine articles analyzed by categorical content. The data revealed positive impacts of PHC in Brazil: best performance of the FHS than to Traditional Basic Units, users recognize the PHC as the gateway of the health system, increasing the professional/user relationship and municipalities those invest in innovative strategies attention. The challenges for the consolidation of PHC excel in studies: classified in most cities studied as regular/partially effective, incipient/unsatisfactory, little impact on improving the health conditions of the population, incipient social participation, difficulties in organizing the PHC, professional devaluation. It is concluded that there are incipient positive impacts of PHC, requiring changes, such as increased planning, organization and qualification, to the consolidation of PHC in Brazil. Studies which evaluate the PHC are extremely important for the reorganization of the health system and overcoming the challenges that still exist in the primary level of attention.

to analyze care strategies for breast cancer screening in Primary Health Care in Brazil. this is a systematic review following the Cochrane Collaboration recommendations. among 355 manuscripts, five were eligible. The patient navigation program by Community Health Agent stood out with the best result, among the strategies: flexibility of goals considering viability; community engagement; team training; active search of the target population by Community Health Agent; request for mammography by physicians; actions integrated to women's health; monitoring of mammography results, absent users, and population coverage by physician and nurse; and assessment of criteria for requesting screening mammography by means of an information system. The population coverage rate in the program ranged from 23% to 88%. Primary Health Care in Brazil presents devices with potential to induce the production of care for breast cancer screening.

This study aimed to evaluate the occurrence of incidents in primary health care in Brazil. Fifteen health professionals working in Family Health Strategy units agreed to anonymously and confidentially record incidents over the course of five months, using the questionnaire Primary Care International Study of Medical Errors (PCISME) questionnaire adapted to the Brazilian context. The overall rate of incidents was 1.11%. The rate of incidents that did not reach patients was 0.11%. The rate of incidents reaching patients but without causing harm was 0.09%. The rate of incidents reaching patients and causing adverse events was 0.9%. Eight types of most frequent errors and administrative failures were identified. Communication failures were the most common contributing factor to incidents in primary health care (53%). The findings show that incidents occur in primary health care (as elsewhere in the health system), but research in this area is still incipient.

BackgroundPolypharmacy is recognized as a global public health problem and one of the greatest challenges related to the aging population. Few studies have investigated the incidence and risk factors for polypharmacy among elderly individuals. These studies provided important information on the issue but were developed in high-income countries. This study investigates the incidence and risk factors for polypharmacy among elderly people assisted by primary health care over a period of 11 years.MethodsThis was a census-based prospective longitudinal study that included people aged 60 years or older living in a small municipality in the state of Rio Grande do Sul, Brazil. The baseline occurred in 2010 and the second wave of the study occurred in 2021. The study population consisted of elderly individuals who did not use polypharmacy at baseline and were reinterviewed in 2021 (N = 128). Data collection in the first and second waves was performed through a household survey using a structured questionnaire. The dependent variable was polypharmacy, defined as the simultaneous use of 5 or more drugs. The independent variables included sociodemographic, health and functionality factors. For multivariate analyses, Poisson regression with robust variance was used, estimating the relative risk and 95% confidence intervals.ResultsThe incidence of polypharmacy was 46.1% in the 11-year period. The highest number of health problems was a risk factor for polypharmacy (RR = 1.177; 95% CI 1.093–1.267).ConclusionsThe incidence of polypharmacy among elderly people assisted in primary health care in Brazil is high. The number of diseases is a risk factor for polypharmacy. These results have implications for future primary health care practices and may support the development of policies, actions and services aimed at reducing polypharmacy and promoting the rational use of drugs in the population at higher risk.

Background: The Primary Health Care (PHC) is the structural foundation of the Unified Health System (SUS), ensuring the first level of care and promoting preventive and assistive actions. Materials and Methods: This study conducted a literature review to analyze the challenges and perspectives of PHC in Brazil. The main findings indicate that, despite advancements, the model faces difficulties related to underfunding, regional inequality, and the need for administrative restructuring. Results: The literature indicates that the Family Health Strategy (FHS) has been the primary reference for evaluating PHC, which may limit the visibility of other care models. Additionally, violence in PHC has proven to be an underreported issue, requiring a more comprehensive intersectoral approach. Another identified challenge was the difficulty of PHC in coordinating Health Care Networks (HCN), compromising continuity of care. The qualification of professionals, the use of digital technologies, and the strengthening of public policies focused on intersectorality were highlighted as fundamental strategies for improving PHC. Conclusion: It is concluded that strengthening PHC requires financial investments, professional qualification, and policies that ensure equity and the integration of health services. Political and institutional commitment will be essential to overcoming the identified barriers and consolidating an efficient and sustainable PHC model in Brazil.

This study describes the structure of oral health services in primary health care in Brazil and the instruments available for the provision of oral health care and to compare the number of instruments according to organizational characteristics of health services and among the macroregions. Of the 23,251 oral health teams (OHTs) in the Public Health System, 17,513 (75.3%) participated in this study. Trained researchers observed the structures of the health services and determined the presence of and whether a sufficient quantity of 36 dental instruments existed. The score of each oral health service was determined by the sum of the number of dental instruments present in sufficient quantity (0 to 36). Central tendency measures were compared along with the variability in these scores according to the organizational characteristics of the services and according to the Brazilian macroregion. No instrument was found to be present in all evaluated services. Basic, surgical and restorative instruments were the most frequently found. Periodontal, endodontic and prosthetic instruments exhibited the lowest percentages. The mean and median numbers of dental instruments were higher for teams that operated over more shifts, those with an oral health technician and those in the South and Southeast regions. The oral health services were equipped with basic, surgical and restorative instruments. Instruments designed for periodontal diagnosis, emergency care and denture rehabilitation were less frequently found in these services. The worst infrastructure conditions existed in the OHTs with the worst forms of care organization and in regions with greater social issues.

Objective: to understand care management in Primary Health Care based on the meanings attributed by workers who work in this context and build a theoretical-explanatory model. Method: this is a qualitative research based on the Grounded Theory on Constructivist Data, developed in the Primary Health Care network of a municipality located in southern Brazil. Participants were selected inductively according to theoretical sampling, totaling 37 workers, divided into four sample groups. Data collection through semi-structured interviews, from January 2017 to November 2018. Data analysis took place in two phases: initial coding and focused coding. The initial codes were classified, synthesized and integrated for the development of the categories, which, articulated, gave rise to the model. To support the analysis, Nvivo®11 was used. Results: the central phenomenon “Managing care in Primary Health Care” was supported by four categories: “Organizing care management”, “Implementing care management in the care environment”, “Relating with other subjects for care management”; “Articulated socially and politically”. These categories composed the theoretical model supported by the constitution of four interdependent dimensions: organizational, relational, care and sociopolitical. Conclusion: care management, implemented in daily work, reveals itself in a variety of practices, conditions and situations that integrate the intertwined world of work and the lives of users and workers of healthcare services. The model helps those involved in care management in Primary Health Care to expand and strengthen care practices committed to users.

Opiniones de los gestores de la atención primaria sobre las fuentes de influencia en la práctica médica. Diferencias con la opinión de los médicos asistenciales

OBJECTIVE:To identify the Speech-Language Pathologist's/Audiologist's Specific and Shared Professional Activities (SPL/AUDPA and ShPA) in Primary Health Care (PHC) in Brazil.METHODS: Initially, an integrative review was carried out involving the legislation on the formation and performance of speech therapists in PHC, from 1981 to 2018, and the search for literature based on the terms "speech-language pathology" and "primary health care", including publications from 2006 to 2006.2019, using the Virtual Health Library (VHL).Additionally, we collected primary expert consensus data about the speech therapists' professional activities using the e-Delphi technique.Speech therapists who agreed to participate answered three electronic forms.The first asked participants to indicate five exclusive professional activities of the speech therapist in PHC.The second requested the validation of the PA list from what was pointed out by more than 70% of the participants in the previous stage.The third corresponded to the ordering of the PAs found in step 2. In a final step, speech therapists from other areas ordered the PAs defined by the previous group.RESULTS: The integrative review pointed to a broad legal and theoretical framework for speechlanguage pathologist/audiologist practice in Primary Health Care in Brazil, as well as reports of professional practices in this scenario throughout the country.The consensus of experts pointed out 24 EPA, common (field) and specific (core) that can be developed by the speech therapist in PHC.Common PAs included the following topics: teamwork, shared care, continuing education, referral and counter-referral, preparation of educational material, health surveillance, reporting and advice, and the exercise of management positions.The specific PAs covered the following topics

Background/Objectives: Strengthening management competencies are essential to ensure effective and equitable Primary Health Care (PHC) systems. Emerging perspectives suggest that effective leadership in PHC could benefit from integrating cognitive, emotional, and social competencies. Although there is existing evidence on the required competencies worldwide and the characterization of PHC managers in Chile, no study has yet developed or validated a specific competency profile for these positions. This study developed and validated a competency profile for PHC managers to provide an evidence-based and context-specific tool for leadership, training, and evaluation. Methods: A mixed-method observational study based on expert judgment was conducted across three Chilean macrozones (northern, central, and southern), involving 36 professionals with recognized experience in PHC management identified through direct contact and snowball sampling. Quantitative validation through the Content Validity Index (CVI) confirmed high expert agreement (CVI ≥ 0.90), while thematic analysis of qualitative responses led to the inclusion of new areas. Results: The final profile comprises 47 competencies organized into knowledge, skills, and attitudes, emphasizing executive functions and social cognition and incorporating emerging domains such as emotional intelligence and institutional support. Beyond managerial relevance, the profile offers a structured framework for designing, implementing, and evaluating competency-based education and training in health sciences. Conclusions: These results also support leadership development and performance assessment, providing an evidence-based reference for professional training initiatives in PHC. This profile emphasizes that leadership development should not be limited to technical competencies, but also encompasses emotional, cognitive, and social dimensions essential for effective performance.

(2007). Tuberculosis patients' reasons for defaulting on tuberculosis treatment: a need for a practical patient-centred approach to tuberculosis management in primary health care. South African Family Practice: Vol. 49, No. 6, pp. 17-17.

BackgroundOsteoarthritis (OA) is one of the most common causes of pain and disability in the adult population. Several studies have documented discordance between general practioners (GP) practice and management recommendations, but there is limited published information about patient reported experience of quality of care. The primary aim of this study was to assess the patient perceived quality of OA management in primary health care. Secondly, we wanted to explore the factors associated with the perceived quality of OA care.MethodsA cross-sectional survey in six general practices in the county of Nord-Trøndelag in Norway, patients with radiologically diagnosed OA, according to ICPC codes L89, L90 or L91 or clinical signs and symptoms corresponding to OA in the hip or knee and patient-reported quality of OA care on the 17-item OsteoArthritis Quality Indicator questionnaire (OA-QI). OA-QI summary pass rates were calculated, in which the numerator represents the number with indicators passed and the denominator represents the total number of eligible persons. Associations with summary pass rates were explored with demographic, disease related and health care related factors as independent variables.ResultsA total of 119 patients were included (response rate 42%). The median summary QI pass rate for all 17 QIs was 47% (Inter Quartile Range 33-65%), but there were large variation between the different items. The referral for weight reduction had the lowest pass rate (8%), whereas the highest pass rate was having received information about the importance of physical activity and exercise (84%). The median summary QI pass rates for both non-pharmacological- (QIs 1–11) and pharmacological (QIs 13–16) treatments were 50% (IQR 25–75). In bivariate regression analyses, only overall treatment satisfaction was significantly associated with QI pass rate (p = 0.001), with unstandardized beta = 6.1 (95% CI 2.7 to 9.5), i.e. a one-point increase on the five-point satisfaction scale was associated with a 6% increase in pass rate.ConclusionConsidering that the median summary QI pass rate was 47%, there might be room for improvement in OA care. Advice and the referral of OA patients in need of weight reduction seem to have the greatest potential for improvement.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-014-0598-x) contains supplementary material, which is available to authorized users.

A introdução das Plantas Medicinais e Fitoterápicos (PMF) na Atenção Primária Básica de Saúde (APBS) necessitou de ferramentas, como o Memento Fitoterápico da Farmacopeia Brasileira (MFFB), que pudessem auxiliar o uso racional e seguro das PMFs. No entanto, poucos são os relatos de êxito sobre o uso dessa importante ferramenta pelos profissionais prescritores na APSB. O objetivo deste trabalho foi analisar a contribuição do MFFB aos profissionais prescritores na APBS. Para isso, foi realizada uma revisão em bases de dados relacionadas com a temática. Os estudos demonstraram que há uma baixa adesão quanto à prescrição dos PMFs na APSB, apesar de existir o memento fitoterápico para auxiliar na prescrição. Essas lacunas podem estar relacionadas com a falta de conhecimento e desestímulo dos profissionais de saúde, devido ao déficit orçamentário das APBS e, também, pela não inserção do conhecimento de fitoterapia nos cursos de graduação. A inclusão do MFFB na prática da fitoterapia clínica é de fundamental importância, pois, trata-se de um recurso que serve para viabilizar, facilitar as prescrições de fitoterápicos pelos profissionais, refletindo positivamente para o aumento dessas prescrições.

Recently, interest on the expenditure on primary healthcare (PHC) has grown due to a series of reforms to its organization and funding. Data on these and other expenses are declared via subfunctions by public health managers through the Brazilian Information System for the Public Budgets in Health (SIOPS). In the public budget, subfunctions detail in which expenditure area the government action was carried out. However, there are problems in the information via subfunctions, and the expenditures in main object areas - such as PHC - are commonly underestimated, if only the records of the specific subfunction are considered. Thus, this article proposes a method to adjust the total expenditure in primary care of each municipality, from 2015 to 2020, allowing for the production of adjusted databases to be used in PHC finance studies in Brazil. Therefore, an investigation based on budgetary-financial execution data in public health actions and services was conducted to produce a methodological framework, observing the following steps: (i) data identification; (ii) development; and (iii) validation of the methodological framework. The methodological framework was created and tested, confirming the validity of the proposed method for adjusting the expenditure declared for PHC in the period from 2015 to 2020. If the adjustment had not been made, the PHC expenditure would have been underestimated by BRL 11.4 billion, in 2015, and BRL 9.6 billion, in 2020, (at current prices), corresponding to a 19.8% and 12.6% underestimation, respectively.

ContextIn crisis-affected health systems, the performance of health zones (also known as health districts) is challenged by recurrent armed conflicts and state fragility. The profiles of health zone managers and contextual factors can significantly influence the zones' ability to effectively respond to population health needs. This study explores these interactions to identify key factors associated with health zones performances in three provinces of Eastern Democratic Republic of Congo (DRC), a region that has endured over three decades of conflict.MethodsThis mixed-methods study was conducted between October 2022 and April 2024, using data covering the period from 2017 to 2022. In the DRC, health zones are managed by Chief Medical Officers (CMOs). We assessed the functionality and performance of health zones using key indicators related to primary healthcare delivery and management. Data on CMO profiles and the operational contexts of their health zones were analyzed to identify factors influencing functionality and performance, through multivariate regressions (p < 0.05). In addition, 17 individual interviews with key health system actors were analyzed thematically to capture perceptions on CMO performance and stability.ResultsCMOs with training in primary healthcare management and extensive professional experience were statistically associated with higher health zone performance. Conversely, instability among CMOs, due to frequent rotations driven by political influences and weak collaboration between decision-making bodies, negatively impacted performance. However, support from international and faith-based partners was associated with improved health zone performance.ConclusionsThis study highlights the importance of investing in capacity-building for health managers to strengthen health systems and improve resilience in crisis settings. Establishing robust governance frameworks that promotes transparency in the recruitment and management of health managers, and ensure stability in human resources, is critical for maintaining and improving health system performance.