Primary health care assessment by users with and without disabilities

Almeida, Maria Helena Morgani de; Pacheco, Samanta; Krebs, Stephanie; Oliveira, Amanda Manso; Samelli, Alessandra; Molini-Avejonas, Daniela Regina; Toldrá, Rosé Colom; Oliver, Fátima Corrêa

doi:10.1590/2317-1782/20172016225

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Original Article • CoDAS 29 (5) • 2017 • https://doi.org/10.1590/2317-1782/20172016225 linkcopy

Primary health care assessment by users with and without disabilities

Authorship SCIMAGO INSTITUTIONS RANKINGS

Purpose To evaluate the core (First Contact, Longitudinality, Comprehensiveness, and Coordination of Services) and derivative (Family Orientation, Community Orientation) attributes of primary health care (PHC) from the perspective of users with and without disabilities.

Methods Observational, cross-sectional study using the Primary Care Assessment Tool (PCAT) with users with and without disabilities of five basic health units (BHU) in a municipality where 55% of the population depends on the Brazilian Unified Health System (SUS). Scores were assigned to the responses given to each of the PHC attributes evaluated.

Results Study participants were 93 (67 physically disabled and 26 without disabilities) PHC users. No statistically significant differences were observed for any attribute on the comparison between the populations. For both groups, the attributes Degree of Affiliation, First Contact - Utilization, Longitudinality, and Coordination of Services - Information System received satisfactory (above cutoff) scores, whereas the attributes First Contact - Accessibility, Coordination of Services - Care Integration, Comprehensiveness, Family Orientation, and Community Orientation received unsatisfactory (below cutoff) scores. Users reported that the health teams are able to satisfactorily identify mobility issues, but there are failures in the recognition of problems of hearing, voice/speech and vision, and in the orientation of services available and services provided.

Conclusion Users with and without disabilities evaluated the health care received similarly, indicating fragilities on the recognition of specific demands. Structural and work process changes should be conducted to ensure Accessibility, Comprehensiveness, and Family and Community Orientation, and thus increase the quality of PHC.

Keywords
Primary Health Care; Disabled Individuals; Health Services Accessibility; Integrality in Health; Health Services Research; Unified Health System

		Users with disability (n = 67)	Users without disability (n = 26)	Total	Percentage
AGE (n = 93)
Children	<18 years	10	5	15	16.12
Adults	18-59 years	37	15	52	55.92
Elderly	>60 years	20	6	26	27.96
GENDER (n = 93)
Female		41	16	57	61.29
Male		26	10	36	38.71
MARITAL STATUS OF ADULTS AND ELDERLY (n = 78)
Single		21	10	31	39.74
Married		18	6	24	30.77
Stable union		1	0	1	1.28
Divorced		3	2	5	6.41
Widowed		7	2	9	11.54
Not informed		6	2	8	10.26
SCHOOLING OF HEAD OF HOUSEHOLD (n = 93)
Illiterate		11	1	12	12.90
Incomplete Elementary School		12	8	20	21.51
Elementary School		18	8	26	27.95
High School		21	9	30	32.26
College		4	0	4	4.30
Not informed		-	-	1	1.08
EMPLOYMENT SITUATION OF ADULTS AND ELDERLY (n = 33)
Self-employed		7	1	8	24.24
Full-time employee		9	10	19	57.58
Informal		2	2	4	12.12
Other		1	1	2	6.06
SITUATION OF ADULTS AND ELDERLY NOT PERFORMING REMUNERATED ACTIVITIES (n = 45)
Sick leave		0	1	1	2.22
Retiree		16	2	18	40.00
Continuous Cash Benefit		3	0	3	6.67
Unemployed		6	2	8	17.78
House wife/husband		9	1	10	22.22
Other		2	1	3	6.67
Not informed		0	2	2	4.44
PARTICIPATION OF ADULTS AND ELDERLY IN COMMUNITY GROUPS (n = 78)
Religious Group		7	1	8	10.26
Cooperative		0	2	2	2.56
Associations		1	1	2	2.56
In more than one group		2	0	2	2.56
Other		18	3	21	26.92
In no groups		8	5	13	16.70
Not informed		20	10	30	38.46
SCHOOL STATUS OF CHILDREN (n = 15)
Attending public school		5	2	7	46.67
Attending private school		1	0	1	6.66
Attending non-specified school		1	0	1	6.66
Not attending school		2	2	4	26.67
Not informed		1	0	1	13.34

Attribute	Dimension	Users without disability Mean (SD)	Users with disability Mean (SD)	p value
Degree of Affiliation	---	3.13 (1.12)	3.30 (1.02)	0.953
First contact	Utilization	7.37 (2.83)	8 (2.56)	0.463
First contact	Accessibility	3.35 (1.50)	3.67 (1.53)	0.745
Longitudinality		6.80 (2.08)	6.98 (2.42)	0.754
Coordination of services	Care integration	7.65 (2.48)	6.82 (2.76)	0.334
Coordination of services	Information system	6.72 (2.66)	6.47 (2.01)	0.773
Comprehensiveness	Services available	6.32 (1.84)	6.20 (1.88)	0.667
Comprehensiveness	Services provided	5.16 (2.70)	4.92 (2.43)	0.707
Family orientation		6.71 (3.26)	5.85 (3.24)	0.451
Community orientation		5.87 (2.70)	5.47 (2.57)	0.717
General score		6.24 (1.75)	6.39 (1.66)	0.622
Essential score		6.46 (1.69)	6.32 (1.52)	0.644

Attribute	Dimension	Users in general	Users <18 years	Users 19-59 years	Users >60 years	p value
Mean (SD)
Degree of affiliation		3.36	3.46 (0.74)	3.15 (1.15)	3.48 (0.77)	0.696
First contact	Utilization	7.78	7.46 (2.32)	7.58 (2.89)	8.31 (2.00)	0.251
First contact	Accessibility	4.60	6.55 (2.38)	3.50 (1.67)	3.76 (1.18)	<0.001
Longitudinality		7.13	7.17 (2.23)	6.59 (2.52)	7.64 (1.64)	0.298
Coordination of services	Care integration	6.32	5.23 (3.67)	7.15 (2.77)	6.60 (2.58)	0.625
Coordination of services	Information system	6.60	6.50 (2.78)	6.28 (2.34)	7.04 (1.81)	0.313
Comprehensiveness	Services available	6.42	6.89 (1.90)	6.31 (1.74)	6.08 (2.11)	0.313
Comprehensiveness	Services provided	5.57	6.23 (3.74)	4.56 (2.39)	5.94 (2.48)	0.052
Family orientation		6.37	6.82 (3.94)	5.98 (3.42)	6.31 (2.91)	0.559
Community orientation		5.88	6.07 (2.12)	5.27 (2.71)	6.22 (2.27)	0.278
General score		6.50	6.80 (1.39)	6.18 (2.01)	6.53 (1.19)	0.736
Essential score		6.66	6.91 (1.23)	6.31 (1.92)	6.76 (1.27)	0.720

ATTRIBUTE	DIMENSION	QUESTIONS	Mean score
FIRST CONTACT	ACCESSIBILITY	C1- Is the BHU you use open on Saturdays or Sundays?	0.61
		C2 - Is the BHU you use is open on at least a few working days a week until 8 pm?	1.71
		C4 - Can you get quick advice on the phone when the BHU is open?	2.9
		C5 - Is there a phone number you can call when you become ill when your BHU is closed?	1.17
		C6 - When the BHU is closed on Saturdays and Sundays and you become ill, will somebody on this service assist you on the same day?	0.95
		C7 - When the BHU is closed on Saturdays and Sundays and you become ill, will somebody on this service assist you on the same da?	0.74
		C8 - Is it easy to schedule a checkup at the BHU you use??	6.36
		C9 - When you arrive at your BHU, do you have to wait more than 30 minutes for a consultation with a physician or nurse (excluding time spent on admission and screening)?	4.07
		C10 - Do you have to wait long or speak with many people to schedule a consultation at your BHU?	6.54
		C11 - Is it difficult to be assisted at your BHU when you believe it is necessary?	5.71
		C12 - Do you have to miss work or school when you need to go to your BHU?	6.15
COORDINATION OF SERVICES	CARE INTEGRATION	E4 – Has your physician/nurse described to you the different BHUs where you could be assisted with your health problem?	5.56
		E5 - Have your physician/nurse or someone working in the BHU assisted you with scheduling this consultation?	6.51
		E6 – Has your physician/nurse written any information to the specialist regarding the reason for this consultation?	6.59
		E9 – Did your physician/nurse seem interested in the quality of care you were given (asked whether you were well or poorly assisted by this specialist or specialist service)?	6.11
COMPREHENSIVENESS	SERVICES AVAILABLE	G2 - Verify if your family can participate in any program of social assistance or social benefits	5.4
		G3 - Nutrition supplementation program (milk, food, etc.)	5.31
		G6 - Dental treatment	6.2
		G8 - Counseling or treatment for drug abuse (lawful or illicit; e.g., alcohol, cocaine, sleeping pills, etc.)	6.15
		G9 - Counseling on mental health problems	6.06
		G12 - Identification (some type of assessment) of hearing disorders	4.84
		G13 - Identification (some type of assessment) of visual disorders	4.51
		G14 - Splinting (e.g., for a sprained ankle)	4.74
		G15 - Removal of warts	3.9
		G17 - Advice on quitting smoking	6.48
		G19 - Removal of ingrown toenail	4.37
		G20 - Counseling about the changes that occur with aging (e.g., decreased memory, risk of falling)	5.82
		G22 - Counseling about what to do if someone in your family becomes disabled and cannot make decisions about health (e.g., organ donation if someone in your family is unable to decide, for example, in a coma)	5.26
	SERVICES PROVIDED	H2 - Safety at home, such as storing medicines safely	5.39
		H3 - Advice on using seat belts or child safety seats when driving/riding in a car	2.47
		H4 - Ways to cope with family conflicts that may occasionally arise	3.42
		H8 - Possible exposure to hazardous substances (e.g., ant/rat poison, bleach) at home, at work, or in the neighborhood	3.74
		H9 - Ask whether there are firearms in the household and guide how to safely store them	1.87
		H10 - How to prevent burns	2.97
		H11 - How to prevent falls	4.38
		H-12 - For women only: how to prevent osteoporosis or brittle bones	5
		H-13 - For women only: caring for common menstruation or menopause problems	5.49
FAMILY ORIENTATION		I1 – Does your physician/nurse ask you about your ideas and opinions (what you think) when planning treatment and care for yourself or a member of your family?	5.11
FAMILY ORIENTATION		I2 – Has your physician/nurse ever asked you about common diseases or problems that may occur in your family (e.g., cancer, alcoholism, depression)?	6.28
COMMUNITY ORIENTATION		J3 - Does your BHU hear community opinions and ideas on how to improve its assistance?	6.44
		J4 - Does the BHU you use survey patients to find out if its services meet their users’ needs?	3.47
		J5 - Does your BHU survey the community to identify health problems that it should know about?	4.7
		J6 - Does your BHU invite you and your family to participate in the Local Health Council (Management Council/User Council)?	3.88

ATTRIBUTE	DIMENSION	QUESTIONS	Mean score
FIRST CONTACT	ACCESSIBILITY	C2 - Do you have to wait long or speak with many people to schedule a consultation at your BHU?	6
		C4 - When you arrive at your BHU, do you have to wait more than 30 minutes for a consultation with a physician or nurse for your child (excluding time spent on admission and screening)?	4.22
		C6 - Can you get quick advice on the phone when the BHU is open?	4.22
COORDINATION OF SERVICES	CARE INTEGRATION	E2 – Have the BHU or a physician/nurse referred your child to a consultation with a specialist or specialized assistance?	6.19
		E4 - Had your child's physician/nurse been informed about the results of this consultation?	5.24
		E5 – After this appointment with the specialist or specialized service, did your physician/nurse talk to you about what happened during this consultation?	3.33
		E6 – Was your physician/nurse interested in the quality of care provided to your child at the specialist or specialized service?	5.24
COMPREHENSIVENESS	SERVICES AVAILABLE	G4 - Nutrition supplementation program (milk, food, etc.)	3.85
		G8 - Counseling and requesting of HIV test	6.41
		G9 - Identification (some type of assessment) of hearing disorders	4.36
	SERVICES PROVIDED	H2 - Safety at home, such as storing medicines safely	5.48
		H3 - Changes in the growth and development of the child, that is, what you should expect at each age, for example, when the child begins to walk, urine control, etc.	6.43
		H5 - Ways to keep your child safe, such as preventing falls or keeping the child away from the stove	5
FAMILY ORIENTATION		I2 – Has your physician/nurse ever asked you about common diseases or problems that occur in your child’s family (e.g., cancer, alcoholism, depression)?	6.19
COMMUNITY ORIENTATION		J3 - Does the BHU survey the community to identify health problems that your child should know about?	4.52
COMMUNITY ORIENTATION		J4 - Does the BHU invite family members to participate in the Local Health Council (Management Council/User Council)?	2.86

ATTRIBUTE	QUESTIONS	Users ≤ 18 years	Users > 18 years
Degree of affiliation	Are there any health professionals, other than physicians or nurses, in the BHU where you are assisted for that is also responsible for your health care?	2.63	2.10
First contact - Utilization	When you need the professional that best knows your health history, does the doctor or nurse always refer you?	3.7	5.25
	Is it easy to schedule a consultation with the professional that knows your health history best in the service you use?	8.15	5.73
	Is it difficult for you to be quickly assisted by the professional in your service that knows your health history best when you believe it is necessary?	2.59	6.15
Longitudinality	When you visit the service where you are cared by the professional that knows your health story best, is it always this professional that assists of you?	9.26	6.46
Longitudinality	Is the professional who knows your health story best aware of your most important problems?	9.26	6.98
Comprehensiveness - Services available	If you have mobility problems, does anyone at this BHU recognize this need?	10	8
	If you have problems using of your hands or arms to perform day-to-day tasks, does anyone at this BHU recognize this need?	_	5.88
	If you have speech/voice problems, does anyone at this BHU recognize this need?	10	5
	If you have psychiatric problems, does anyone at this BHU recognize this need?	9.17	4.58
	If you have intellectual problems, does anyone at this BHU recognize this need?	6.67	6.67
	If you have a hearing impairment, does anyone at this BHU recognize this need?	_	3.33
	If you have vision problems, does anyone at this BHU recognize this need?	10	5.25
	If you have problems related to the lack of any part of your body, does anyone at this BHU recognize this need?	_	9.05
	If you have problems moving any part of your body, does anyone at this BHU recognize this need?	10	8.13
	If necessary, does your caregiver receive guidance from the BHU to provide care?	6.67	4.44
	If so, do you receive orientation from the BHU to provide this care?	5	3.86

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[1] Mann Whitney test at 5% significance level (p<0.05)

[2] Captions: PCAT = Primary Care Assessment Tool; SD = standard deviation