| FHU 1 |
Carried it out |
Contact tracing was not carried out;
Telemonitoring was performed;
Active search was not carried out. |
Was a vaccination center against Covid-19 |
"No, contact tracing was not carried out. We did [the test] in those who came there, you know? We made suggestions. For example, if someone came, a wife, we suggested that the husband do it [the test]. If they had symptoms, we would suggest it, right? But it was not traced, no, we didn't make phone calls, trace it, not that." (I24)
"We performed telemonitoring. We had some people who were working from home, who were professionals within the risk group, and they did this telemonitoring. Even one of the doctors who worked with us, he designed a telemonitoring program." (I13)
"But active search for what? For Covid? […], no." (I24)
"We spent more time here, in the [unit] area, organizing forms, records, this kind of thing. We served patients here at the center." (I1) |
Nonstructured;
Nonsystematic;
Nonparticipatory. |
Provision of care for Covid-19 only |
Provision of care for Covid-19 only |
"[Care was] suspended right at the beginning of the pandemic. Right at the beginning, we only focused on care for Covid." (I13)
"There was a shift." (I24)
"There was a shift, a planning of how the flow would work, so much so that here, in the unit, user embracement was carried out, what we nowadays call Flow B, as we determined the flows as Flow A and B, that is, Flow A is for symptomatic patients and Flow B, for patients who are not symptomatic respiratory." (I13)
"I love health care. To help people, to guide people. If I can do anything to help, I'll do it." (I1)
"The patients, I think, are well monitored, they are cared for, you know? All in all, we help them, you know? Patients don't come here just because of a dental complaint; they seek the service because of that, but if I see something different, I already refer them, you know? So, yeah, I think it's very interesting." (I24) |
| FHU 2 |
Carried it out |
Contact tracing was not carried out;
Telemonitoring was not performed;
Active search was not carried out. |
Was a vaccination center against Covid-19 |
"Contact tracing was unofficially done. The identification was ok, but contact tracing was done in a very informal way with the user, you know?" (I25)
"We received a tablet from… [SMS program], but the program did not move forward, it weakened, there was no encouragement, it was forgotten. And amid the tests, we couldn't carry it out." (I25)
"We tried [implementing] some strategies by using WhatsApp groups and such, but we had some problems, which was the discussion of the work of the community health agent […], so in the end, we ended up focusing on what everyone wanted, for everyone to feel safe, to choose performing active search for users, because at that beginning people died and nobody wanted to be responsible for it." (I25) |
Nonstructured;
Nonsystematic;
Nonparticipatory — meeting with the team to organize the shift. |
Hypertension,
diabetes and
procedures |
Consultations, specific actions via Whatsapp, health education app for pregnant women, waiting room, prescriptions renewal, welcoming of spontaneous demand without scheduling for scheduled demand |
"Yes, they were aimed at risk groups. We kept prenatal care, children's care, and patients with chronic conditions, such as diabetics, hypertensive individuals, tuberculosis, so we did not interrupt it, no. We only interrupted those more elective clinical consultations." (I25)
"There was no planning, even so ‘cause someone could be absent […] it was always according to the day or the shift, who was there for user embracement and adding one more, there always had someone. But we cannot say that there was a plan for the whole week or the month, no." (I14)
"The reason why I showed up to work, [because] I already have experienced some difficulties before working, with family members, you know, to need care and not be welcomed, not be cared for, and as I had the opportunity, I really took the opportunity to try to make a little difference. ‘Cause even if I did not have the conditions to provide care, I could always welcome them, even if the doctor couldn't see them, I'd say for them to come tomorrow that we would make it work, you know? To welcome them properly, that's very important." (I2) |
| FHU 3 |
Carried it out (October 2021) |
Contact tracing was carried out at the time of testing of symptomatic patients, asking them to attend the unit;
Telemonitoring was not performed;
Active search was rarely carried out |
Was a vaccination center against Covid-19 |
"I asked how many people there were in the house, if they had any symptom, and if someone had symptoms, I'd say for them to come here" (I15)
"Our schedule was perfectly ok. In 2021, it was the vaccine; in 2022, it was practically testing; and I think that, at the end of 2022, the Covid issue was getting better, and we resumed those activities that were specific to the PSF." (I26)
"Rarely [referring to active search], ‘cause most people came out of spontaneous demand really. The vast majority came due to spontaneous demand." (I26) |
Nonstructured;
Nonsystematic;
Nonparticipatory — shift per team/day. |
Hypertension,
diabetes and
procedures |
Consultations for clinical care |
"Hiperdia, which is the Brazilian program aimed at providing care for hypertensive and diabetic patients, prenatal care, family planning, children's health, the smoking program is held here, preventive cervical cancer screening, Guthrie test, vaccination, dressings, testing for sexually transmitted infections, hepatitis B and C, AIDS and syphilis, medical clinic appointments, dental appointments, PSE, tuberculosis, and leprosy." (I26)
"Of the pandemic. Since the opening of the unit, we only carry out visits or registration, but visits reduced a lot, and educational activities, which is the work done by CHAs, right? Promoting prevention, health promotion and protection, that doesn't happen. I've been waiting [for it] to this day." (I3)
"’Cause I love working with Primary Health Care, I really care about it, about prevention, I like it. I've never worked in a hospital, I like Primary Health Care." (I15) |
| FHU 4 |
Carried it out |
Telemonitoring was performed;
The other professionals reported that there was no telemonitoring or contact tracing;
Active search was not carried out;
Contact tracing was not carried out. |
It was not a vaccination center against Covid-19 |
"I think it was because of the flow, which was very massive. I think it was about it [in relation to not performing telemonitoring]." (I16) |
Nonstructured;
Nonsystematic;
Nonparticipative — meeting with nurses and the manager to organize the shift |
Hypertension, diabetes and procedures |
Consultations for clinical care, prescriptions renewal, health communication on the way from home to the unit |
"Everything was done here at the center, but during the pandemic, a lot was suspended. But, you know, it depends on the period we're talking about. Because after the vaccinating started and cases decreased, some services were resumed, but we used to do everything, hypertension, diabetes, prenatal care, children's care, family planning, all these actions. Now, there was a suspended time." (I27)
"Boy, we went through some hard times here… So, we tried, indeed, to make a planning, not everyone would gather, because as it was a pandemic, we could not get everyone together, but some did, a nurse from each team would meet with the manager and talk, whether to make a planning, organize shifts, but it was carried out somehow, yeah. We would gather to talk things through, organize shifts, you know?" (I4)
"It's a matter of profile, actually. Since college, I have identified with the public health area, since my first job, I already wanted to work in Primary Health Care, in PSF, but I have had experience in management, experience in specialized care, and I like Primary Health Care, because you are not solely focused on treating the disease, but on preventing, promoting health. And that's one thing that captivates me in Primary Health Care, you can do both, you can provide care, but also promote health." (I27) |
| FHU 5 |
It was not carried out |
Active search was carried out;
Contact tracing was carried out at the time of testing of symptomatic patients, asking them to attend the unit;
Telemonitoring was performed. |
Was a vaccination center against Covid-19 |
"The active search was sometimes carried out, with some professionals and health agents. There was…, they had a printed form of a while ago, for positive cases. They had a printed form for follow-up […]." (I28)
"I think only in a few specific cases [referring to active search]." (I5)
"The professional who provided care usually identified, you know, the patient who needed monitoring. And then, professionals themselves performed the monitoring via telephone contact or the health agent, or the health agent went to the patient's home to perform this monitoring." (I28) |
Nonstructured;
Nonsystematic;
Nonparticipatory — team meetings to organize shifts. |
Hypertension and
diabetes |
Reduced consultations and waiting room concerning Covid-19 topics |
"We reduced the number of consultations. And then there was the shift issue, right? It also depended on the day, you know? Depending on the shift, there were some professionals focused on the care of symptomatic respiratory patients and others were doing the same routine care." (I28)
"It's because, actually, there's not much hypertension and diabetes like before, when we had Hiperdia. In fact, it's an appointment with the same clinician, and they also see hypertensive and diabetic patients." (I28)
"We always discussed it in team meetings." (I5)
"It's the issue with wages [laughs] and also because, like, the way […] to work like that, be closer to the community. The actions that are inserted in the health unit, I think it's very interesting, this direct contact we have with the patient." (I17) |
| FHU 6 |
Carried it out (for a period of one month) |
Active search was carried out in specific cases;
Contact tracing was not carried out;
Telemonitoring varied. |
Was a vaccination center against Covid-19 |
"You mentioned… [the SMS program] and I remember that, indeed, there was one…, but it started at the end. Not in the end, but at a time when the pandemic was not so severe. It took a long time for it to start, but we had the…, sometimes, we had patient monitoring. It was not a constant thing." (I29)
"Except when the reference contacted the unit and asked to do an active search for this patient. But it was nothing like that…, for example, if we knew that a certain patient had Covid; it was nothing certain, you know." (I18) |
Nonstructured;
Nonsystematic;
Little participatory — team meeting once. The shift was organized by the manager. |
Hypertension and
diabetes |
Consultation — spontaneous demand |
"In the beginning, to establish how this user embracement would take place, there was a meeting; but afterwards, a pre-organized shift was followed." (I18)
"Of routine programs, I think almost none. Probably, planning and obstetrics, for prenatal follow-up. I believe that only these… [referring to programs for children's care, diabetes, tuberculosis, oral health] yes, it was interrupted." (I29)
"We had guidance, what guidance to provide for users upon their arrival, for instance, Hiperdia patients, when they arrived, if they needed a prescription, if their prescription had expired, they were seen in user embracement, so the doctor could be informed and renew this prescription, not always requiring a consultation. I think it interfered a lot in the care for these patients." (I18)
"Oh, I'm passionate about health care." (I6) |
| FHU 7 |
Tests were not performed |
Active search was carried out;
Telemonitoring was performed;
Contact tracing was carried out at the time of
telemonitoring. |
Was a vaccination center against Covid-19 |
"Right, as it was determined that CHAs would only have to visit patients in cases of actual priority. They did not have to make periodic visits. Then, it was very restricted indeed, [the visits would be made] only if they knew about a suspected case there." (I30)
"There was for the issue of symptomatic respiratory patients. Even before TQT, testing, we did it. Every 48 hours, we called patients. At first, it was 14 days of isolation. In this period of 14 days, every 48 hours, we called patients to know how they were doing, for instance, if someone in their home presented with any symptom, got worse, how was the patient during the 14 days of isolation." (I19)_
"The same team. Usually, the traced contacts were, like, for example, we called a patient and the patient said that the daughter presented with symptoms, then we traced this daughter, right, and explained [the situation], you know, so they could come to the unit to be examined." (I19) |
Nonstructured;
Systematic;
Participatory — meeting with all professionals to organize the shift and depending on the need. |
Provision of care for Covid-19 only |
Provision of care for Covid-19 only |
"Pretty much nothing, to be honest. We were completely focused on Covid We suspended medical care, even following the guidance of the Department of Health. At that time of the pandemic, we weren't supposed to see patients." (I19)
"There was a meeting once a week [about] what wasn't working, we would fix it, especially the doctors and nurses." (I7)
"In fact, in practice, no, because, like I said, we were all focused on Covid, so it turned out that the other programs were really left aside." (I19)
"When I first started, I was smitten. At first, I found it boring, but I started to see the issues focused on prevention, education, and then I fell in love [with it]." (I19)
"Because that was the area I identified with the most." (I30) |
| FHU 8 |
It was not carried out |
Active search was carried out on demand;
Telemonitoring was performed;
Contact tracing was carried out at the time of telemonitoring. |
Was a vaccination center against Covid-19 |
"There was a monitoring system, the staff did it, nurses, dentists. I don't know if the doctor was part of this monitoring, of calling people to know how they were doing, the symptoms, if there was someone else in the house who had presented with symptoms, if they had taken the test and tested positive." (I20)
"Yes, both them and myself, I carried out many visits by cell phone, [by] calling the patient. I called them to know how they were, I was monitoring them." (I8)
"In some cases, yes, we asked the community agent to carry out this active search, right? It was more difficult when patients weren't…, when their area had no agent. That's quite harder, you know? Then we tried to call, we really did…, but visiting them was difficult sometimes." (I31) |
Nonstructured;
Nonsystematic;
Little participative — meetings. |
Urgent demands |
Consultations, procedures and pharmacy |
"Prenatal care was maintained, care for more urgent things… but, for example, prescriptions for hypertension and hypoglycemia… for, like, hypertensive and hypoglycemic patients, they were extended without having an expiration date, right, which is usually 6 months… […] basically, we were seeing symptomatic patients, prenatal care, people with a more urgent complaints. Cervical cancer screening exams were also suspended. Everything that was no longer urgent had to be suspended. Educational activities were also suspended." (I31)
"There were some moments. But, like, in fact, much of what we did was… it has already been determined by the district itself. We had meetings, but very occasional meetings, as we barely had time to have these meetings with everyone. […] But I remember that a lot was determined by the district: how is it going to work, who are we going to see, how many patients approximately." (I31)
"And, you know, that compelled me, because taking care of people is what I love, right? […] you can change people's lives in relation to their own health […] small things, you know? Guidance regarding the care for oneself, which some people don't have, sometimes, but when you get there, you start taking care of that family, that person, those people, it changes everything. It is fulfilling." (I8) |
| FHU 9 |
Carried it out |
Telemonitoring was not performed —
lack of HR;
Active search was carried out;
Contact tracing was carried out at the time of testing symptomatic patients, requesting them to attend the unit. |
Was a vaccination center against Covid-19 |
"Because here, in the District, there was a policy…, there still is, right: where you get a vaccine for Covid, you don't test for it. So we interspersed this reference: sometimes it was a vaccine reference, sometimes it was a test reference." (I32)
"We had it, like, at the time of the appointment, we identified the contacts and called them, right." (I32)
"And then… But, you know, they did not always come. But we called them…, we even gave them a term, which the patient signed, with the name of all contacts, saying that they had a commitment to attend the unit." (I32) |
Nonstructured;
Nonsystematic;
Participatory — meetings. |
Diabetes and hypertension. |
Consultations, dressings, pharmacy, exams to schedule in the system. |
"So, the scheduling was online, for consultations that continued to be in person, because there were hypertensive patients for whom prescription renewal was not enough, diabetics who require a closer care. Now, there were others who had recently been seen, with recent exams, and we could perform teleconsultation. Or, then, in this first stage, we would ask for an exam via teleconsultation, right, we would leave all the exams and prescriptions separated and, once the patient had the results, then we would schedule a face-to-face appointment, which was a more complete consultation." (I32)
"So, I carried out the initial plan, the manager asked me to do so. I made an initial plan and then gathered the team. There were representatives of NASF, CHAs, dentists, doctors. And then, we discussed what would be feasible and what should be changed. In the end, we did…, we passed it on to the rest of the unit, per category, team, and adapted it, also according to the demand. Everyone could have a say." (I32)
"Me? Unemployment. I was unemployed, I got this job and here I am." (I9) |
| FHU 10 |
Carried it out |
Telemonitoring was performed;
Contact tracing was not carried out;
Active search was not carried out. |
Was a vaccination center against Covid-19 |
"That time, I can't explain, no. But I know that positive patients were immediately telemonitored, all this kind of consultation. Now, for how long […]." (I21)
"It was not carried out, no, ‘cause they said that the patients didn't let them enter their houses. There was also that issue of PPE, that all of them had to be protected accordingly, there was the issue of patients’ refusal." (I21).
"[Regarding active search] So, we do… The actual figure was 750, so we always prioritized, you know, those cases that… As we already have a certain contact of years with the community, so we already know who the most vulnerable, most exposed people are, so these were the people that we always […]." (I10)
"[Regarding contact tracing] No, I think it was only the patients who were positive." (I21) |
Nonstructured;
Nonsystematic;
Nonparticipatory — shift per professional category. |
Does not mention hypertension and diabetes |
Consultations |
"Here in the unit, basically, I was the only nurse… so, I ended up on testing…, and there was a shift between dentists and me. So, we saw all kinds of cases, but it was through shifts. One day we were working on Covid-related care, the other we were focused on our own appointments." (I33)
"I think that… vaccination worked. There were days that it worked and other days that it didn't. We did not have much contact with this part of leprosy and tuberculosis, because that was the responsibility of the doctor. We did not have much contact [with it], to know whether was it working or not […], they had some [referring to the doctors] who stayed there in the room, seeing pregnant women. This part of tuberculosis and leprosy we do not know. (I21)
"The day of the week was the day of the team, that's how it worked. […], for example, Tuesday was my team's day, so we had that responsibility on Tuesday. On Wednesday, it was another team." (I10)
"Look, I think one of the main reasons is the issue of demand… so, the Primary Health Care demand is much bigger, because you have a larger amount of PSF, of Health Centers. So, I came to Primary Health Care mostly because of this and for identifying with it. I rather work with programmed actions, so I can have control of them, than, for example, with BP. With BP, nothing is controlled, every day is a different dynamic, you know, in the hospital. So, that's why I prefer Primary Care." (I33) |
| FHU 11 |
Carried it out |
Telemonitoring was performed;
Active search was not carried out — lack of CHAs;
Contact tracing was not carried out. |
Was a vaccination center against Covid-19 |
"From four to five days, we did the active search to know if the patient…, how the patient was." (I11)
"Yes. After the appointment, all suspected or confirmed patients were sent to me, then I did this monitoring, telemonitoring, within 14 days. And then, as soon as they were tested and received the result, I ended it, if they already had no symptoms. If symptoms persisted, I continued performing it." (I22)
"We did it for a while, but it wasn't continuous. Vaccine and testing were always carried out, the Department of Health made rotations. So, for some time, we had the vaccine; another time, we had testing. And the Department created strategies and made rotations among the units." (I34) |
Nonstructured;
Nonsystematic;
Nonparticipatory — shifts organized by the manager. |
Chronic patients |
Consultations and prescriptions renewal |
"So, you mean the provision of care, am I right? We had a phase of the pandemic [in which] the Department restricted the number of consultations […], as this unit was inaugurated in 2020, it was inaugurated in the pandemic boom. […] We were told to focus only on Covid…, so we examined these symptomatic patients. We saw patients of other programs, but only chronic patients, you know, who had [chronic conditions], needed a prescription, who received some continuous treatment. But the prevention part, at that moment, we stopped doing it so the team could be focused on the pandemic. After controlling this situation and with the beginning of vaccination, cases were getting milder, we began to have more availability to resume prevention actions of Primary Health Care." (I34)
"Everyone had to work, you know? The manager organized the shifts for providing care, who was going to be on the shift for welcoming respiratory symptomatic patients and who would be in the testing. And all the professionals were involved in this shift." (I34)
"Damn, you got me! How have I chosen it? In fact, I didn't choose it. […] when I applied for the public tender, in the selection process, I chose direct management, but with 40 hours, aiming at working in urgency and emergency. But then, when I got in, they sent me to Primary Health Care. I didn't choose it." (I22) |
| FHU 12 |
Tests were not performed |
Active search was not carried out;
Contact tracing was not carried out;
There was an attempt to perform telemonitoring. |
Was a vaccination center against Covid-19 |
"We tried [in relation to telemonitoring], right, but there was only one phone for the whole unit. It didn't work." (I35)
"No, we didn't have it [regarding contact tracing]. Guidance was provided by the doctor, in case patients had contact with someone, he asked them to take the test somewhere." (I23)
[In relation to active search] It's like I said, right, we tried, but we couldn't have proper access to patients, ‘cause we only had one cell phone. And then this phone stopped working. That was it, we couldn't […]." (I35) |
Nonstructured;
Nonsystematic;
Non-participatory — shift. |
Hiperdia |
Consultations |
"[…] And then in the most urgent care, the demand here was […] the patients were decompensated, so, you know […] many decompensated patients, with hypertension and diabetes, mental health, this kind of thing, so they needed a closer follow-up, because they did not have a health unit here. So, we focused on them. And then, some cases of the pandemic increased, and we already provided care for those too, the Covid cases. It was like that, the usual demands, right, and the Covid demands." (I35)
"There was a shift. Each day there was a responsible team, each day a doctor, and once a week there was rotation." (I35)
"Girl, when I applied for the public tender, I didn't even believe I was going to work. At the moment, even when I did it, I was unemployed, I needed a job, and when the news came, my God, I couldn't believe it. And today, here I am, right? I like what I do, I like to be an agent, that's it." (I12) |
Covid-19 and chronic conditions: lessons to strengthen care in primary health care