Evaluation of the health attention to pregnant women with HIV: comparison between primary and specialized service

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Abstract

ABSTRACT The public network for health care of pregnant women with HIV, in Santa Maria, Rio Grande do Sul/Brazil, includes primary and specialized care services. Objective: Evaluating whether the type of service interferes in the quality score of the health care in the experience of the pregnant women with HIV. Methods: Cross-sectional study, with data collection from April-November/2014, with 78 participants. The Primary Care Assessment Tool-Brazil instrument was applied and the Pearson's Chi-square test and Fisher's exact test were used. Results: The quality of care received was evaluated as unsatisfactory both in primary care (6.50) and in specialized care (6.35). Conclusion: The type of service interferes with the quality of care, which can affect women's choice of service. It is necessary to improve the quality of both types of services and to search for the management of shared care to attend both the usual care of gestation and the specificity of infection.

Translated abstract

RESUMO A rede pública para atenção à saúde de gestantes com HIV, no município de Santa Maria, Rio Grande do Sul/Brasil, inclui os serviços de atenção primária e especializada. Objetivo: Avaliar se o tipo de serviço interfere no escore de qualidade da atenção à saúde na experiência das gestantes com HIV. Métodos: Estudo transversal, com coleta de dados de abril-novembro/2014, com 78 participantes. Foi aplicado o instrumento Primary Care Assessment Tool-Brasil e utilizados os testes Qui-quadrado de Pearson e Exato de Fisher. Resultados: A qualidade da atenção recebida foi avaliada como insatisfatória tanto na atenção primária (6,50) quanto na especializada (6,35). Conclusão: O tipo de serviço interfere na qualidade da atenção, o que pode repercutir na escolha do serviço pelas mulheres. Há necessidade de melhoria da qualidade de ambos os serviços e de busca pelo cuidado compartilhado para atender tanto cuidados habituais da gestação quanto especificidade da infecção.

Translated abstract

RESUMEN La red pública de atención de salud de mujeres embarazadas con VIH, en Santa María, Rio Grande do Sul/Brasil, incluye servicios de atención primaria y especializada. Objetivo: Evaluar si el tipo de servicio interfiere en el puntaje de calidad de la atención de salud en la experiencia de las mujeres embarazadas con VIH. Métodos: estudio transversal, con la recolección de datos de abril-noviembre/2014, con 78 participantes. Se aplicó el instrumento Primary Care Assessment Tool-Brasil y se utilizaron la prueba de Chi-cuadrado de Pearson y exacta de Fisher. Resultados: La calidad de la atención recibida fue evaluada insatisfactoria tanto en la atención primaria (6,50) como en la especializada (6,35). Conclusión: El tipo de servicio interfiere en la calidad de la atención, lo que puede repercutir en la elección del servicio por las mujeres. Hay necesidad de mejorar la calidad de ambos servicios y buscar el cuidado compartido para atender tanto cuidados habituales de la gestación como especificidad de la infección.

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Development of the Chinese primary care assessment tool: data quality and measurement properties.

Hui Yang, Leiyu Shi, Lydie A Lebrun … (2013)

The aim of this study was to translate and adapt the Primary Care Assessment Tool to assess the perceptions of the quality of primary care among patients in China and to examine the psychometric properties of the adapted Primary Care Assessment Tool Chinese version (PCAT-C). A cross-sectional survey to assess the validity and reliability of PCAT-C using standard psychometric techniques. Outpatient departments of five state-level and provincial-level hospitals and four municipal-level hospitals as well as nine community health centers in Changsha, China. A total of 2532 patients visiting primary care providers. The PCAT-C was acceptable to patients, as evidenced by low proportions of missing data and a full range of possible scores for all items. Two items were eliminated following principal component analysis and reliability testing. The principal component analysis extracted eight multiple-item scales and one single-item scale. Multiple-item scales had reasonable internal consistency and high item-scale correlations. This study represents the first attempt to construct an instrument for assessing patient reports on the quality of primary care, which is applicable to the Chinese context. Psychometric assessments indicated that the PCAT-C is a useful instrument for assessing the core attributes of primary care in China.

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The roles and training of primary care doctors: China, India, Brazil and South Africa

Robert Mash, Magda Almeida, William C W Wong … (2015)

China, India, Brazil and South Africa contain 40% of the global population and are key emerging economies. All these countries have a policy commitment to universal health coverage with an emphasis on primary health care. The primary care doctor is a key part of the health workforce, and this article, which is based on two workshops at the 2014 Towards Unity For Health Conference in Fortaleza, Brazil, compares and reflects on the roles and training of primary care doctors in these four countries. Key themes to emerge were the need for the primary care doctor to function in support of a primary care team that provides community-orientated and first-contact care. This necessitates task-shifting and an openness to adapt one’s role in line with the needs of the team and community. Beyond clinical competence, the primary care doctor may need to be a change agent, critical thinker, capability builder, collaborator and community advocate. Postgraduate training is important as well as up-skilling the existing workforce. There is a tension between training doctors to be community-orientated versus filling the procedural skills gaps at the facility level. In training, there is a need to plan postgraduate education at scale and reform the system to provide suitable incentives for doctors to choose this as a career path. Exposure should start at the undergraduate level. Learning outcomes should be socially accountable to the needs of the country and local communities, and graduates should be person-centred comprehensive generalists.

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Development of the Korean primary care assessment tool--measuring user experience: tests of data quality and measurement performance.

N Sung, Jaiyong Kim, H. Park … (2009)

To develop a tool for assessing the performance of primary care services in South Korea from the patient's perspective and to test the validity of the tool under the conceptual framework of the recently developed definition of primary care in Korea. Item development for questionnaire and a cross-sectional survey for tool validation at 16 primary care clinics. All family physicians included in this study were required to have practiced at their current clinic for at least 2 years. A nine expert panel was assembled for tool development and patients (or guardians) who had visited their primary care clinic on six or more occasions over a period of more than 6 months participated in the survey. Scores corresponding to each domain of primary care. A total of 722 effective data sets were used for the analysis. Five items were eliminated from the preliminary 30-item tool after expert discussions at two seminars. Another four items were eliminated by principle component analysis. For each of the four domains (comprehensiveness, coordination function, personalized care, and family/community orientation), tests of scaling assumptions were well satisfied by all Likert-scaled measures. On the other hand, 'first contact' turned out to be a composite domain with five independent single-item scales. The Korean primary care assessment tool (version 1) consists of four multi-item scales and one composite scale. Widespread application of this tool will provide an empirical basis for the measurement, monitoring and continuous improvement of primary care in South Korea.

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Author and article information

Contributors

Raquel Einloft Kleinubing: Role: ND

Daniel Gonzalo Eslava: Role: ND

Stela Maris de Mello Padoin: Role: ND

Cristiane Cardoso de Paula: Role: ND

Journal

Journal ID (publisher-id): ean

Title: Escola Anna Nery

Abbreviated Title: Esc. Anna Nery

Publisher: Universidade Federal do Rio de Janeiro (, RJ, Brazil )

ISSN (Print): 1414-8145

ISSN (Electronic): 2177-9465

Publication date (Print and electronic): March 2019

Volume: 23

Issue: 2

Electronic Location Identifier: e20180258

Affiliations

[1] Santa Maria Rio Grande do Sul orgnameUniversidade Federal de Santa Maria Brazil

[2] Bogotá orgnameFundación Universitaria del Área Andina Colombia

Article

Publisher ID: S1414-81452019000200210

DOI: 10.1590/2177-9465-ean-2018-0258

SO-VID: 06131d92-fb75-4733-94ae-2f9aa13d1a98

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This work is licensed under a Creative Commons Attribution 4.0 International License.

History

Date accepted : 04 January 2019

Date received : 25 August 2018

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Figures: 0, Tables: 0, Equations: 0, References: 38, Pages: 0

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SciELO Brazil

Keywords: Atenção à Saúde,VIH,Mujeres Embarazadas,Salud de la Mujer,Investigación en Servicios de Salud,Atención a la Salud,HIV,Pregnant Women,Women's Health,Health Services Research,Health Care,Gestantes,Saúde da Mulher,Avaliação de serviços de saúde

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Keywords: Atenção à Saúde, VIH, Mujeres Embarazadas, Salud de la Mujer, Investigación en Servicios de Salud, Atención a la Salud, HIV, Pregnant Women, Women's Health, Health Services Research, Health Care, Gestantes, Saúde da Mulher, Avaliação de serviços de saúde

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Most cited references 34

Development of the Chinese primary care assessment tool: data quality and measurement properties.

The roles and training of primary care doctors: China, India, Brazil and South Africa

Development of the Korean primary care assessment tool--measuring user experience: tests of data quality and measurement performance.

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