Essential attributes of Primary Health Care: national results of PMAQ-AB

ABSTRACT The concept of a comprehensive Primary Health Care (PHC) and its quality can be evaluated by the effectiveness of the following attributes: first contact service, longitudinality, comprehensiveness and coordination. The objective of this article is to analyze the effectiveness of PHC attributes in team practice from the perspective of professionals and users, comparing the results of the National Program for Access and Quality Improvement in Primary Health Care (PMAQ-AB), between cycles 1 and 2. Quantitative study, with identification of the teams participating in the two cycles and operationalization of the PHS attributes through the selection of PMAQ-AB variables relevant to each attribute. We compared the national results of 12.680 Basic Health Units, 15.668 teams and 58.517 users. Some attributes improved from cycle 1 to cycle 2. The best results were first contact and comprehensiveness, confirming the gradual constitution of the Basic Health Units as an accessible first contact service, with a diversified scope of actions, although insufficient. The attributes with worse evaluation were longitudinality, with low continuity and quality of the professional-patient relationship; and coordination, due to difficulties of access to specialized care and insufficient shared records.

摘要：综合初级卫生保健（Primary Health Care, PHC）及其服务质量，可通过以下四项核心属性的有效性开展评估：首诊服务、纵向连续性、全面性与协调性。本文旨在从医护人员与服务使用者的视角，分析团队执业模式下初级卫生保健属性的有效性，并对比全国初级卫生保健准入与质量改善计划（PMAQ-AB）第一周期与第二周期的评估结果。本研究为定量研究，选取参与两个周期评估的医疗团队作为研究对象，通过筛选与各初级卫生保健属性相关的PMAQ-AB变量，实现对各项属性的操作化定义。本研究共纳入12680所基层卫生单元、15668支医疗团队以及58517名服务使用者的全国性评估数据进行对比分析。结果显示，部分初级卫生保健属性在第一周期至第二周期间得到改善：首诊服务与全面性两项属性表现最优，证实基层卫生单元正逐步构建为可及性良好的首诊服务载体，服务覆盖范畴日趋多元，但仍存在不足。表现较差的两项属性分别为纵向连续性与协调性：前者体现为医患关系的连续性与服务质量偏低；后者则源于专科转诊准入困难、共享诊疗记录建设不完善等问题。