Evaluation of comprehensive care for older adults in primary care services

Abstract

OBJECTIVE: To evaluate the performance of comprehensive care for older adults in primary care services in the Brazilian Unified Health System in the state of São Paulo, Brazil. METHODS: A total of 157 primary care services from five health regions in midwestern São Paulo responded, from October to December 2014, the pre-validated 2014 questionnaire for primary care services assessment and monitoring. We selected 155 questions, based on national policies and guidelines on this theme. The responses indicate the service performance in older adults’ care, clustered into three areas of analysis: health care for active and healthy aging (45 indicators, d1), chronic noncommunicable diseases care (89 indicators, d2), and support network in aging care (21 indicators, d3). Performance was measured by the sum of positive (value 1) or negative (value 0) responses for each indicator. Services were clustered according to k-means of the performance scores of each domain. After weighting the domains (Z tests), we estimated the associations between the scores of each domain and independent management variables (typology, planning and evaluation of services), with simple and multiple linear regression. RESULTS: Chronic noncommunicable diseases care (d2) showed, for all clusters, better average performance (55.7) than domains d1 (35.4) and d3 (39.2). Service performance in the general area of planning and evaluation associates with the performance of older adults’ care. CONCLUSIONS: The evaluated services had incipient implementation of comprehensive care for older adults. The evaluation framework can contribute to processes to improve the quality of primary health care.

Educational and Care-Related Dialogical Pathway on Active Aging With Family Health Strategy Professionals

“…In order to complement the discussions, related themes emerged in the Culture Circle, such as senescence (natural and healthy aging process, without changing the basic needs of daily living) and senility (aging associated with chronic conditions and functional disabilities), 7,19 the second being even more associated with the aging process by the study participants.…”

“…19 It is noteworthy that the Brazilian demographic aging is a fact, but it should not be associated with inactivity, disability and dependence. 7,[23][24][25] Finally, public policies must be structured by aligning the different determinants of active aging, in order to consider the different trajectories of people and the positive side of aging, breaking with the barriers that limit social participation and the contributions of the elderly to society. 19,23 It is noteworthy that the elderly would not demand excessive spending on health services if public health policies and actions were geared to the specifics of this public, replacing the curative logic with social justice, safety and comfort.…”

“…In addition to this care deficiency, the basic training of professionals hardly includes the health of the elderly as a priority, especially in the context of health promotion 6 reinforcing that the weaknesses of the population's health care fall on the incorporation of actions aimed at promoting active aging, the organization of the health service for the robust elderly and the integration with the intersectoral networks of health care. 7 Thus, educational actions with professionals are necessary, especially those organized in a dialogical and reflective way, 8 allowing the collective construction of new knowledge and practices in relation to active aging in PHC.…”

Acesso e utilização dos serviços de saúde por idosos segundo microrregionais de saúde [Health services access and use by older adults, by health micro-regions] [Acceso y uso de servicios de salud por adultos mayores, según microrregiones de salud]

“…Esses resultados demonstram a relevância do SUS como fonte de acesso e uso daqueles com 60 anos ou mais de idade no país. Entretanto, reforçam a necessidade de investimentos do serviço público no atendimento às demandas da população idosa, no que condiz a implementação de ações efetivas a esse público, conforme preconiza o Ministério da Saúde 35 . Nesse sentido, a regionalização e territorialização em saúde podem favorecer o conhecimento das especificidades da população atendida, de forma a envolver as diversas facetas referentes ao cuidado, como a promoção da saúde, a prevenção de agravos, o diagnóstico precoce, o tratamento e a reabilitação, considerando nesse processo os determinantes sociais de saúde e adoecimento.…”

The Role of Primary Health Care Toward Healthy Aging

“…9 In addition to preventing health problems at the community level, primary care (PHC) is designated as a priority to assist and monitor the health of the local population. 10 These PHC centers are also expected to provide ongoing management and care. Their ideal position is to provide elderly people with regular and long-term contact and continuous care to prevent or delay disability caused by chronic health conditions.…”