Desenvolvimento de materiais para a sistematização, avaliação e monitoramento do processo de atenção domiciliar na Atenção Primária à Saúde

Abstract

Introduction and objective: The increase in demand for Home Care (HC) that accompanies population aging and the associated multimorbidity require an expansion of the offer and improvement of the quality of care. The vast majority of people monitored in HC in Primary Health Care (PHC) are in Home Care Modality 1 (HC1), intended for users who are stable. Despite the importance of HC in PHC, national studies indicate that there are weaknesses in terms of structure and processes to be faced. The present study aimed to develop instruments for the systematization, evaluation and monitoring of processes, that is, the activities and procedures of health professionals in the HC carried out in the PHC. Methodology: The literature review, highlighting the manual “Home Care in Primary Health Care”, from the Ministry of Health, will be used for the construction of instruments aimed at adapting HC to the principles of SUS: Universality, Equity and Comprehensiveness; and the essential and derived attributes of PHC, according to Bárbara Starfield's assumptions. Thus, the following will be prepared: a spreadsheet of Objectives, Goals, Indicators and Actions (OGIA); a form for individual follow-up; and an automated spreadsheet for population monitoring and assessment. The materials will be evaluated by doctors and nurses from four Family Health Strategy (FHS) teams in São Borja, Rio Grande do Sul, from September 2021 to March 2022. Results: In this study, 36 indicators were defined for the evaluation of the HC process in PHC, which supported the elaboration of the proposed instruments. Health professionals who evaluated the content and verified the applicability of the instruments considered that the vast majority of process indicators had high relevance, adequately evaluated the achievement of the objective and was useful to support interventions. The form and the automated spreadsheet were considered useful and important, but the evaluators considered that weaknesses in the structure and work process compromise the incorporation of materials into the routine of the service, in addition to making it difficult to obtain some indicators. They identified a lack of time to fill in instruments that often require the duplication of records performed routinely at the Basic Health Unit (BHU), and the existence of gaps in continuing education for HC and health care for the elderly. Based on the analysis performed by health professionals, the instruments were improved. Conclusion: The form and the automated worksheet provide the self-assessment of the work process by health professionals, equipping teams for individual clinical follow-up, in addition to monitoring and population assessment of HC performed in PHC. Thus, these tools make it possible to identify weaknesses and support the definition of actions to be developed to qualify HC in PHC.