Utilização e qualidade da assistência ao puerpério na Atenção Primária

Abstract

This thesis aimed to evaluate the use and quality of puerperium care in primary healthcare (PHC), in the Programme for Improving Access and Quality in Primary Care (PMAQ-AB). The target population was made up of women with children up to two years old, users of basic health units (UBS) evaluated by the Programme. The data used came from the PMAQ-AB External Evaluation phase, Cycles I (2012), II (2014) and III (2018), available on the PHC Secretariat website. Descriptive and time trend analyses were used to assess the temporal trend of puerperium care, using variance weighted least squares regression according to the social context variables (region, social vulnerability index (SVI), population size and Family Health Strategy (FHS) coverage). When assessing the quality of puerperium care, only data from Cycle III was used and a synthetic indicator was created from the sum of seven variables, with positive responses to six or seven questions being considered puerperium quality. The exposures were characteristics of the users and the municipality. The association was measured by bivariate analysis using the chi-squared test for linear trend and heterogeneity. Crude and adjusted multivariate analyses were carried out using Poisson regression with robust variance adjustment. A significance level of 5% was considered for all analyses. Cycles I and III were approved by the Research Ethics Committee of the Federal University of Pelotas (opinion numbers 38/2012 and 2,453,320, respectively). Cycle II was approved by the Research Ethics Committee of the Federal University of Goiás, opinion 487.055. The prevalence of puerperium consultations was 57.7 per cent, 54.5 per cent and 53.0 per cent in the three cycles respectively, showing a reduction in the mean annual variation (MAV) (-0.61p.p; p<0.001). The increase in the frequency of this type of consultation was seen in the north (0,8 p.p; p=0,007) and north-east (0.5 p.p; p=0.001) and in municipalities with very high SVI (1.1p.p). However, VMA decreased in municipalities with populations over 300,000 and in all categories of FHS coverage in the municipality. Only 19.5 per cent of women received a quality consultation. Breast exams and physical/gynaecological exams were reported by less than half of the sample. Women living in the Northeast, in municipalities with 100% FHS coverage, aged 40 or over, at the extremes of family income and who received a visit from the CHW in the first week after giving birth were more likely to have a quality consultation. PHC showed low coverage and quality in puerperium consultations, requiring efforts from managers and professionals to improve the indicators. Furthermore, the pro-equity finding reveals the strength of the PMAQ-AB combined with the ability of the region and the poorest municipalities to overcome when they have incentives and policies in favour of social justice.