Evaluation of Primary Care Services in São Paulo State, Brazil

INTRODUCTION: Expand the quality and resolubility of Primary Care services is a outstanding challenge for health systems worldwide. The self-assessment tool of primary care services (QualiAB) developed by Brazilian research conducted in 2007, was implemented in 2010 in primary care services in the State of São Paulo. Objectives: assess the quality of Primary Care services in the State of São Paulo according characteristics of care organization and local management.

METHODS: Electronic Multiple Choice Questionnaire answered by local managers and team of primary care health services after voluntary adhesion of the municipal manager. Consists of 65 questions scored: 0 (poor), 1 (acceptable) or 2 (standard expected). Two dimensions are evaluated: Health Assistance and Management.

RESULTS: QualiAB was answered by 2375 services in 586 cities (90.8 % of the state), the most with less than 100,000 inhabitants. The overall average was 1.23, median 1.28. Of total 43.6% are Family Health Services (USF), 32% of traditional Primary Care services (UBS), with 18.6 % UBS with Community Health Agent or Family Health Teams and 5.7 % others. Assistance indicators had  on average score  less than 1: attendance on oral health, attendence on alcoholism, treatment for syphilis on pregnant women, duration of medical appointment, health education in the waiting room. Management had worse performance: board meetings community management, frequency of team meetings and trained professionals in the last year. Services organized as Family Health tend to have better results.

CONCLUSIONS: The primary care services require large investments in the organization of healthcare and local management, and improvement resources. The technical support from the state to little municipalities with direct involvement of teams and managers contributes to policies to enhance the quality.