Changes in Quality Indicators relating to Organization of Primary Care Services between 2007 and 2010 in São Paulo State, Brazil

INTRODUCTION:  The expansion of Brazilian Public Primary Health Care (BPPHC) must to be preceded by continuous quality improvement. Nowadays, several policies and training of health workforce are undertaken to ensure universal access, equity and comprehensiveness in the health system. The self-assessment tool QualiAB ("Evaluation of the Quality of Primary Care Services") addresses characteristics of care organization and local management. The managers of 350 Primary Care Units and their teams filled the QualiAB in 2007 and 2010 from 85 cities of the São Paulo State – Brazil. To determine the trends of the quality indicators used, we compared 2007 outcomes with 2010.

METHODS:  We used 60 indicators, wich were categorized into three grades: 0 (poor), 1 (acceptable) or 2 (standard expected). We used the chi-square test. Statistical significance considered when p≤0.05 with a confidence interval of 95%. Data analysis was carried out with SPSS (version 21.0). 

RESULTS:  34 indicators showed significant changes (% of units with progression to the expected standard compared 2007). There are improve on 10 indicators of the managerial dimension, especially those related to the coordination of work and access to basic inputs, as tests and drugs. On the assistance dimension, 19 indicators showed positive progression especially provision of nursing and oral health appointments. Had poor performance 1 indicator management and 7 assistance.

CONCLUSIONS:  The results indicate improved quality of BPPHC, while identifying weaknesses to overcome. However the number of indicators in standard expected may indicate a need ever more demanding of rigor in the assessment, from the conception of quality as incremental attribute.