scholarly journals Perfil da população cadastrada em uma Unidade Básica de Saúde da Família: a importância da classificação de risco familiar

2021 ◽  
Vol 3 (2) ◽  
pp. 84-94
Author(s):  
Sandy Borges ◽  
Fernanda de Jesus Santiago ◽  
Luciana Saraiva da Silva
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
High Risk ◽  
Family Health ◽  
Minas Gerais ◽  
Risk Classification ◽  
Family Risk ◽  
Cross Sectional ◽  
Primary Health

A Atenção Básica (AB) é considerada o primeiro nível de atenção em saúde e tem na Saúde da Família sua estratégia prioritária para expansão e consolidação. O objetivo do estudo foi descrever o perfil e a classificação de risco familiar dos usuários de uma Unidade Básica de Saúde da Família em Uberlândia, Minas Gerais. Trata-se de um estudo transversal, com dados coletados dos Sistemas de Informações, nos anos 2017 e 2018. Foram analisadas variáveis sociodemográficas, classificação dos grupos populacionais e risco familiar. Para a classificação de risco familiar foram considerados fatores socioeconômicos (grau de alfabetização do chefe da família, renda e abastecimento de água) e fatores clínicos (grau de risco dos seguintes grupos/condições: gestante, criança, hipertensão, diabetes, doença renal crônica ou outras condições crônicas de alto risco). Foram avaliados 1553 usuários, sendo 70,6% do sexo feminino. A faixa etária predominante foi entre 40 e 59 anos (33,23%) e a menos atendida foi a de adolescentes entre 14 e 17 anos (1,55%). Em relação à classificação de risco, observou-se maiores prevalências de hipertensão com médio risco, diabetes de alto risco e tuberculose de baixo risco. O estudo evidencia a importância do fortalecimento de políticas públicas, que visem à promoção e monitoramento das condições de saúde na AB. Palavras-chave: atenção básica, fator de risco, doença crônica.   Abstract Primary Health Care (PHC) is considered the first level of health care and has in Family Health its priority strategy for expansion and consolidation. The objective of the study was to describe the profile and family risk classification of users of the Family Health Unit in Uberlândia, Minas Gerais. This is a cross-sectional study, with data collected from the municipality's Information Systems, during the years 2017 and 2018. Sociodemographic variables, classification of population groups and family risk were analyzed. For the classification of family risk, socioeconomic factors (degree of literacy of the head of the household, income and water supply) and clinical factors (degree of risk of the following groups/conditions: pregnant woman, child, hypertension, diabetes, chronic kidney disease or other high-risk conditions). A total of 1553 users were evaluated, 70.6% of whom were female. The predominant age group was that of adults between 40 and 59 years old (33.23%) and the least attended was that of adolescents between 14 and 17 years old (1.55%). Regarding the risk classification, there was a higher prevalence of medium-risk hypertension, high-risk diabetes and low-risk tuberculosis. The study highlights the importance of strengthening public policies, aimed at promoting and monitoring health conditions in PHC. Keywords: primary health care, risk factors, chronic disease.  

Reasons for encounter in primary health care in Brazil

2020 ◽  
Vol 37 (5) ◽  
pp. 648-654
Author(s):  
Patricia S Chueiri ◽  
Marcelo Rodrigues Gonçalves ◽  
Lisiane Hauser ◽  
Lucas Wollmann ◽  
Sotero Serrate Mengue ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Family Health ◽  
Cross Sectional Study ◽  
Geographic Region ◽  
Cross Sectional ◽  
Primary Health ◽  
Family Health Strategy ◽  
Specialized Care ◽  
Reasons For Encounter

Abstract Background Primary health care (PHC) delivery in Brazil has improved in the last decades. However, it remains unknown whether the Family Health Strategy teams are meeting the health needs of the population. Objectives To describe the reasons for encounter (RFEs) in PHC in Brazil and to examine variations in RFEs according to sex, age and geographic region. Methods This descriptive study is part of a national cross-sectional study conducted in 2016. The sample was stratified by the number of PHC physicians per geographic region. Physicians who had been working for at least 1 year in the same PHC unit were included. For every participating physician, 12 patients aged ≥18 years who had attended at least two encounters were included. Patients were asked about their RFEs, which were classified according to the International Classification of Primary Care. Results In 6160 encounters, a total of 8046 RFEs were coded. Seven reasons accounted for 50% of all RFEs. There was a high frequency of codes related to test results, medication renewal and preventive medicine. RFEs did not vary significantly by sex or geographic region, but they did by age group (P < 0.001). The rates of prescriptions, requests for investigations and referrals to specialized care were 71.1%, 42.8%, and 21.3%, respectively. Conclusion This novel study opened the ‘black box’ of RFEs in PHC in Brazil. These findings can contribute to redefining the scope of PHC services and reorienting work practices in order to improve the quality of PHC in Brazil.

scholarly journals PERFIL DOS PROFISSIONAIS DA ATENÇÃO PRIMÁRIA À SAÚDE, VINCULADOS AO CURSO DE ESPECIALIZAÇÃO EM SAÚDE DA FAMÍLIA UNA-SUS NO RIO GRANDE DO SUL

2020 ◽  
Vol 1 ◽  
pp. 04
Author(s):  
Giovani Sturmer ◽  
Maria Eugênia Bresolin Pinto ◽  
Monica Maria Celestina de Oliveira ◽  
Alessandra Dahmer ◽  
Airton Tetelbom Stein ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Family Health ◽  
Rio Grande ◽  
Cross Sectional Study ◽  
Physical Structure ◽  
Health Unit ◽  
Rio Grande Do Sul ◽  
Cross Sectional ◽  
Primary Health

No Brasil, a Atenção Primária em Saúde (APS) é porta de entrada no serviço de saúde do Sistema Único de Saúde (SUS). A rede é constituída por unidades de saúde onde profissionais preparados para atuar na prevenção e manutenção da saúde da comunidade buscam atender às necessidades locais de forma equitativa, eficaz e precisa. O objetivo deste estudo é descrever o perfil dos profissionais da APS, vinculados a Especialização em Saúde da Família – UNA-SUS UFCSPA. Foi realizado um estudo transversal com profissionais da saúde não participantes do Programa Mais Médicos, que atuam na APS no Rio Grande do Sul vinculados ao curso, entre 2011 e 2013, para observar as características dos profissionais e o seu vínculo com o trabalho. Entre os 277 avaliados, a maioria são mulheres, enfermeiras, com média de 35 anos, formadas a menos de 10 anos, 88% trabalham em ESF, e 73,1% participam de equipes de saúde bucal. A pós-graduação concluída direcionada para APS foi observada em 30% dos profissionais; e 56,3% estavam no primeiro trabalho em APS, com media de 4,5 anos de atuação; 40,4% tinham outra atividade remunerada (77% médicos). Observou-se que 59% estavam satisfeitos com o tipo de vínculo, e entre a maioria foi observada a satisfação com as condições gerais de trabalho (58,1%), com a estrutura física e com os equipamentos das unidades (58,3%). Observaram-se profissionais com menor idade e pouca especialidade na área, entretanto, todos eles buscando aprimoramento através da Especialização para melhorar sua atuação na APS.Palavras-chave: Atenção Primária à Saúde. Saúde da Família. Profissionais da Saúde.ABSTRACTIn Brazil Primary Health Care (PHC) is the gateway to health service of the Unified Health System. The network consists of health unit where professionals seek to meet local needs fairly and effectively, and it must rely on trained professionals to work in community health prevention and maintenance. The aim of this study is to describe the profile of PHC professionals who are linked to UNA-SUS–UFCSPA’s Specialization Program in Family Health. A cross-sectional study with health professionals who work in PHC in Rio Grande do Sul and were linked to the program between 2011 and 2013 was conducted to observe the characteristics of professionals and their relationship with work. Among the participants (277), the majority are women, nurses with an average of 35 years, professionals for less than 10 years, 88% work in FHS, and 73.1% with oral health team. The completed a graduate degree focused on PHC was observed in 30% of the professionals; 56.3% were working their first job in PHC, with a median of 4.5 years of operation; and 40.4% engaged in another paid activity (77% physicians). It was observed that 59% were satisfied with their type of employment, and most participants showed to be satisfied with their general working conditions (58.1%) and the physical structure and equipment of the health unit (58.3%). Younger professionals and with little expertise in the area were observed, however all of them were seeking development through Specialization to improve their performance in PHC.Keywords: Primary Health Care. Family Health. Health Personnel.

scholarly journals Knowledge and attitude of patients with diabetes mellitus in Primary Health Care

2017 ◽  
Vol 21 (4) ◽  
Author(s):  
Suelen Cordeiro Assunção ◽  
Alisson Pereira Fonseca ◽  
Marise Fagundes Silveira ◽  
Antônio Prates Caldeira ◽  
Lucinéia de Pinho
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Primary Health Care ◽  
Family Health ◽  
Negative Attitude ◽  
Cross Sectional ◽  
Primary Health ◽  
Patients With Diabetes ◽  
Family Health Strategy ◽  
Knowledge And Attitude

Abstract Objective: To evaluate the knowledge and attitude of patients with diabetes mellitus in Primary Health Care and associated factors. Methods: Cross-sectional, quantitative and analytical study with 353 patients with type 2 diabetes mellitus in Family Health Strategy units. The Knowledge and Psychological Attitudes Questionnaires were used for data collection, as well as a script with sociodemographic, economic and clinical data. Results: The majority of the population was female (73.1%), aged more than 50 years (81.5%), diagnosed for more than five years (54.9%) and with a per capita income of up to half a minimum wage (59.3%). The scores of knowledge and attitude were low. Age (p = 0.001) and level of education (p = 0.002) were variables associated with knowledge about diabetes mellitus. Conclusion: Users had a low level of knowledge about diabetes, indicating an unsatisfactory result in self-care and mainly a negative attitude towards coping with this disease.

scholarly journals The Prevalence of Abdominal Adiposity among Primary Health Care Physicians in Bahia, Brazil: An Epidemiological Study

2021 ◽  
Vol 18 (3) ◽  
pp. 957
Author(s):  
André Luiz Brandão Costa ◽  
Magno Conceição das Merces ◽  
Amália Ivine Costa Santana ◽  
Douglas de Souza e Silva ◽  
Rodrigo Fernandes Weyll Pimentel ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Waist Circumference ◽  
Family Health ◽  
Cross Sectional Study ◽  
Abdominal Adiposity ◽  
Cross Sectional ◽  
Primary Health ◽  
The Family ◽  
Primary Health Care Physicians

Background: Labor activities are demanding for workers and can induce occupational stress. Primary health care (PHC) workers have faced problems that can lead to the development of stress and abdominal obesity. The aim of this study was to estimate the prevalence of abdominal adiposity among primary health care physicians in the metropolitan mesoregion of Salvador, Bahia. Methods: This is a cross-sectional study conducted with physicians from the family health units (FHUs) of the metropolitan mesoregion of Salvador, Bahia, Brazil. The number of FHUs corresponded to 41 teams (52 physicians). Anamnesis was performed and a questionnaire was applied. The clinical examination consisted of measuring waist circumference (WC), blood pressure levels (BP), and body mass index (BMI), as well as examining for acanthosis nigricans. Blood samples were collected for biochemical dosages. The data obtained were analyzed by SPSS version 22.0. Results: The sample included 41 physicians (response rate: 78.8%), of which 18 were women (44.0%). The percentage of overweight participants represented by BMI was 31.7%. The hypertriglyceridemia prevalence was 29.2%. HDL-c was low in 48.7% of the participants. The waist circumference measurement revealed a prevalence of abdominal adiposity of 38.8% (women) and 34.8% (men). Conclusions: Medical professionals in PHC are more susceptible to having higher abdominal adiposity, especially female physicians.

scholarly journals AVALIAÇÃO DA ESTRATÉGIA SAÚDE DA FAMÍLIA EM SÃO SEBASTIÃO – DISTRITO FEDERAL

2019 ◽  
Vol 10 (3) ◽  
Author(s):  
Virgílio Luiz Marques De Macedo ◽  
Luciana Fontes Vieira ◽  
Rinaldo De Souza Neves ◽  
Suderlan Sabino Leandro
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Quality Of Care ◽  
Primary Health Care ◽  
Family Health ◽  
Cross Sectional ◽  
Primary Health ◽  
Distrito Federal ◽  
First Contact

Objetivo: Avaliar a qualidade da assistência prestada por profissionais da Estratégia Saúde da Família em São Sebastião, Distrito Federal, na atenção a pacientes portadores de Hipertensão Arterial Sistêmica e Diabetes Mellitus. Metodologia: Trata-se de um estudo descritivo-exploratório transversal de cunho quantitativo com 107 usuários e 27 profissionais de saúde. Resultados: Foram avaliados como satisfatórios pelos usuários apenas os atributos acesso de primeiro contato – utilização e coordenação – sistema de informação. Para os profissionais, os atributos acesso de primeiro contato – acessibilidade e orientação comunitária foram considerados insatisfatórios, indicando que a qualidade da assistência por meio do acesso e informação é aceitável para os usuários e deficiente para os profissionais. Conclusão: Os dados apresentados evidenciam que a Atenção Primária a Saúde não está exercendo sua função de porta de entrada, de coordenadora e ordenadora da Rede de Atenção à Saúde.Descritores: Avaliação em Saúde; Atenção Primária à Saúde; Estratégia de Saúde da Família; Hipertensão; Diabetes Mellitus.EVALUATION OF THE FAMILY HEALTH STRATEGY IN SÃO SEBASTIÃO - FEDERAL DISTRICTObjective: To evaluate the quality of care provided by the health team of Primary Health Care of São Sebastião, Distrito Federal, in the attention to patients with Systemic Arterial Hypertension and Diabetes Mellitus. Method: This is a descriptive-exploratory cross-sectional quantitative study with 107 patients e 27 health profissionals. Results: Only the attributes of first contact access - utilization and coordination - information system were evaluated as satisfactory by the users. For professionals, the attributes of first contact access - accessibility and community orientation were considered unsatisfactory, indicating that the quality of care through access and information is acceptable for users and disabled for professionals. Conclusion: The data presented shows that Primary Health Care is not performing its function as gateway, as coordinator and ordinator of the Health Care Network.Descriptors: Health Evaluation; Primary Health Care; Hypertension; Diabetes Mellitus.EVALUACIÓN DE LA ESTRATEGIA SALUD DE LA FAMILIA EN SÃO SEBASTIÃO - DISTRITO FEDERALObjetivo: Evaluar la calidad de la asistencia prestada por profesionales de la Estrategia Salud de la Familia en São Sebastião, Distrito Federal, en la atención a pacientes portadores de Hipertensión Arterial Sistémica y Diabetes Mellitus. Método: Se trata de un estudio descriptivo-exploratorio transversal de cuño cuantitativo com 107 clientes e 27 profesionales de salud. Resultados: Se evaluaron como satisfactorios por los usuarios sólo los atributos acceso de primer contacto - utilización y coordinación - sistema de información. Para los profesionales, los atributos acceso de primer contacto - accesibilidad y orientación comunitaria se consideraron insatisfactorios, indicando que la calidad de la asistencia a través del acceso e información es aceptable para los usuarios y deficiente para los profesionales. Conclusión: Los datos presentados evidencian que la Atención Primaria a la Salud no está ejerciendo su función de puerta de entrada, de coordinadora y ordenadora de la Red de Atención a la Salud.Descriptores: Evaluación en Salud; Atención Primaria de Salud; Hipertensión; Diabetes Mellitus.

scholarly journals Primary health care attributes of family health teams with and without family physician

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A C F Martins ◽  
G A Pereira ◽  
W P P Gomes ◽  
C N Monteiro ◽  
C A S Siqueri ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Service Management ◽  
Assessment Tool ◽  
Family Health ◽  
Cross Sectional Study ◽  
Point Of View ◽  
Cross Sectional ◽  
Primary Health ◽  
Care Assessment

Abstract Background The four essential attributes of primary health care (PHC): access, longitudinality, comprehensiveness and coordination, guide the professional practices of service management and also the professionals of the family health strategy teams. Family medicine residence (FMR) is the speciality that trains medical practitioners capable of acting properly in PHC. It develops a person-centred approach, oriented towards the individual, his family and community, which dialogues with the PHC precepts of comprehensive patient care from a social point of view. Thus, the objective of this study was to verify whether there are differences in the PHC attributes perceived by patients treated by teams with FMR doctors and by the others. Methods This was an observed cross-sectional study conducted during 2019, which used the Adult Primary Care Assessment Tool (PCATool) to evaluate preliminarily 28 PHC teams working at the city of São Paulo, Brazil. The teams were compared based on 337 patient answers using domains medians and Mann-Whitney tests. The study was approved by the ethics committee. Results Eight teams (28.6%) had doctors trained in FMR. The attributes of longitudinality and access were very similar between the two groups. The teams with FMR doctors showed better evaluations in the components: information systems, median 7.78, versus 6.67 (p = 0.391); services available, median 6.52, versus 6.06 (p = 0.086); and services received, median 4.85, versus 3.85 (p = 0.180) of the coordination and comprehensiveness attributes. Conclusions We didn't find statistically significant results indicating better PHC attributes of teams with FMR doctors, based on user perception. A continuous study is recommended to follow the evolution of this speciality in the PHC context. Key messages FMR is a fundamental key to PHC and must be evaluated continuously. It is necessary to strengthen their insertion in the Brazilian health system and discuss the ways to do so.

scholarly journals Avaliação dos atributos da atenção primária à saúde nas ações de controle da hanseníase [Assessment of the attributes of primary health care in leprosy control actions] [Evaluación de los atributos de la atención primaria a la salud en las acciones de control de la lepra]

2018 ◽  
Vol 26 ◽  
pp. e31925 ◽  
Author(s):  
Nayara Figueiredo Vieira ◽  
Fernanda Moura Lanza ◽  
Francisco Carlos Félix Lana ◽  
José Ramón Martínez-Riera
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Health Professionals ◽  
Minas Gerais ◽  
Control Measures ◽  
Assessment Instrument ◽  
Cross Sectional ◽  
Primary Health ◽  
Leprosy Control

Objetivo: avaliar a presença e extensão dos atributos da atenção primária nas ações de controle da hanseníase, na visão dos profissionais de saúde. Método: estudo transversal, envolvendo 251 profissionais da atenção primária de Betim. Utilizou-se o Instrumento de avaliação de desempenho da atenção primária nas ações de controle da hanseníase, mediante entrevistas, sendo o escore calculado por meio da média das respostas dadas pelas Escala de Likert. Foi aprovado pelo Comitê de Ética e Pesquisa da Universidade Federal de Minas Gerais. Resultados: forte orientação do serviço (≥6,6) nos atributos porta de entrada, integralidade dos serviços disponíveis e prestados, e orientação familiar; e fragilidades (<6,6) no acesso, orientação comunitária e profissional. Conclusão: ao avaliar a presença e extensão dos referidos atributos, os profissionais constataram deficiências que prejudicam a qualidade das ações de controle da hanseníase. Torna-se necessário integrar as ações da endemia na atenção primária para eliminar esse grave problema de saúde pública.ABSTRACTObjective: to evaluate the presence and extent of the attributes of primary health care in leprosy control measures in the view of health professionals. Method: this cross-sectional study involved 251 primary health care personnel in Betim. The Assessment Instrument primary care performance in leprosy control measures was used through interviews, with scores calculated as means of Likert Scale responses. The study was approved by the research ethics committee of Minas Gerais Federal University. Results: strengths (≥ 6.6) were service orientation to gateway attributes, comprehensiveness of services available and provided, and the family; and weaknesses (<6.6) were access, and orientation towards the community and health professionals. Conclusion: when evaluating the presence and extent of the attributes, the health professionals found deficiencies that impaired the quality of leprosy control measures. Measures to address the endemic must be integrated into primary care in order to eliminate this serious public health problem.RESUMENObjetivo: evaluar la presencia y extensión de los atributos de la atención primaria en las acciones de control de la lepra desde el punto de vista de profesionales de salud. Método: estudio transversal, involucrando a 251 profesionales de la atención primaria de Betim. Se utilizó el Instrumento de evaluación de rendimiento de la atención primaria en las acciones de control de la lepra, a través de entrevistas, siendo la puntuación calculada a través del promedio de las respuestas dadas por la escala de Likert. Estudio aprobado por el Comité de Ética en Investigación de la Universidad Federal de Minas Gerais. Resultados: fuerte orientación del servicio (≥6,6) en los atributos puerta de entrada, integralidad de los servicios disponibles y ofrecidos, orientación familiar y fragilidades (<6,6) en el acceso, orientación comunitaria y profesional. Conclusión: al evaluar la presencia y extensión de los mencionados atributos, los profesionales constataron deficiencias que perjudican la calidad de las acciones de control de la lepra. Se hace necesario integrar las acciones de la endemia en la atención primaria para eliminar este grave problema de salud pública.

scholarly journals Assessment of primary health care: health professionals’ perspective

2014 ◽  
Vol 48 (spe) ◽  
pp. 122-128 ◽  
Author(s):  
Simone Albino da Silva ◽  
Denismar Alves Nogueira ◽  
Camila Maria da Silva Paraizo ◽  
Lislaine Aparecida Fracolli
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Assessment Tool ◽  
Family Health ◽  
Healthcare Services ◽  
Cross Sectional ◽  
Family Health Program ◽  
Primary Health ◽  
Care Assessment ◽  
First Contact

Objective To assess primary health care attributes of access to a first contact, comprehensiveness, coordination, continuity, family guidance and community orientation. Method An evaluative, quantitative and cross-sectional study with 35 professional teams in the Family Health Program of the Alfenas region, Minas Gerais, Brazil. Data collection was done with the Primary Care Assessment Tool - Brazil, professional version. Results Results revealed a low percentage of medical experts among the participants who evaluated the attributes with high scores, with the exception of access to a first contact. Data analysis revealed needs for improvement: hours of service; forms of communication between clients and healthcare services and between clients and professionals; the mechanism of counter-referral. Conclusion It was concluded that there is a mismatch between the provision of services and the needs of the population, which compromises the quality of primary health care.




scholarly journals Assessing the care of children under one year old in Primary Health Care

2013 ◽  
Vol 21 (2) ◽  
pp. 554-561 ◽  
Author(s):  
Maria Cândida de Carvalho Furtado ◽  
Janaina Carvalho Braz ◽  
Juliana Coelho Pina ◽  
Débora Falleiros de Mello ◽  
Regina Aparecida Garcia de Lima
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Assessment Tool ◽  
Family Health ◽  
Health Care Team ◽  
Cross Sectional ◽  
Primary Health ◽  
Care Assessment ◽  
One Year ◽  
Primary Care Assessment Tool

OBJECTIVE: to analyze the presence and extent of Primary Health Care attributes and the strength of affiliation of children under one year old in a Family Health Unit. METHOD: cross-sectional, descriptive study conducted between October 25, 2010 and May 14, 2011 with 44 mothers, using the Primary Care Assessment Tool to collect data. Data were analyzed by calculating the Essential Primary Health Care and General Primary Health Care scores. RESULTS: mothers recognized and experienced aspects of accessibility, comprehensive care and coordination of care, as well as community guidance, marked by a concern and involvement on the part of the health team in the children's care, their families and community. CONCLUSION: The Primary Health Care team makes efforts to approach the community and meet their health needs, seeking instruments that aid the promotion of qualified care to children.

scholarly journals Primary Health Care: care coordinator in regionalized networks?

2016 ◽  
Vol 50 (0) ◽  
Author(s):  
Patty Fidelis de Almeida ◽  
Adriano Maia dos Santos
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Emergency Services ◽  
Family Health ◽  
Structured Interviews ◽  
Cross Sectional Survey ◽  
Care Coordinator ◽  
Cross Sectional ◽  
Interprofessional Communication ◽  
Primary Health

RESUMO OBJECTIVE To analyze the breadth of care coordination by Primary Health Care in three health regions. METHODS This is a quantitative and qualitative case study. Thirty-one semi-structured interviews with municipal, regional and state managers were carried out, besides a cross-sectional survey with the administration of questionnaires to physicians (74), nurses (127), and a representative sample of users (1,590) of Estratégia Saúde da Família (Family Health Strategy) in three municipal centers of health regions in the state of Bahia. RESULTS Primary Health Care as first contact of preference faced strong competition from hospital outpatient and emergency services outside the network. Issues related to access to and provision of specialized care were aggravated by dependence on the private sector in the regions, despite progress observed in institutionalizing flows starting out from Primary Health Care. The counter-referral system was deficient and interprofessional communication was scarce, especially concerning services provided by the contracted network. CONCLUSIONS Coordination capacity is affected both by the fragmentation of the regional network and intrinsic problems in Primary Health Care, which poorly supported in its essential attributes. Although the health regions have common problems, Primary Health Care remains a subject confined to municipal boundaries.

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