Acesso aos serviços de Atenção Primária à Saúde na perspectivas de profissionais: correlações entre o Primary Care Assessment Tool e o modelo conceitual de acesso universal

Abstract

Assis and Jesus (2012) propose an analysis model to understand universal access to health services. The model considers five dimensions: political, economic-social, technical, organizational, and symbolic. This study aimed to analyze access from the perspective of health professionals. This is a multi-method (cross-sectional and methodological), quantitative study, from 2021 to 2022 with nurses and doctors from PHC in the state of Goiás. The AFC analyzed the items of the Primary Care Assessment Tool (PCATool) instrument and their relationship with the dimensions of the model. Data collection was carried out through a validated questionnaire, containing the first part with the sociodemographic profile and the second part with questions divided into 9 components according to the essential and derived attributes of the Primary Care Assessment Tool - PCATool (PCATool-Brazil) instrument. The questionnaire data were analyzed by the statistical software R (R version 4.1.2; Vienna, Austria) (R Core Team, 2021). To analyze access, a descriptive analysis was performed, and Confirmatory Factor Analysis (CFA) was performed to analyze the dimensions of access. The results showed a sample of 308 health professionals in the 47 municipalities that participated in the study. The overall average age of the participants was 37.5 years, with a predominance of females (82.8%) and self-declared white skin color (43.5%). The CFA found a correlation between the scores of the items measured in the PCATool and the dimensions of the model, being significant for three (organizational, technical and symbolic) of the five (political and economic-social) dimensions, highlighting the attributes Comprehensiveness, Community Orientation and Family. The CFA highlighted the main demands of access in PHC, dimensioned the scope of investigation of the PCATool instrument and demonstrated the weaknesses of the instrument. Regarding the lack of confirmation of the theoretical constructs of the political and economic-social dimensions, assessing access through the PCATool may not reflect the reality of Brazilian services and users, as well as bias political decision-making.