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Advisor(s)
Abstract(s)
Introdução: Os Cuidados de Saúde Primários (CSP) são o primeiro contacto de
pessoas, famílias e comunidades com o Serviço Nacional de Saúde (SNS), garantindo acesso
livre e gratuito aos utentes e tratando de todas as suas questões de saúde,
independentemente da idade, género ou outras características pessoais em causa. Em
Portugal, os Cuidados de Saúde Primários então associados às Unidades Locais de Saúde
(ULS) e aos Agrupamentos de Centro de Saúde (ACeS). Estes últimos são serviços de saúde
com autonomia administrativa que são compostos por várias unidades funcionais: as
Unidades de Cuidados na Comunidade (UCC), as Unidades de Cuidados de Saúde
Personalizados (UCSP), as Unidades de Recursos Assistenciais Partilhados (URAP), as
Unidades de Saúde Familiar (USF) e as Unidades de Saúde Pública (USP). Destas unidades,
as mais dirigidas para os cuidados personalizados médicos e de enfermagem são as USF e
as UCSP, no entanto, com várias disparidades, quer ao nível da autonomia, hierarquia,
contratualização, incentivos, entre outros.
Objetivo: Identificar e descrever a organização dos Cuidados de Saúde Primários
em Portugal, assim como reconhecer as práticas de organização que contribuam para a
eficácia e para a eficiência na prestação de cuidados de saúde e na satisfação dos utentes e
profissionais.
Métodos: Esta revisão sistemática foi realizada com base nas linhas orientadoras
do PRISMA. A pesquisa foi realizada através da PubMed, EBSCO, SCOPUS e Web of
Science, limitada a artigos escritos em espanhol, inglês e português e publicados entre os
anos de 2005 e 2022. A data da última pesquisa foi dia 17 de janeiro de 2023. A avaliação
dos artigos foi realizada através da “Newcastle-Ottawa Quality Assessment Scale”.
Resultados: Nos dezassete estudos foram avaliados os modelos organizativos dos
Cuidados de Saúde Primários em Portugal, particularmente as ACeS, as UCSP e as USF. Dos
estudos considerados, sete assentavam sobre a avaliação da implementação das USF e/ou
ACeS, quatro acerca dos indicadores de desempenho contratualizados, três estudos sobre a
satisfação dos utentes e outros três sobre a satisfação dos profissionais de saúde. Quanto à
satisfação dos utentes e dos profissionais de saúde podemos observar que esta é satisfatória,
sendo que as USF obtêm melhores percentagens de satisfação quando comparadas com as
UCSP. Entre as USF, as do modelo B são as mais satisfatórias e com profissionais de saúde mais comprometidos, onde a classe médica é aquela que está mais comprometida. No que
se refere aos indicadores de contratualização podemos observar que a sua introdução foi
benéfica, levando a uma melhor prestação de cuidados de saúde. Relativamente à avaliação
da implementação das USF e ACeS conclui-se que desta resultaram cuidados mais
eficientes, acessíveis, equitativos, com equipas prontas para trabalhar em equipa e prestar
os melhores cuidados de saúde aos utentes.
Conclusão: Nesta revisão constatou-se que a organização dos Cuidados de Saúde
Primários em Portugal evolui cada vez mais para uma prestação de cuidados mais eficazes
e eficientes. Desde a criação das USF, em especial as do modelo B, que estas unidades
funcionais permitem uma maior qualidade, continuidade, acessibilidade e satisfação para
os doentes e para os profissionais de saúde. Isto só é alcançado com profissionais de saúde
motivados e realizados, com condições laborais favoráveis e equipas multidisciplinadas,
melhorando a organização e recompensando as boas práticas de prestação de saúde.
Introduction: Primary Health Care (PHC) are the first point of contact for persons, families and communities with the National Health Service (NHS), ensuring free access to patients and addressing all their health issues regardless of age, gender or other personal characteristics. In Portugal, primary health care is associated with Health Local Units (ULS) and Clusters of Health Centers (ACeS). These last ones are health services with administrative autonomy that are composed of several functional units: Community Care Units (UCC), Personalized Health Care Units (UCSP), Shared Assistance Resource Units (URAP), Family Health Units (USF), and Public Health Units (USP). Among these units, the ones focused on personalized medical and nursing care are USF and UCSP, but with numerous differences in terms of autonomy, hierarchy, contracting, incentives, and others. Objective: Identify and describe the organization of Primary Health Care in Portugal, as well as recognize organizational practices that contribute to effectiveness and efficiency in providing health care and satisfaction for users and professionals. Methods: This systematic review was based on the PRISMA guidelines. The search was conducted through PubMed, EBSCO, SCOPUS, and Web of Science, limited to articles written in Spanish, English, and Portuguese and published between 2005 and 2022. The last search was conducted on January 17, 2023. The assessment of the articles was performed by using the "Newcastle-Ottawa Quality Assessment Scale". Results: The seventeen studies analysed the organizational models associated with Primary Health Care in Portugal particularly ACeS, UCSP, and USF. From the studies considered, seven were based on the assessment of the implementation of USF and/or ACeS, four on contracted performance indicators, three on user’s satisfaction and other three on health professionals’ satisfaction. Regarding user and healthcare professionals’ satisfaction, it can be observed that it is satisfactory, with USF obtaining higher satisfaction percentages when compared to UCSP. Among USF, those with model B are the most satisfactory, with more committed healthcare professionals, with the medical class being the most committed ones. About the contracted performance indicators, their introduction was beneficial, leading to better health care delivery. Concerning the assessment of the implementation of USF and ACeS, it is concluded that this resulted in more efficient, accessible, equitable care, with health professionals ready to work as a team and provide the best healthcare to users. Conclusion: This systematic review found that the organization of Health Care in Portugal are evolving towards providing increasingly effective and efficient health care. Since the creation of USF, especially model B units, these functional units have allowed for greater quality, continuity, accessibility and satisfaction for patients and health professionals. This is only achieved with motivated and fulfilled health professionals, with good working conditions and multidisciplinary teams, improving organization and rewarding good health care provision practices.
Introduction: Primary Health Care (PHC) are the first point of contact for persons, families and communities with the National Health Service (NHS), ensuring free access to patients and addressing all their health issues regardless of age, gender or other personal characteristics. In Portugal, primary health care is associated with Health Local Units (ULS) and Clusters of Health Centers (ACeS). These last ones are health services with administrative autonomy that are composed of several functional units: Community Care Units (UCC), Personalized Health Care Units (UCSP), Shared Assistance Resource Units (URAP), Family Health Units (USF), and Public Health Units (USP). Among these units, the ones focused on personalized medical and nursing care are USF and UCSP, but with numerous differences in terms of autonomy, hierarchy, contracting, incentives, and others. Objective: Identify and describe the organization of Primary Health Care in Portugal, as well as recognize organizational practices that contribute to effectiveness and efficiency in providing health care and satisfaction for users and professionals. Methods: This systematic review was based on the PRISMA guidelines. The search was conducted through PubMed, EBSCO, SCOPUS, and Web of Science, limited to articles written in Spanish, English, and Portuguese and published between 2005 and 2022. The last search was conducted on January 17, 2023. The assessment of the articles was performed by using the "Newcastle-Ottawa Quality Assessment Scale". Results: The seventeen studies analysed the organizational models associated with Primary Health Care in Portugal particularly ACeS, UCSP, and USF. From the studies considered, seven were based on the assessment of the implementation of USF and/or ACeS, four on contracted performance indicators, three on user’s satisfaction and other three on health professionals’ satisfaction. Regarding user and healthcare professionals’ satisfaction, it can be observed that it is satisfactory, with USF obtaining higher satisfaction percentages when compared to UCSP. Among USF, those with model B are the most satisfactory, with more committed healthcare professionals, with the medical class being the most committed ones. About the contracted performance indicators, their introduction was beneficial, leading to better health care delivery. Concerning the assessment of the implementation of USF and ACeS, it is concluded that this resulted in more efficient, accessible, equitable care, with health professionals ready to work as a team and provide the best healthcare to users. Conclusion: This systematic review found that the organization of Health Care in Portugal are evolving towards providing increasingly effective and efficient health care. Since the creation of USF, especially model B units, these functional units have allowed for greater quality, continuity, accessibility and satisfaction for patients and health professionals. This is only achieved with motivated and fulfilled health professionals, with good working conditions and multidisciplinary teams, improving organization and rewarding good health care provision practices.
Description
Keywords
Cuidados de Saúde Primários Organização Unidade de Cuidados de Saúde Personalizados Unidade de Saúde Familiar