Organización y actuación de la atención primaria en la pandemia: estudio transversal según el tamaño de la población de los municipios¹
DOI:
https://doi.org/10.4025/ciencuidsaude.v24i1.75443Palabras clave:
COVID-19, Atención primaria de salud, Vigilancia en salud pública, Gestión en salud, DemografiaResumen
Objetivo: analizar la organización y atención de la Atención Primaria de Salud (APS) para casos sospechosos o confirmados de Covid-19 en municipios brasileños, según el tamaño de la población. Metodología: enfoque transversal, analítico y exploratorio, con 1.474 gestores de laAPS que respondieron a un cuestionario a través de Google Forms entre abril y septiembre de 2022. Los análisis utilizaron razones de prevalencia y regresión de Poisson con efecto aleatorio. Resultados: en municipios pequeños (tamaños 1 y 2), la disponibilidad de pantallas faciales fue un 11% más frecuente (p<0,01) y la de la estructura y el equipo para las pruebas fue un 8% mayor (p=0,02) que en tallas 3 o 4. En estos lugares, la atención en una sala separada fue un 35% más frecuente (p<0,01), la revisión previa de las camas fue un 78% más frecuente (p<0,01) y la vigilancia activa un 28% mayor (p<0,01). La revisión de síntomas cada 48 horas fue un 52% más prevalente (p<0,01). Por otro lado, la adopción de protocolos clínicos para síndromes similares a la gripe fue un 9% menor (p=0,01). Los municipios de tamaño medio (3 y 4) presentaron menor disponibilidad de delantales (p=0,03) y menor desinfección entre visitas (p<0,01), además de indicadores de seguimiento peores. Conclusión: el tamaño de la población influyó en la respuesta de la APS, que fue más ágil en municipios pequeños y más compleja en los grandes.
Descargas
Los datos de descarga aún no están disponibles.
Referencias
1. World Health Organization. COVID-19 Weekly Epidemiological Update. 2021. Disponível em: https://www.who.int/publications/m/item/weekly-epidemiological-update---19-january-2021
2. Lui L, Lima LL, Aguiar R, Machado JA, Albert C. A potência do SUS no enfrentamento à Covid-19: alocação de recursos e ações nos municípios brasileiros. Trabalho, Educação e Saúde. 2022;20:e00247178. doi: https://doi.org/10.1590/1981-7746-ojs00247
3. Silva BRGD, Corrêa APV, Uehara SCDSA. Primary health care organization in the Covid-19 pandemic: scoping review. RevSaude Publica. 2022;56:94. doi: https://10.11606/s1518-8787.2022056004374.
4. Tan X, Liu C, Wu H. Reflections on China's primary care response to COVID-19: roles, limitations and implications. Prim Health Care Res Dev. 2022;23:e46. doi: https://10.1017/S1463423622000378.
5. Huang J, Gopalan A, Muelly E, Hsueh L, Millman A, Graetz Iet al. Primary care video and telephone telemedicine during the COVID-19 pandemic: treatment and follow-up health care utilization. Am J Manag Care. 2023;29(1):e13-e17. doi: https://10.37765/ajmc.2023.89307
6. Barros RDD, Aquino R, Souza LEPF. Evolução da estrutura e resultados da Atenção Primária à Saúde no Brasil entre 2008 e 2019. CienSaude Colet. 2022;27:4289-4301. doi: https://doi.org/10.1590/1413-812320222711.02272022
7. Viana ALDÃ, Rocha JSY, Elias PE, Ibañez N, Novaes MH. Models of primary health care in large cities in the State of São Paulo: effectiveness, efficaciousness, sustainability and governableness. Cien Saude Colet. 2006;11(3):577. doi: https://doi.org/10.1590/S1413-81232006000300009
8. Lui L, Lima LL, Aguiar R, Machado JA, Albert C. A potência do SUS no enfrentamento à Covid-19: alocação de recursos e ações nos municípios brasileiros. Trabalho, Educação e Saúde. 2022;20:e00247178. doi: https://doi.org/10.1590/1981-7746-ojs00247
9. Instituto Brasileiro de Geografia e Estatística (IBGE). Perfil de Informações Básicas Municipais. Perfil dos Municípios Brasileiros, Livro, 2017. Rio de Janeiro: IBGE; 2017. Disponível em: https://biblioteca.ibge.gov.br/visualizacao/livros/liv101595.pdf
10. Ministério da Saúde (BR). Secretaria de Atenção Primária à Saúde. Protocolo de Manejo Clínico do Coronavírus (COVID-19) na Atenção Primária à Saúde. Versão 9. Brasília: Ministério da Saúde; 2020. 41 p. Disponível em:https://portaldeboaspraticas.iff.fiocruz.br/biblioteca/protocolo-de-manejo-clinico-do-coronavirus-covid-19-na-atencao-primaria-a-saude/
11. Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702-6. doi: https://doi.org/10.1093/aje/kwh090
12. Farsalinos K, Poulas K, Kouretas D, Vantarakis A, Leotsinids M, Kouvelas D, et al. Improved strategies to counter the COVID-19 pandemic: Lockdowns vs. primary and community healthcare. Toxicology Reports. 2021;sl,8:1-9. doi: https://doi.org/10.1016/j.toxrep.2020.12.001
13. Teixeira AD, Postali FAS, Ferreira-Batista NN, Diaz MDM, Moreno-Serra R. The role of primary healthcare amid the COVID-19 pandemic: Evidence from the Family Health Strategy in Brazil. SocSci Med. 2024;359:117221. doi: https://10.1016/j.socscimed.2024.117221
14. Vieira-Meyer APG, Forte FDS, Maia MG. Community health workers perspective on the COVID-19 impact on primary health care in Northeastern Brazil. Cad Saúde Pública. 2023;39(7). doi: https://doi.org/10.1590/0102-311XEN007223
15. Massuda A, Malik AN, Vecina-Neto G, Tasca R, Ferreira-Junior WC. The resilience of the Brazilian National Health System in the face of the COVID-19 pandemic. Cadernos EBAPE. 2021;19(spe). doi: https://doi.org/10.1590/1679-395120200185
16. Assefa Y, Gilks CG, Reid S, Pas R, Gete DG, Damme WV. Analysis of the COVID-19 pandemic: lessons towards a more effective response to public health emergencies. Globalization and Health. 2022[s.l.],18,(1):1-12. doi: https://doi.org/10.1186/s12992-022-00805-9
17. Tenreiro P, Ramalho A, Santos P. COVID-19 patients followed in Portuguese Primary Care: a retrospective cohort study based on the national case series. Fam Pract. 2022;39(1):52-58. doi: https://10.1093/fampra/cmab098. PMID: 34448861.
18. Tan X, Liu C, Wu H. Reflections on China's primary care response to COVID-19: roles, limitations and implications. Prim Health Care Res Dev. 2022 Aug 5;23:e46. doi: https://10.1017/S1463423622000378.
19. Giatti LL, Ribeiro RA, Nava AFD. Emerging complexities and rising omission: Contrasts among socio-ecological contexts of infectious diseases, research and policy in Brazil. Genetics and Molecular Biology. 2021; 44(1)[s.1]e20200229. doi: https://doi.org/10.1590/1678-4685-GMB-2020-0229
20. Grigera J. Adding insult to injury: the Covidâ€19 crisis strikes latinamerica. DevelopmentandChange. 2022;53(6):1335-61. doi: https://doi.org/10.1111/dech.12740
21. Miskolci R. Beyond science denialism: disinformation during the Covid-19 pandemic. Sociologias. 2023;25:1-26. doi: http://doi.org/10.1590/18070337-123090EN
22. Pozzatti A, Farias LW. From emergency to structure: ways to fight Covid-19 via international cooperation in health from Brazil.Rev. Bras. Polit. Int.2022;65(1). doi: https://doi.org/10.1590/0034-7329202200106
23. Pasquale S, Gregorio GL, Caterina A, Francesco C, Beatrice PM, Vicenzo P et al. COVID-19 in low-and middle-income countries (LMICs): a narrative review from prevention to vaccination strategy. Vaccines. 2021;9(12):1477. doi: https://doi.org/10.3390/vaccines9121477
24. Du Z, Tian L, Jin DY. Understanding the impact of rapid antigen tests on SARS-CoV-2 transmission in the fifth wave of COVID-19 in Hong Kong in early 2022. Emerging Microbes & Infections. 2022;11(1):1394–1401. doi: https://doi.org/10.1080/22221751.2022.2076616
25. Requia WJ, Kondo EK, Adams MD, Gold DR, Struchiner CJ. Risk of the Brazilian health care system over 5572 municipalities to exceed health care capacity due to the 2019 novel coronavirus (COVID-19). Science of the Total Environment. 2020;[s.1]730:139-44. doi: https://doi.org/10.1016/j.scitotenv.2020.139144
26. Santos RVS, Moura HSD, Delpino FM, Nascimento MC, Ramos ACV, Berra TZ, et al. Concordância à s medidas de flexibilização durante a pandemia de covid-19 no Brasil. CiêncCuid Saúde. 2023;22:e66049. doi: https://doi.org/10.4025/ciencuidsaude.v22i0.66049
27. Palamim CVC, Marson FAL. Covid-19–The availability of ICU beds in Brazil during the onset of the pandemic. Annalsof Global Health. 2020;86(1):100. doi: https://doi.org/10.5334/aogh.3025
28. Silva LL, Dutra AC, Andrade L, Iora PH, Ramajo GLR, Gualda IAP, et al. Emergency care gap in Brazil: geographical accessibility as a proxy of response capacity to tackle COVID-19. Frontiers in Public Health. 2021;9. doi: https://doi.org/10.3389/fpubh.2021.740284
29. Massuda A, Malik AN, Vecina-Neto G, Tasca R, Ferreira-Junior WC. The resilience of the Brazilian National Health System in the face of the COVID-19 pandemic. Cadernos EBAPE. 2021;19(spe). doi: https://doi.org/10.1590/1679-395120200185
2. Lui L, Lima LL, Aguiar R, Machado JA, Albert C. A potência do SUS no enfrentamento à Covid-19: alocação de recursos e ações nos municípios brasileiros. Trabalho, Educação e Saúde. 2022;20:e00247178. doi: https://doi.org/10.1590/1981-7746-ojs00247
3. Silva BRGD, Corrêa APV, Uehara SCDSA. Primary health care organization in the Covid-19 pandemic: scoping review. RevSaude Publica. 2022;56:94. doi: https://10.11606/s1518-8787.2022056004374.
4. Tan X, Liu C, Wu H. Reflections on China's primary care response to COVID-19: roles, limitations and implications. Prim Health Care Res Dev. 2022;23:e46. doi: https://10.1017/S1463423622000378.
5. Huang J, Gopalan A, Muelly E, Hsueh L, Millman A, Graetz Iet al. Primary care video and telephone telemedicine during the COVID-19 pandemic: treatment and follow-up health care utilization. Am J Manag Care. 2023;29(1):e13-e17. doi: https://10.37765/ajmc.2023.89307
6. Barros RDD, Aquino R, Souza LEPF. Evolução da estrutura e resultados da Atenção Primária à Saúde no Brasil entre 2008 e 2019. CienSaude Colet. 2022;27:4289-4301. doi: https://doi.org/10.1590/1413-812320222711.02272022
7. Viana ALDÃ, Rocha JSY, Elias PE, Ibañez N, Novaes MH. Models of primary health care in large cities in the State of São Paulo: effectiveness, efficaciousness, sustainability and governableness. Cien Saude Colet. 2006;11(3):577. doi: https://doi.org/10.1590/S1413-81232006000300009
8. Lui L, Lima LL, Aguiar R, Machado JA, Albert C. A potência do SUS no enfrentamento à Covid-19: alocação de recursos e ações nos municípios brasileiros. Trabalho, Educação e Saúde. 2022;20:e00247178. doi: https://doi.org/10.1590/1981-7746-ojs00247
9. Instituto Brasileiro de Geografia e Estatística (IBGE). Perfil de Informações Básicas Municipais. Perfil dos Municípios Brasileiros, Livro, 2017. Rio de Janeiro: IBGE; 2017. Disponível em: https://biblioteca.ibge.gov.br/visualizacao/livros/liv101595.pdf
10. Ministério da Saúde (BR). Secretaria de Atenção Primária à Saúde. Protocolo de Manejo Clínico do Coronavírus (COVID-19) na Atenção Primária à Saúde. Versão 9. Brasília: Ministério da Saúde; 2020. 41 p. Disponível em:https://portaldeboaspraticas.iff.fiocruz.br/biblioteca/protocolo-de-manejo-clinico-do-coronavirus-covid-19-na-atencao-primaria-a-saude/
11. Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702-6. doi: https://doi.org/10.1093/aje/kwh090
12. Farsalinos K, Poulas K, Kouretas D, Vantarakis A, Leotsinids M, Kouvelas D, et al. Improved strategies to counter the COVID-19 pandemic: Lockdowns vs. primary and community healthcare. Toxicology Reports. 2021;sl,8:1-9. doi: https://doi.org/10.1016/j.toxrep.2020.12.001
13. Teixeira AD, Postali FAS, Ferreira-Batista NN, Diaz MDM, Moreno-Serra R. The role of primary healthcare amid the COVID-19 pandemic: Evidence from the Family Health Strategy in Brazil. SocSci Med. 2024;359:117221. doi: https://10.1016/j.socscimed.2024.117221
14. Vieira-Meyer APG, Forte FDS, Maia MG. Community health workers perspective on the COVID-19 impact on primary health care in Northeastern Brazil. Cad Saúde Pública. 2023;39(7). doi: https://doi.org/10.1590/0102-311XEN007223
15. Massuda A, Malik AN, Vecina-Neto G, Tasca R, Ferreira-Junior WC. The resilience of the Brazilian National Health System in the face of the COVID-19 pandemic. Cadernos EBAPE. 2021;19(spe). doi: https://doi.org/10.1590/1679-395120200185
16. Assefa Y, Gilks CG, Reid S, Pas R, Gete DG, Damme WV. Analysis of the COVID-19 pandemic: lessons towards a more effective response to public health emergencies. Globalization and Health. 2022[s.l.],18,(1):1-12. doi: https://doi.org/10.1186/s12992-022-00805-9
17. Tenreiro P, Ramalho A, Santos P. COVID-19 patients followed in Portuguese Primary Care: a retrospective cohort study based on the national case series. Fam Pract. 2022;39(1):52-58. doi: https://10.1093/fampra/cmab098. PMID: 34448861.
18. Tan X, Liu C, Wu H. Reflections on China's primary care response to COVID-19: roles, limitations and implications. Prim Health Care Res Dev. 2022 Aug 5;23:e46. doi: https://10.1017/S1463423622000378.
19. Giatti LL, Ribeiro RA, Nava AFD. Emerging complexities and rising omission: Contrasts among socio-ecological contexts of infectious diseases, research and policy in Brazil. Genetics and Molecular Biology. 2021; 44(1)[s.1]e20200229. doi: https://doi.org/10.1590/1678-4685-GMB-2020-0229
20. Grigera J. Adding insult to injury: the Covidâ€19 crisis strikes latinamerica. DevelopmentandChange. 2022;53(6):1335-61. doi: https://doi.org/10.1111/dech.12740
21. Miskolci R. Beyond science denialism: disinformation during the Covid-19 pandemic. Sociologias. 2023;25:1-26. doi: http://doi.org/10.1590/18070337-123090EN
22. Pozzatti A, Farias LW. From emergency to structure: ways to fight Covid-19 via international cooperation in health from Brazil.Rev. Bras. Polit. Int.2022;65(1). doi: https://doi.org/10.1590/0034-7329202200106
23. Pasquale S, Gregorio GL, Caterina A, Francesco C, Beatrice PM, Vicenzo P et al. COVID-19 in low-and middle-income countries (LMICs): a narrative review from prevention to vaccination strategy. Vaccines. 2021;9(12):1477. doi: https://doi.org/10.3390/vaccines9121477
24. Du Z, Tian L, Jin DY. Understanding the impact of rapid antigen tests on SARS-CoV-2 transmission in the fifth wave of COVID-19 in Hong Kong in early 2022. Emerging Microbes & Infections. 2022;11(1):1394–1401. doi: https://doi.org/10.1080/22221751.2022.2076616
25. Requia WJ, Kondo EK, Adams MD, Gold DR, Struchiner CJ. Risk of the Brazilian health care system over 5572 municipalities to exceed health care capacity due to the 2019 novel coronavirus (COVID-19). Science of the Total Environment. 2020;[s.1]730:139-44. doi: https://doi.org/10.1016/j.scitotenv.2020.139144
26. Santos RVS, Moura HSD, Delpino FM, Nascimento MC, Ramos ACV, Berra TZ, et al. Concordância à s medidas de flexibilização durante a pandemia de covid-19 no Brasil. CiêncCuid Saúde. 2023;22:e66049. doi: https://doi.org/10.4025/ciencuidsaude.v22i0.66049
27. Palamim CVC, Marson FAL. Covid-19–The availability of ICU beds in Brazil during the onset of the pandemic. Annalsof Global Health. 2020;86(1):100. doi: https://doi.org/10.5334/aogh.3025
28. Silva LL, Dutra AC, Andrade L, Iora PH, Ramajo GLR, Gualda IAP, et al. Emergency care gap in Brazil: geographical accessibility as a proxy of response capacity to tackle COVID-19. Frontiers in Public Health. 2021;9. doi: https://doi.org/10.3389/fpubh.2021.740284
29. Massuda A, Malik AN, Vecina-Neto G, Tasca R, Ferreira-Junior WC. The resilience of the Brazilian National Health System in the face of the COVID-19 pandemic. Cadernos EBAPE. 2021;19(spe). doi: https://doi.org/10.1590/1679-395120200185
Descargas
Publicado
2025-12-28
Número
Sección
Articulo originale
Cómo citar
Organización y actuación de la atención primaria en la pandemia: estudio transversal según el tamaño de la población de los municipios¹. (2025). Ciência, Cuidado E Saúde, 24(1). https://doi.org/10.4025/ciencuidsaude.v24i1.75443
