Search

Objective: This work aims to describe the national and international scientific production that addresses the longitudinality attribute in Primary Health Care. Methodology: This study is based on a bibliometric, quantitative study prepared in June 2021 in the Web of Science database. Result and Discussion Result and Discussion: 58 publications were collected and analyzed in the period from 1997 to 2021, there is the dissemination of the theme especially from the year 2010, with emphasis on Brazil as a place of affiliation of most studies and the weak network of collaboration between topic authors. Conclusion: Bibliometrics indicates that despite the resurgence of research related to the subject in question, it is still necessary to encourage research to know the different locoregional specificities and thus strengthen the attribute in Primary Health Care. Objetivo: Este trabajo tiene como objetivo describir la producción científica nacional e internacional que aborda el atributo de longitudinalidad en la Atención Primaria de Salud. Metodología: Este estudio se basa en un estudio bibliométrico, cuantitativo, elaborado en junio de 2021 en la base de datos Web of Science. Resultado y Discusión: 58 publicaciones fueron recolectadas y analizadas en el período de 1997 a 2021, hay difusión del tema especialmente a partir del año 2010, con énfasis en Brasil como lugar de afiliación de la mayoría de los estudios y la débil red de colaboración entre los autores del tema. Conclusión: La bibliometría indica que a pesar del resurgimiento de investigaciones relacionadas con el tema en cuestión, aún es necesario incentivar investigaciones para conocer las diferentes especificidades locorregionales y así fortalecer el atributo en la Atención Primaria de Salud. Objetivo: Este trabalho tem como objetivo descrever a produção cientifica nacional e internacional que aborda o atributo longitudinalidade na Atenção Primária à Saúde. Metodologia: Este estudo baseia-se em um estudo bibliométrico, de cunho quantitativo elaborado em junho de 2021 na base de dados Web of Science. Resultado e Discussão: Foram coletadas e analisadas 58 publicações no período de 1997 a 2021, verifica-se a difusão da temática especialmente a partir do ano de 2010, com destaque para o Brasil como local de afiliação da maioria dos estudos e a fraca rede de colaboração entre autores do tópico. Conclusão: A bibliometria indica que apesar do recrudescimento da pesquisa relacionada ao assunto em questão, ainda é necessário incentivo a pesquisa para conhecer as diferentes especificidades locorregionais e assim fortalecer o atributo na Atenção Primária à Saúde.

La contratación en Colombia ha sido un factor que ha generado afectaciones en el personal de salud, donde gran parte de este personal está por medio de contratos flexibles, ya sea contratos por obra labor o prestación de servicios. Esto es un método de las organizaciones para mejorar los gastos de contratación y las actividades que realiza el personal asistencial. Esta estrategia en las organizaciones genera una mayor precarización de los contratos del personal y por consiguiente una ruptura de los atributos de la APS. Las afectaciones a los atributos rompen con el objetivo que tiene la APS y no permite que su implementación sea adecuada en la ESE, así mismo afecta la atención centrada en los usuarios y genera costos mayores al sistema de salud, haciendo un sistema más curativo que preventivo. El presente estudio tiene como finalidad estudiar el comportamiento de los trabajadores de la salud basado en su tipo de contratación, prestaciones que manejan y salarios, con el fin de evidenciar desde su perspectiva las afectaciones en el desempeño y en como esto afecta la longitudinalidad de la APS y la atención centrada en el paciente en la ESE Unidad Funcional de la ciudad de Zipaquirá. Los hallazgos del estudio lograron evidenciar como el personal de salud tiene una alta desmotivación al momento de realizar sus actividades laborales, esto debido a la contratación que manejan, con prestaciones que no son adecuadas a su cargo y con pocas garantías de estabilidad en la institución, a pesar de esto el personal trata de generar vínculos con sus pacientes como se describen en el atributo de la longitudinalidad todo centrado en la continuidad de la atención, pero muchas veces la ausencia del personal que cambia de trabajo, la movilidad entre los servicios dentro de la institución, los tiempos de consulta, la desmotivación y las cargas administrativas extra que generan en la ESE, no siempre permite realizar ese vínculo con los pacientes, dañando el programa de APS que quiere brindar la institución. Hiring in Colombia has been a factor that has generated effects on health personnel, where a large part of this personnel is through flexible contracts, either contracts for work or provision of services. This is a method used by organizations to improve hiring costs and the activities carried out by healthcare personnel. This strategy in the organizations generates a greater precariousness of the personnel contracts and consequently a rupture of the attributes of the PHC. These affectations to the attributes break with the objective of the PHC and does not allow its implementation to be adequate in the ESE, it also affects the care centered on the users and generates higher costs for the health system, making a system more curative than preventive. . The purpose of this study is to study the behavior of health workers based on their type of contract, benefits they manage and salaries, in order to show from their perspective the effects on performance and how this affects the longitudinality of the PHC and patient-centered care in the ESE Unidad Funcional de Zipaquira The findings of the study were able to show how health personnel have a high level of demotivation when carrying out their work activities, due to the hiring they handle, with benefits that are not adequate for their charge and with few guarantees of stability in the institution. Despite this, the staff tries to create links with their patients as described in the attribute of longitudinality, all focused on the continuity of care, but often the absence of staff who change jobs, mobility between services within the institution, the consultation times, the lack of motivation and the extra administrative burdens that they generate in the ESE, do not always allow this link to be made with the patients, damaging the PHC program that the institution wants to offer. Magíster en Administración en Salud Maestría

Despite relational continuity (RC) with the doctor being key to care quality for chronic patients, particularly in fragmented healthcare systems, like many in Latin America (LA), little is known about RC and its attributes, particularly regarding specialists. Aim: We aim to analyse chronic patients’ perceptions of RC with primary (PC) and secondary (SC) care doctors, and record changes between 2015 and 2017 in the public healthcare networks of six LA countries. An analysis of two cross-sectional studies applying the CCAENA questionnaire to chronic patients (N = 4881) was conducted in Argentina, Brazil, Chile, Colombia, Mexico, and Uruguay. The dependent variables of RC with PC and SC doctors were: consistency, trust, effective communication, and synthetic indexes based on RC attributes. Descriptive and multivariate analyses were performed. Although the RC index was high in 2015, especially in PC in all countries, and at both levels in Argentina and Uruguay, low perceived consistency of PC and SC doctors in Colombia and Chile and of SC doctors in Mexico revealed important areas for improvement. In 2017 the RC index of SC doctors increased in Chile and Mexico, while SC doctors’ consistency in Colombia decreased. This study reveals important gaps in achieving RC with doctors, particularly in SC, which requires further structural and organisational reforms.

Background This study aimed to explore associations between various elements of primary care, patient satisfaction, and loyalty. Methods This cross-sectional study used a modified version of the Primary Care Assessment Tool (PCAT), which was adapted for Japan. We distributed the PCAT questionnaire to patients aged 20 years or older at five rural primary care centres in Japan. We confirmed the validity and reliability of the measure for our study. Next, we examined which elements of primary care were related to patient satisfaction and loyalty using Spearman’s correlation and structural equation modelling. Results Of 220 eligible patients, 206 participated in this study. We developed nine component scales: first contact (regular access), first contact (urgent access), longitudinality, coordination, comprehensiveness (variety of care), comprehensiveness (risk prevention), comprehensiveness (health promotion), family-centeredness, and community orientation. Longitudinality and first contact (urgent access) were related with patient satisfaction. Longitudinality, first contact (regular access), and family-centeredness were related to patient loyalty. In the structural equation modelling analysis, two variables were significantly related to loyalty, namely a combined variable including longitudinality and first contact (regular access), along with family-centeredness. Conclusions While a patient satisfaction model could not be distilled from the data, longitudinality, first contact (urgent access), and family-centeredness were identified as important elements for the cultivation of patient loyalty. This implies that primary care providers need to develop a deep understanding of patients’ contexts and concerns and pay attention to their level of access to cultivate greater patient loyalty.

Submitted by Boris Flegr (boris@uerj.br) on 2021-01-06T14:30:52Z No. of bitstreams: 1 DISSERTACAO FINAL_ANA_CAROLINA_LOPES_NEVES.pdf: 3722271 bytes, checksum: 451306611de0a07b9f01928d3b96564a (MD5) Made available in DSpace on 2021-01-06T14:30:52Z (GMT). No. of bitstreams: 1 DISSERTACAO FINAL_ANA_CAROLINA_LOPES_NEVES.pdf: 3722271 bytes, checksum: 451306611de0a07b9f01928d3b96564a (MD5) Previous issue date: 2019-01-30 The aim of this study is "relationships between professionals in the Family Health Care Sector (ESF) and the influence on hypertension and diabetic care given to patients, from the perspective of the longitudinally that the care provides, according to the Social Networks Analysis . Objectives: Analyze how relationships between ESF professionals and patients with hypertension and diabetes are shaped in the viewpoint of Social Network Analysis and identifying the influence of these relations and positions in the perspective of care and longitudinality. Metodology: The following is a descriptive study, mixed with both a quantitative and qualitative approach, the research participants are professionals from the basic ESF team (nurses, doctors, medical technicians, community health agents, and administrative assistants) having the setting as two Municipal Family Health Care Units, one located in the Middle of Paraíba and the other in the State of Rio de Janeiro. The Units were coded as U1 and U2. To collect data, a semi-structured interview was used according to a script, containing open questions that allowed answers to be responded in a narrative format. There were 12 U1 professionals interviewed as well as 09 U2 professionals, totaling 21 interviews. The interviews/narratives were analyzed and for the quantitative portion, through social media analysis, initiating sociograms in which the position and role of the actors in the networks can be analyzed, according to the measures of centrality and intermediation. This part of the study is conducted using the Ucinet software and its graphic component NetDraw. As for the qualitative approach the analysis of thematic-categorial material was used. Results: The information from the studied social networks, interfere directly with the results from the analysis. Pierre Bourdieu concepts in regard to capitals and habitus were clearly identified in the networks. In regards to relationships and positions in the studied networks, they seem to have a positive effect in the management of the team, in the work process and in attempts regarding the continuity of the patients care with hypertension and diabetes. The difficulty was seen regarding essential care throughout the patient's lifelong, as well as to establish a link between professionals and the patient. The most trusted professionals as well as the ones with a greater central value in both networks were the doctors from both teams. Considering this fact as well as others that were discussed throughout the study , negatively influences the care and longitudinality of the person with hypertension and diabetes, pointing to the centrality of a biomedical model and to a possible return of APS in the context of the reality studied. Este estudo possui como objeto as relações entre os profissionais da Estratégia de Saúde da Família (ESF) e sua influência na assistência às linhas de cuidado de hipertensão e diabetes, na perspectiva do cuidado e da longitudinalidade, segundo a ótica da Análise de Redes Sociais . Objetivos: Analisar como se configuram as relações entre os profissionais da ESF quanto à assistência aos usuários com hipertensão e diabetes, segundo a ótica da Análise de Redes Sociais; identificar qual a influência destas relações e posições na perspectiva do cuidado e da longitudinalidade. Metodologia: Estudo descritivo, com abordagem qualitativa e quantitativa, possuindo como participantes da pesquisa profissionais da equipe de ESF (enfermeiros, médicos, técnicos de enfermagem, agentes comunitários de saúde e auxiliares administrativos), tendo como cenário duas Unidades de Saúde da Família (USF) de um município de grande porte localizado na região do Médio Paraíba no Sul, no estado do Rio de Janeiro. As unidades foram codificadas como U1 e U2. Para a coleta dos dados, foi utilizada entrevista semiestruturada mediante roteiro, permitindo respostas em narrativa. Foram entrevistados 12 profissionais da U1 e 09 profissionais da U2, totalizando 21 sujeitos entrevistados. Os dados foram analisados, para o segmento quantitativo, mediante Análise de Redes Sociais (ARS), o qual permite gerar medidas de centralidades dos atores e construção do sociograma, utilizando-se para isto, os softwares Ucinet e Netdraw; para o segmento qualitativo, foi utilizada a Análise de Conteúdo Temático-categorial. Resultados: A conformação das redes sociais estudadas, interferem diretamente nos resultados da análise destas. Os conceitos de Pierre Bourdieu quanto aos capitais e habitus foram claramente identificados nas redes no campo da atenção básica das USF estudadas. As relações e posições nas redes pesquisadas parecem interferir positivamente quanto à gestão da equipe, no processo de trabalho desta, e nas tentativas quanto à continuidade do cuidado ao usuário com hipertensão e diabetes. Foi visualizada a dificuldade quanto ao cuidado integral ao usuário ao longo da vida, bem quanto ao estabelecimento de vínculo entre profissionais e usuários. O profissional mais citado e com maior valor central em ambas redes foram as médicas das duas equipes; este fato, atrelado a outros que foram discutidos ao longo do estudo, influencia negativamente no cuidado e longitudinalidade à pessoa com hipertensão e diabetes, apontando para a centralidade do modelo biomédico e para um possível retorno à APS seletiva no contexto da realidade estudada.

Introduction: During the past two decades, HIV and Sexual and Reproductive Health services in Namibia have been provided in silos, with high fragmentation. As a consequence of this, quality and efficiency of services in Primary Health Care has been compromised. Methods: We conducted an operational research (observational pre-post study) in a public health facility in Namibia. A health facility assessment was conducted before and after the integration of health services. A person-centred integrated model was implemented to integrate all health services provided at the health facility in addition to HIV and Sexual and Reproductive Health services. Comprehensive services are provided by each health worker to the same patients over time (longitudinality), on a daily basis (accessibility) and with a good external referral system (coordination). Prevalence rates of time flows and productivity were done. Results: Integrated services improved accessibility, stigma and quality of antenatal care services by improving the provider-patient communication, reducing the time that patients stay in the clinic in 16% and reducing the waiting times in 14%. In addition, nurse productivity improved 85% and the expected time in the health facility was reduced 24% without compromising the uptake of TB, HIV, outpatient, antenatal care or first visit family planning services. Given the success on many indicators resulting from integration of services, the goal of this paper was to describe “how” health services have been integrated, the “process” followed and presenting some “results” from the integrated clinic. Conclusions: Our study shows that HIV and SRH services can be effectively integrated by following the person-centred integrated model. Based on the Namibian experience on “how” to integrate health services and the “process” to achieve it, other African countries can replicate the model to move away from the silo approach and contribute to the achievement of Universal Health Coverage.

Brazil is experiencing a time of change in pattern of care: from 'traditional' to Family Health Strategy (FHS), a model guided by the principles of people, family and community-centred medicine. The heterogeneity in care currently offered affects the primary care impact. This study aims to evaluate the longitudinality of care and correlate this primary care principle to the utilization pattern of care among patients hospitalized due to preventable conditions, comparing the two care models currently offered in Brazil. It is a cross-sectional, analytical and descriptive study with a quantitative approach. The sample consisted of 501 patients from 0 to 14 years old. Data was collected in 2011 and the Primary Care Assessment Tool (PCATool-Brazil) child version was used. Bivariate and multivariate analyses were performed including patient-related variables (age, maternal education, income and type of diagnosis) and care model. From the hospitalizations occurred during the period, 65.2% were Ambulatory Care Sensitive Conditions. Patients evaluated 'longitudinality' as regular. Both the care continuity dimension and the utilization pattern of care services showed a link with the care model offered. Findings suggest that the FHS care model, based on the assumptions of people-centred medicine, was associated with better ratings of care continuity, which was reflected in a more appropriate utilization pattern of care services.

ResumenLa reforma de la atención primaria en España de 1984 fue pro-contenido, en el sentido de añadir capacitación y recursos (horas de formación y dedicación al trabajo, y mejora de las condiciones materiales de éste). La reforma no consiguió fomentar la longitudinalidad, ni dio más poder al médico de familia. Es decir, la reforma no logró ser pro-coordinación y facilitar el papel central del médico de cabecera en la prestación de servicios. Con los años persiste la escasa longitudinalidad de la atención, pues no se ha estimulado el estilo de trabajo que la fomenta (con sus beneficios clínicos y de salud pública). Es longitudinalidad la relación que se establece a largo plazo entre el médico general/de familia y los pacientes de su consulta. Se define como: a) la atención por el mismo médico a lo largo de toda la vida de la mayoría de los problemas del paciente y b) el reconocimiento de la población y de los pacientes de una fuente de cuidados con la cual se cuenta para el contacto inicial y para el seguimiento de los problemas. La tendencia social y clínica lleva a responder antes, más intensamente, con medios más poderosos y más especialistas a más problemas de salud, lo que convierte a las actividades médicas en peligrosas. Frente a esta tendencia, el lema clínico debería ser «menos es mejor», y eso implica grandes dosis de longitudinalidad. Son varias las medidas que podrían mejorar la longitudinalidad y se refieren a incentivos de «permanencia», aumento del componente de capitación hasta acercarse al 50% del total de la remuneración, mejora de la polivalencia del médico de cabecera, inclusión de la familia en el cupo y una reforma pro-coordinación que convierta a los especialistas en consultores.AbstractThe reform of primary care in Spain in 1984 focussed mainly on skills and knowledge (physician training and working hours) and material resources (new buildings). The reform did not succeed in improving longitudinal care nor did it give primary care physicians greater power, that is, the reform did not increase coordination or strengthen the central role of the family physician in services provision. The lack of longitudinality has persisted over the years since the working methods that encourage it (and its resulting clinical and public health benefits) have not been stimulated. Longitudinality is the personal relationship established over the years between general practitioners and their patients and is defined as (a) care by the same family physician of most of the patient's problems throughout his or her life, and (b) the recognition by patients and the population of a stable source of care to be used for initial contact and for the follow-up of problems. The tendency in the medical profession and society at large is to respond to an increasing number of health problems more quickly and intensely, with increasingly powerful means and with a greater number of specialists. In turn, this tendency makes medical activities dangerous. To counteract this tendency, a motto of “less is better” should be adopted, implying greater longitudinality. Many initiatives could improve longitudinality, such as incentives for not moving, increasing the capitation component of remuneration to nearly 50%, broadening the range of general practitioners’ skills, including family members in the same patient list, and transforming the role of specialists into that of consultants.

A longitudinalidade, que trata do acompanhamento do paciente ao longo do tempo por profissionais da equipe de atenção primária em saúde (APS), é considerada característica central deste nível assistencial. O atendimento a este atributo está relacionado com resultados positivos, o que justifica sua utilização para fins de avaliação da APS. Por outro lado, o termo não é usual entre os autores brasileiros, e na literatura internacional o termo continuidade do cuidado é utilizado com sentido semelhante. O presente estudo consiste em revisão conceitual sobre a longitudinalidade/continuidade do cuidado, bem como a identificação de suas dimensões, de forma a favorecer a avaliação do atendimento ao referido atributo. Como resultado, destaca-se a semelhança entre os termos, embora as dimensões identificadas para o atributo não sejam totalmente coincidentes. A revisão permitiu a adoção de três dimensões em acordo com o contexto do sistema de saúde público brasileiro: identificação da unidade básica como fonte regular de cuidado, vínculo terapêutico duradouro e continuidade informacional. A proposta de variáveis para a avaliação da APS aqui apresentada vai ao encontro dessas dimensões.Longitudinality, which is concerned with Primary Health Care (APS) professionals accompanying patients over time, is considered a central feature of this level of health care. The fulfilment of this attribute is related to positive health results, which justify its use for assessing Primary Health Care. On the other hand, the term is not commonly used by Brazilian authors, and in international literature the term "continuity of care" is used with a similar meaning. Therefore, this study is composed of a conceptual revision of longitudinality/continuity of care, as well as the identification of its dimensions so as to enable the actual performance of this attribute to be assessed. As a result, the similarity between the two terms is highlighted, although the identified dimensions of each attribute do not entirely coincide. The revision allowed three dimensions to be adopted in accordance with the context of the Brazilian public health care system: identification of the basic unit as a regular source of care, a long-lasting treatment bond and continuous information. The proposal of an APS evaluation variables presented herein is line with these dimensions.

Background: Longitudinal clinical experiences are a common component of undergraduate medical curricula, yet these programs have not been systematically characterized in US medical schools. Objective: Our study sought to identify and characterize longitudinal clinical programs (LCPs) in US medical schools and measure associations between programs’ structures and goals. Design: Using a mixed-methods approach, we conducted a secondary analysis of data from publicly available websites. We conducted a systematic keyword search of the websites of 137 LCME-accredited US medical schools to identify LCPs. We included programs with student–patient interactions of at least six months. We categorized programs using qualitative thematic analysis and compared associations between program structures and goals. Results: We identified 98 LCPs in 69 schools. Half (52.0%) of LCPs occurred during the core clinical year. Program structures included ‘clinic attachments’ (50.0%), ‘longitudinal integrated clerkships’ (26.5%), and ‘patient attachments’ (20.4%). We identified goals in 89 programs, including ‘exposing students to specific topics, patient demographics, or practice settings’ (78.7%); ‘clinical or professional skill development’ (65.2%); and ‘understanding the patient experience’ (19.1%). Patient attachments were associated with ‘exposure to specific patient demographics’ (P = .04) and ‘understanding the patient experience’ (P = .03). Pre-clinical programs were associated with clinical skills development (P = .01). Conclusions: Our study identifies the scope and nature of LCPs in US medical schools. Understanding connections between educational structures and goals may guide program design and research investigations of educational processes and outcomes.

Submitted by Maicon Juliano Schmidt (maicons) on 2015-07-07T14:38:20Z No. of bitstreams: 1 Cassiane Silocchi.pdf: 6011461 bytes, checksum: e5e3279059623981a42d409d891825bd (MD5) Made available in DSpace on 2015-07-07T14:38:20Z (GMT). No. of bitstreams: 1 Cassiane Silocchi.pdf: 6011461 bytes, checksum: e5e3279059623981a42d409d891825bd (MD5) Previous issue date: 2014-01-31 CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior O novo perfil demográfico, nutricional e epidemiológico da população muda o cenário sanitarista, porque as doenças crônicas não transmissíveis (DCNT) assumem papel de destaque, exigindo uma mudança nas práticas e na organização do sistema de saúde. Assim, o trabalho tem como objetivo analisar as práticas das equipes de atenção primária no cuidado longitudinal de pessoas com DCNT, como o diabetes mellitus (DM) e a hipertensão arterial sistêmica (HAS) em um município da região metropolitana de Porto Alegre/RS. A pesquisa é descritiva, exploratória com abordagem qualitativa. A coleta de dados desenvolveu-se em duas etapas. Na primeira etapa foram entrevistadas pessoas com DCNT para conhecer a percepção das mesmas sobre sua saúde, doença e cuidado. A partir disso, foram realizadas discussão focais com quatro equipes da Estratégia de Saúde da Família (ESF) tendo presente elementos que apareceram nas entrevistas. A análise interpretativa chamada de hermenêutica dialética foi a técnica utilizada para a análise dos dados. Os resultados retrataram dificuldades para criar vínculo; para desenvolver uma prática para além da resposta à demanda e para responsabilizar-se pelo usuário diante dos entraves na rede. Essas dificuldades aparecem no desenvolvimento de ações educativas que motivem mudanças comportamentais no estilo de vida e no acompanhamento do usuário em suas necessidades de acesso à rede atenção à saúde. No estudo aparece que as práticas dos profissionais estão pautadas por modelos prescritivos e autoritários de educação em saúde e tendo como foco das ações a patologia e não a promoção da saúde. Planejar o funcionamento dos serviços de saúde e investir em educação permanente para profissionais das equipes de atenção primária possibilitam melhorias no cuidado longitudinal de pessoas com DCNT. The new demographic, nutritional and epidemiological profiles of our population changes the sanitarians cenario, because non-communicable chronic diseases (NCDs) assume a prominent role, demanding a radical change on the practices and organization of the health care system. Thus, the study aims to examine the practices of primary care teams in the longitudinal care of people with NCDs, such as diabetes mellitus (DM) and hypertension (SAH) in a municipality in the metropolitan region of Porto Alegre, RS, Brazil. The research is descriptive, exploratory with a qualitative approach. Data collection was developed in two stages. In the first stage people with NCDs were interviewed to know the same about their perception of health, illness and care. From there, focus discussion were held with four teams of the Family Health Strategy (FHS) having elements that appeared in the interviews. The interpretative analysis called hermeneutic dialectic was the technique used for data analysis. The results showed that teams have difficulty to establish a relationship with this person; to develop a practice beyond the mere answer to demand and to be responsible for the user before all the intricacies of the system. These difficulties show up on the development of educational actions that motivate behavioral changes in lifestyle and monitoring of the user in his necessities of access to health care. In this study, we see that practices from professionals are based on prescriptive and authoritative models of education on health, focused on actions on pathology and not the promotion of health. Planning the operation of public health and investment in continuing education for professional teams in primary care opens up possibilities for improvements in the longitudinal care of people with NCDs.

A longitudinalidade, que trata do acompanhamento do paciente ao longo do tempo por profissionais da equipe de atenção primária em saúde (APS), é considerada característica central deste nível assistencial. O atendimento a este atributo está relacionado com resultados positivos, o que justifica sua utilização para fins de avaliação da APS. Por outro lado, o termo não é usual entre os autores brasileiros, e na literatura internacional o termo continuidade do cuidado é utilizado com sentido semelhante. O presente estudo consiste em revisão conceitual sobre a longitudinalidade/continuidade do cuidado, bem como a identificação de suas dimensões, de forma a favorecer a avaliação do atendimento ao referido atributo. Como resultado, destaca-se a semelhança entre os termos, embora as dimensões identificadas para o atributo não sejam totalmente coincidentes. A revisão permitiu a adoção de três dimensões em acordo com o contexto do sistema de saúde público brasileiro: identificação da unidade básica como fonte regular de cuidado, vínculo terapêutico duradouro e continuidade informacional. A proposta de variáveis para a avaliação da APS aqui apresentada vai ao encontro dessas dimensões. Longitudinality, which is concerned with Primary Health Care (APS) professionals accompanying patients over time, is considered a central feature of this level of health care. The fulfilment of this attribute is related to positive health results, which justify its use for assessing Primary Health Care. On the other hand, the term is not commonly used by Brazilian authors, and in international literature the term "continuity of care" is used with a similar meaning. Therefore, this study is composed of a conceptual revision of longitudinality/continuity of care, as well as the identification of its dimensions so as to enable the actual performance of this attribute to be assessed. As a result, the similarity between the two terms is highlighted, although the identified dimensions of each attribute do not entirely coincide. The revision allowed three dimensions to be adopted in accordance with the context of the Brazilian public health care system: identification of the basic unit as a regular source of care, a long-lasting treatment bond and continuous information. The proposal of an APS evaluation variables presented herein is line with these dimensions.

FUNDAMENTO: El objetivo fue comparar la continuidad y longitudinalidad de la medicina general en cuatro países europeos del modelo público asalariado. MÉTODOS: Estudio descriptivo y prospectivo. 63 médicos generales/de familia asalariados registraron todos los encuentros (directos/indirectos) con sus pacientes durante una semana, en centros públicos y estatales de atención primaria de España, Finlandia, Portugal y Suecia. RESULTADOS: El 92% de los encuentros fueron en el despacho médico; fueron directos el 75%; la media de consultas por semana y médico fue de 103. El problema principal de salud fue crónico en el 42% de los casos y agudo en el 31%. El paciente había sido atendido previamente por ese problema en el 63% de los encuentros y por otro problema en el 79%. El médico conocía profesionalmente a algún familiar en el 66% de los pacientes atendidos. CONCLUSIONES: Los países estudiados presentan un grado variable de continuidad y longitudinalidad en medicina general (de mayor a menor: Portugal, España, Suecia y Finlandia). En España las consultas son de corta duración, y con un escaso uso de sistemas de prescripción repetida; en Portugal se forma lista de espera de pacientes, bloqueando la asistencia de los problemas agudos; en Finlandia falta el listado de pacientes, lo que despersonaliza la asistencia; y en Suecia también se forman listas de espera y se hace un mayor uso de la consulta indirecta (especialmente mediante el teléfono). BACKGROUND: The goal was to compare continuity and longitudinality of general practice in four European countries with public salary earner models. METHODS: Descriptive and prospective study. 63 publicly remunerated general practitioners/family doctors registered all (direct/indirect) contact with their patients over a period of one week in public and state primary assistance centres in Spain, Finland, Portugal and Sweden. RESULTS: 92% of the contacts were held in the doctor’s surgery; 75% were direct; the average number of visits per week, per doctor was 103. In 42% of cases, the main health problem was chronic and in 31% acute. In 63% of the visits, the patient had already been examined in relation to the same problem and 79% for a different problem. In 66% of cases, doctors knew a relative of the patients examined. CONCLUSIONS: The surveyed countries show a variable degree of continuity and longitudinality in general practice (from high to low: Portugal, Spain, Sweden and Finland). In Spain, visits are short and repeated prescription systems rare; in Portugal, waiting lists are used, thereby impeding assistance for acute problems; in Finland, there are no patient lists, which de-personalises assistance; finally, in Sweden, there are also waiting lists and a wider usage of indirect consultation (mainly by telephone).