Avaliação do uso e percepção do idoso em relação à integralidade na atenção primária entre a população idosa adscrita à estratégia de saúde da família em uma cidade do sul de Minas Gerais

Abstract

Introduction: Population aging is one of the greatest challenges of contemporary public health. The growth of the elderly population generates demands for health services increasing their expenses. The investment in Primary Health Care has been a valid option to keep this population active and functional, integrating preventive, curative, individual and collective actions. The evaluation of the use of health services, as well as the users' knowledge regarding integrality, allows us to measure the effectiveness of the system. Objective: To evaluate the knowledge of the elderly in relation to integral care in primary care. Method: A cross - sectional, population - based observational study of the elderly in the city of Alfenas- MG, adscribed to the Family Health Strategy. The initial sample was composed of the elderly of six Basic Health Units, totalizing 211 individuals. Data were collected from medical records related to the years 2015 and 2016, and data were taken from self-report of the use of services related to the same period, collected at a home visit. In the second visit, in 166 elderly, the PCATool questionnaire was applied. To evaluate the agreement between the use of self-reported and recorded health services, Kappa statistics and percentage of concordance, sensitivity, specificity, positive and negative predictive values were applied. The evaluation of the knowledge of the elderly in relation to integrality was made through the descriptive analysis for each question of the integrality domains of PCATool. We calculated the medians of the use of each service and the Prevalence Ratio by Poisson Regression model. Results: The initial sample consisted of 63.5% of the female elderly, with a mean age of 70.24 (± 6.48) years. The agreement between records and reports for dentals attendance showed a higher Kappa magnitude (k = 0,271), a greater balance between sensitivity and specificity (69% and 60%, respectively). Concerning the predictive values, hospitalization had a low positive predictive value (8%), and consultations at the secondary level had a low negative predictive value (37%). The analysis of the knowledge of the elderly in the perspective of completeness revealed that 57% of the sample reports receiving guidance about the changes that occur with aging. This fact contrasts negatively with the "drop prevention" items (20%) and "disability guidelines" (13%), which showed low results, showing that they are little discussed. The measurement of the medians of the use of the services revealed similar behavior in all analyzed items. The association between use and knowledge about completeness was made through the Poisson regression analysis. The results evidenced the non-association between the use and knowledge of the service. Conclusions: the values of agreement between self- report and records in the medical record show the poor quality of the records. The results of the PCATool questionnaire reveal points to be improved in the elderly approach to Primary Care, especially in specific issues of this population. The results point to a non-association between use and knowledge of the Network.