Análise dos atributos da atenção primária à saúde no cuidado da pessoa idosa adscrita na estratégia saúde da família, a partir da pesquisa nacional de saúde (PNS) 2019

Abstract

This study described the sociodemographic profile, the presence of chronic diseases, and medication use among older adults. It assessed the quality of care for this population by examining the integration of Primary Health Care (PHC) attributes, examined the association of these attributes across geographic regions, and investigated their relationship with Basic and Instrumental Activities of Daily Living. This is a cross-sectional study based on secondary data from the 2019 National Health Survey (PNS), with a representative sample of older adults registered in the Family Health Strategy. The variables include sociodemographic aspects, chronic diseases, questions related to care actions within the PHC framework regarding its attributes—first-contact access, longitudinality, care coordination, and comprehensiveness—Brazilian geographic regions, and functional capacity, based on self-reported ability to independently perform Basic and Instrumental Activities of Daily Living. Descriptive statistical analyses, factor analysis, and multiple correspondence analysis were conducted using the R software with the survey package. The data analysis revealed that the sample comprised 28,637 older adults, with an average age of 70 years. Among them, 54.1% identified as non-white, 93.5% had more than four years of education, and 51.6% lived with a partner. Among the participants, 58.3% reported hypertension, and 76.1% used medication daily. Regarding PHC actions, 80% of older adults reported consulting the same physician when new health problems arose (first-contact access), 77.7% stated that the same professional attended them in all consultations (longitudinality), and 78.8% reported receiving referrals to specialists when necessary (care coordination). More than 67% received counseling on nutrition, sleep, hygiene, physical activity, medication use, and fall prevention (comprehensiveness). Factor analysis identified three dimensions of PHC attributes: Factor 1 (comprehensiveness), Factor 2 (first-contact access and longitudinality), and Factor 3 (a distinct aspect of comprehensiveness). Care coordination had a low overaimpact and was not incorporated into any of the factors. Regionally, greater adherence to PHC attributes was observed in the North, Northeast, and South regions, whereas the Southeast showed a lack of first-contact access, longitudinality, and care coordination. Finally, an association was found between first-contact access and longitudinality with functional independence in Instrumental Activities of Daily Living (IADLs), but not in Basic Activities of Daily Living (BADLs). The findings highlight the central role of PHC in promoting the health of the older population but also reveal regional disparities and specific limitations in the evaluated attributes. These limitations include the reduced impact of care coordination, which was not integrated into any of the identified factors, and the lack of association between PHC attributes and BADLs. Additionally, regional disparities, such as the absence of first-contact access, longitudinality, and care coordination in the Southeast, expose weaknesses in the uniform implementation of PHC attributes. This study highlights the crucial role of PHC in improving functional capacity and quality of life among older adults by ensuring timely access, continuity, and comprehensive care. However, regional inequalities highlight the need for more equitable public policies and improved PHC team training. The results reinforce PHC as a strategic pillar for active and sustainable aging in Brazil.