Methodology for the assessment of primary health care activities

A case study assessed health care activities in a primary health care facility to help develop methodologies for health care work assessment and for the proposal of leading categories for use in such processes. The study was conducted at the health center of the School of Medicine of the University of Sao Paulo using the assessment of care activities aimed at emergency care and programmed care of chronic patients (in this case those suffering from hypertension and diabetes) as empirical material. The data sources were patient medical records. Three evaluation sessions of emergency care were delivered; these corresponded to the three distinct moments of the organization of care provided in the delivery of adult health care. The evaluation of a sample of patients receiving care during February-May 1989 indicated the predominance of women in reproductive age and only 32% of the patients were followed up. The monitoring of chronic patients consisted of 1) the evaluation of the delivery of health care from June 1990 to May 1991 and 2) the effectiveness of the control of blood pressure from January 1992 to June 1993. 839 patients out of 3793 who attended had high blood pressure and/or diabetes mellitus. Frequency of visit varied significantly in association with medical condition: there were only 3.4 visits a year by patients with exclusive hypertension 5.2 visits by diabetic patients with or without associated hypertension and 4.5 visits by patients with hypertension with other chronic diseases. There was an average reduction of 8.8 mmHg in diastolic blood pressure between the initial time of visit to the health center and the following visit. The reduction of systolic blood pressure amounting to an average of 17.7 mmHg was significant.