Medicina de família e comunidade no Brasil : perfil, satisfação com o trabalho e qualidade da Atenção Primária à Saúde.

Abstract

ABSTRACT OF ARTICLE I - Brazilian family physicians: who are they and what do they work on? An exploratory study of Brazilian Family Medicine’s socioeconomic and occupational profile. Introduction: FM is, by definition, a clinical medical specialty centered in PHC. However, formal specific education in FM is not mandatory to work in Brazilian PHC services. FM training provides subsidies for a wide range of career opportunities. Objective: The objective of the present study was to investigate Brazilian FP’s socioeconomic and occupational profile. Methodology: Cross-sectional descriptive exploratory national survey, using a self-applied digital questionnaire. 6,759 invitations to participate in the survey were emailed to Brazilian FP between June and December 2017. Results: 150 questionnaires were answered, of which 107 (71.3%) were valid. The sample’s geographic distribution was similar to the Brazilian context, predominating participants from the Southeast (51.4%) and South (29.9%) regions. Brazilian FP are generally young (mean age = 39 years; SD ±7.11), female (57.9%), married (72%), childless (46.7%), non-smoking (88.8%) and sedentary (86%). FP in Brazil belong to high social class (72%), have low prevalence of divorces (6.5%) and became specialists by concluding a two-year FM medical residency program (73.8%). It’s predominant to have one exclusive full time job (37.4%) instead of working multiple jobs at the same time (32.7% have three or more concurrent jobs). Most FP work in the Brazilian public health system (84.8%), the Unified Health System, with long work hours (90.5% work weekly 40 hours or more) and lengthy job tenure (mean 56.93 months). Most FP work in PHC services (71%), but many also work in teaching (44.9%) or management (25.9%). Conclusion: Therefore, the present study contributes to the understanding of Brazilian FM’s socioeconomic and occupational profile and suggests topics for future research. ABSTRACT OF ARTICLE II - Association between family physicians’ job satisfaction and quality of the Primary Health Care provided: an exploratory cross-sectional Brazilian study. Introduction: The association between physicians’ job satisfaction and quality of care provided has been evidenced by several studies, including in the context of PHC. However, no researches relating primary care physician’s job satisfaction and quality of the PHC provided, measured through Starfield’s PHC domains, were found. Objective: To study the relationship between Brazilian family physicians’ (FP) job satisfaction and quality of PHC provided (PHC assessment). Study design: Cross-sectional exploratory national survey, using a digital, structured, self-applied questionnaire, sent by email, between June and December 2017. Participants: 82 Brazilian FP working in PHC services across the country. Outcomes: Job satisfaction, measured through the Job Satisfaction Questionnaire S20/23; and PCH quality, measured through the Primary Care Assessment Tool (PCAT), provider version; both validated for Portuguese. Results: Moderate scores of job satisfaction were found (mean = 3.4; SD ±0.87), between indifference and partial satisfaction. PHC assessment scores demonstrated adequate quality of PHC (cut off ≥ 6.6), both in essential domains (mean = 6.89; SD ±0,84) and in general (mean = 7.06; SD ±0,86) analysis. Significant positive correlation was found between FP’s job satisfaction and PCAT scores (essential domains score r = 0,291; p = 0,008 and general PCAT score r = 0,303; p = 0,006). Conclusions: The positive association between FP’s job satisfaction and quality of PHC provided reinforce the importance of enhancing FP’s job satisfaction and improving working conditions in Brazilian PHC settings.