Immigrant women are at greater risk for postpartum depression (PPD) compared to non-immigrant women and experience multiple barriers to accessing health services to address their needs. This mixed method study explored the multi-level factors that contribute to the postpartum mental health of immigrant women in Canada and their ability to access requisite health services. In the quantitative phase, data from a longitudinal prospective cohort survey of women were used to examine predictors of PPD over the first postpartum year for a sample of women who delivered at two hospitals in Toronto, Ontario. In the qualitative phase, an interpretive descriptive design shaped by an integrated knowledge translation approach was used to understand the factors immigrant women living in Scarborough, Ontario (a region of Toronto) perceive as contributing to their postpartum emotional health and the factors immigrant women and care providers perceive as influencing access to health services. Across quantitative and qualitative findings, factors contributing to PPD among immigrant women included a lack of social support, individual and community-level challenges faced in terms of the social health determinants, physical health status, and client-provider relationships. Factors contributing to reduced access to health services included: lack of system knowledge, social health determinants, organizational and system barriers, limited access to treatment, and a need for service integration and system navigation support. Immigrant women in Canada experience numerous health inequities that increase their risk for PPD and v prevent them from accessing service supports to address PPD concerns. The Canadian health care system needs to be responsive to individual needs in order to facilitate equitable access and address the health needs of Canadian immigrant women and their families. The diversity and proportion of immigrants in Canada calls for a linguistically and culturally supportive health care system with a strategic approach to enhancing accessibility to address health inequities. / Dissertation / Doctor of Philosophy (PhD) / Immigrant women have a 2-3 times higher risk for postpartum depression (PPD) than native-born women. This study explored the factors that contribute to PPD among immigrant women in Canada and how health services can help them get the care they need, from the perspective of immigrant women and care providers. This study found increased PPD risk when women lacked social support, had physical health issues, and faced challenges such as low income and lack of English language skills. Working with care providers could help address these challenges or make it more difficult to get care. Immigrant women had more difficulty getting services when they lacked knowledge about the health care system, faced social, financial, and language-based barriers to care, and experienced barriers when using available services. The findings from this research can inform the design and delivery of health care to best meet the needs of immigrant women with PPD.

Prenatal care (PNC) is an essential health service that can reduce adverse health and social outcomes through prevention, detection and treatment of abnormalities of pregnancy. It offers an opportunity to mitigate the impact of the Social Determinants of Health (SDoH) on individual patients through advocacy and referral to social services. Despite a publicly funded health care system in Canada, disparities in access to PNC persist. Much is known about the barriers to PNC and client experiences of inadequate PNC (IPNC). Very little is known about care provider perspectives of IPNC, what should be done about it and are the barriers to doing it. The goal of this project was to address this gap in knowledge to inform the development of novel care delivery models that could reduce disparities in access to PNC in Hamilton. Using a Critical Theory lens, I conducted an interpretive descriptive study using individual interviews and focus groups with health and social service providers in Hamilton to explore their understandings of IPNC. Participants viewed IPNC as a small but important phenomenon disproportionately impacting people who are marginalized. The experience of IPNC is chaotic, worrisome and joyful for providers. An interdisciplinary, midwifery-led outreach PNC model would better meet the needs of the client population and providers alike. A Community Centred Care model of PNC embodies and enhances participant suggestions for addressing IPNC. Access to abortion, postpartum care and newborn apprehension require special attention. Peer participation and the impacts of patriarchy and racism must be addressed in the development of future PNC models. The ways in which participants described and proposed intervening in IPNC revealed an individualized understanding of the SDoH that is paralleled in existing research on IPNC. This conceptualization of the problem obscures the root causes of disparities in access and warrants future consideration. / Thesis / Master of Science (MSc) / Prenatal care (PNC) can help to reduce complications of pregnancy and birth and connect expecting families with other support services. Even though health care is free in Canada, people who are marginalized struggle to access enough PNC. We know the complexities of people’s lives and their negative experiences with the health care system prevent them from getting PNC. We know little about what PNC for people who don’t access it is like for the providers or why they can’t make their care easier to access. Mindful of systems of power, the goal of this research is to explore how health and social service providers understand inadequate PNC (IPNC), to inform accessible PNC models. Participants proposed an interdisciplinary outreach PNC model responsive to needs of the community. The Social Determinants of Health were an important part of how participants understood IPNC which shaped the way that they proposed to address it.

Dada a complexidade epidemiológica do câncer de mama e a escassez de estudos sistemáticos sobre este assunto na região norte do Brasil, este trabalho consiste no primeiro levantamento epidemiológico e assistencial em saúde tomando como base a assistência ao câncer de mama no norte do Tocantins, entre 2010 e 2015, tendo como referência o Hospital Regional de Araguaína. Os objetivos foram: verificar a qualidade das informações cadastradas no SIS-RHC quanto à completude do preenchimento dos dados referentes às mulheres com câncer de mama; avaliar a variação temporal dos percentuais de casos em estádios precoce e tardio da doença no momento do diagnóstico; analisar o tempo decorrido para se conseguir a primeira consulta, o diagnóstico e o tratamento e, analisar a associação entre as variáveis sociodemográficas com o estadiamento do tumor no momento do diagnóstico (precoce e tardio). Foram excluídas as variáveis com grau de incompletude acima de 20%. Verificou-se que: a variável ocupação teve 35,1% de preenchimento incompleto e foi excluída da análise; escolaridade apresentou 10,6% de incompletude, alcoolismo 13,5% e tabagismo 12,8%; as demais variáveis apresentaram menos de 10% de incompletude; a maioria das pacientes se apresentou com doença avançada (51,1%); não houve diferença dos percentuais de pacientes com estádios precoces e tardios ao longo dos anos avaliados (p=0,757); a mediana do tempo para consulta foi de 158 dias e para tratamento foi de 182 dias; as mulheres com estadiamento precoce levaram mais tempo para iniciarem o tratamento comparativamente àquelas com estadiamento tardio (p=0,011); as mulheres de raça/cor preta (p=0,012), analfabeta (p=0,003) e de procedência do Pará (p=0,009) apresentaram maior porcentagem de estadiamento tardio no momento do diagnóstico. Assim, concluiu-se que as variáveis da base de dados são fontes de informação consideráveis; a maioria das mulheres foi diagnosticada com doença avançada e a evolução temporal da proporção de casos avançado e precoce não demonstrou mudanças variacionais ao longo dos anos; a qualidade do serviço ambulatorial do HRA para consultas em mastologia mostrou-se precária com tendência a priorizar o atendimento aos pacientes com doença avançada. Por fim, foi identificado associação de câncer de mama em estádio avançado nas mulheres de raça/cor preta, analfabetas e provenientes do estado do Pará. / Considering the epidemiological complexity of breast cancer and the few systematic studies on this subject in the North region of Brazil, this study is the first epidemiological and health care survey based on the assistance to breast cancer in the north of Tocantins, having as reference the Regional Hospital of Araguaína (RHA). The aims were: to verify the quality of the information of the variables registered in SIS-RHC regarding the completeness of the data on women with breast cancer; to evaluate the temporal variation of the percentages of cases in early and advanced stages of the disease at diagnosis; to evaluate the elapsed time to obtain the first consultation, the diagnosis and the treatment, and to analyze the association between sociodemographic variables with the tumor stage at diagnosis (early and advanced). This is an analytical study, with secondary data of breast cancer in women between 2000 and 2015 assisted at the RHA. Variables with a degree of incompleteness above 20% were excluded. It was verified that: the variable occupation was incomplete in 35.1% of the forms and was excluded from the analysis; schooling presented 10.6% of incompleteness, alcoholism 13.5% and smoking 12.8%; the other variables showed less than 10% of incompleteness; most of patients presented advanced disease (51.1%); there was no difference of the percentages of patients with early and late stages over the years assessed (p = 0.757); the median of time for consultation was 158 days and for treatment 182 days; women with early stage took more time to initiate treatment compared to those with advanced stage (p = 0.011); women of black race (p = 0.012) , illiterate (p = 0.003) and from the state of Pará (p = 0.009) had a higher percentage of advanced stage at the time of diagnosis. Thus, it was concluded that the database variables are considerable sources of information; most women were diagnosed with advanced disease and the temporal evolution of the proportion of advanced and early cases did not show variational changes over the years; the quality of the ambulatory service of the RHA for consultations on Mastology was shown to be precarious with tendency to prioritize care for patients with advanced disease. Finally, we identified an association of advanced stage breast cancer in women of black race, illiterate and that come from the state of Pará.

Este estudo teve por objetivo analisar a relação entre capacidade funcional e fragilidade ao acesso de idosos aos serviços de saúde oferecidos pela Estratégia Saúde da Família. Trata-se de um estudo transversal, descritivo, com amostra aleatória constituída por 128 idosos assistidos pela Estratégia Saúde da Família (ESF) em uma Unidade Básica de Saúde (UBS) de Embu das Artes, município da região metropolitana de São Paulo.Os instrumentos utilizados foram: Questionário para caracterização sóciodemográfica dos idosos; Questionário sobre acesso e utilização dos serviços de saúde; Índice de Katz e Escala de Lawton para avaliação da capacidade funcional e a Edmonton Frail Scale (EFS) para avaliação de fragilidade. Como resultados observou-se predomínio de idosos do sexo feminino, na faixa etária de 60 a 69 anos, de cor parda, com baixa escolaridade e de religião católica. Foi observado que 81,2% possuíam renda própria. A morbidade mais citada foi a hipertensão arterial. Quanto ao acesso 84,4% declararam utilizar exclusivamente serviços públicos de saúde e 48,4% referiram dificuldade de acesso aos serviços de saúde, tendo como principais causas barreiras arquitetônicas, citada por 13,3% e má qualidade dos serviços por 13,3%. A avaliação da capacidade funcional revelou que 68% apresentavam independência completa para as Atividades Básicas de Vida Diária(ABVD´s), nas Atividades Instrumentais de Vida Diária (AIVD´s) 27,3% apresentavam independência, 55,5% independência parcial e 17,2% dependência total. Com relação à fragilidade foi verificado que 48,5% eram não-frágeis, 21,4% eram aparentemente vulneráveis a fragilidade,13,6% apresentavam fragilidade leve, 6,8% fragilidade moderada e 9,7% fragilidade severa. Foi verificada associação significativa entre capacidade funcional e acesso, a maior parte dos idosos com algum tipo de dependência apresentou dificuldade de acesso. Não foi observado associação entre fragilidade e acesso. Espera-se que os resultados estimulem profissionais da Atenção Básica, especialmente da ESF a utilizarem estes instrumentos de rastreamento na avaliação dos idosos e reflitam se os serviços e a forma como são ofertados estão acessíveis aos idosos, considerando a condição funcional deste grupo etário. / The purpose of this study was to analyze the relation between the functional capacity and frailty of elderly individuals accessibility to the health service provided by the Family Health Strategy. This is a cross-sectional, descriptive study, which had a random sample comprised by 128 elderly individuals assisted by the Family Health Strategy (FHS) at a Primary Health Care Center in Embu das Artes, a city located in the metropolitan area of São Paulo. The instruments used were: Questionnaire for the socio-demographic characterization of the elderly; Questionnaire on the accessibility and utilization of health services; Katz Index and Lawtons Scale to evaluate functional capacity, and the Edmonton Frail Scale (EFS) to evaluate frailty. Results showed that most elderly participants were female, with 69 years of age, brown, with low educational level, and catholic. It was observed that 81.2% had their own income. The most referred morbidity was arterial hypertension. As for the accessibility, 84.4% reported using only public health services, and 48.4% referred facing difficulties regarding health service accessibility, mainly because of architectural barriers, as reported by 13.3%, and the poor quality of services, reported by 13.3%. The functional capacity evaluation revealed that 68% were fully independent for Activities of Daily Living (ADLs), in the Instrumental Activities of Daily Living (IADLs) 27.3% were independent, 55.5% partialy independnet, and 17.2% completely dependent. As for frailty, it was found that 48.5% were non-frail, 21.4% were apparently vulnerable to frailty, 13.6% presented mild frailty, 6.8% moderate frailty and 9.7% severe frailty. It was found there is a significant association between functional capacity and accessibility, the majority of the elderly with some form of dependence had accessibility difficulty. No association was observed between frailty and accessibility. The present study results could encourage primary health care professionals, especially those working with the FHS, to use these screening instruments to evaluate the elderly and analyze whether the services and how they are provided are accessible to the elderly, considering the functional condition of this specific age group.

Made available in DSpace on 2018-06-04T19:14:36Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-03-21 / O atual estudo avaliou os serviços de Atenção Primária à Saúde que as crianças de 0 a 12 anos utilizaram num município de pequeno porte, o Município de Joanópolis, SP, do ponto de vista dos responsáveis legais e dos profissionais de saúde. Os responsáveis legais (os pais) entrevistados avaliam os serviços de saúde para os seus filhos como 5,62/10 (Escore Geral de Atenção Primária à Saúde), o que é inferior ao determinado de 6,60. Os pais apontam uma insatisfação com os atributos de acessibilidade, longitudinalidade, integralidade-serviços prestados, e orientação familiar e comunitária. Se considerarmos o Escore Essencial de APS a média é 6,92. Os profissionais de saúde entrevistados consideram os serviços como inadequados: o escore geral de Atenção Primária à Saúde é 5,52 e o escore essencial é 5,67. O único atributo considerado adequado é a acessibilidade. Há uma discrepância de escores entre os pais e os profissionais de saúde sobre a acessibilidade dos serviços de saúde para as crianças em Joanópolis. Os atuais resultados, num município de pequeno porte, são comparáveis com os resultados dos estudos publicados nos grandes centros urbanos: em ambos os cenários a orientação familiar e comunitária é insatisfatória, o que nos leva a perguntar sobre que tipo de APS falamos no Brasil. O estudo aprofundou-se na dimensão de acesso aos serviços de saúde. Observou-se que quase um terço das crianças estudadas são moradoras da zona rural: mesmo tendo uma barreira geográfica as crianças rurais conseguiram acessar os serviços de APS neste estudo. As crianças de todas as faixas etárias conseguiram acessar os serviços de APS nesta pesquisa: a distribuição normal da idade das crianças estudadas é um indicador de acesso aos serviços de saúde, mesmo estudando o acesso realizado. Os pais que moram na zona rural consideram a qualidade dos cuidados prestados menos vezes como “muito bom” comparado com os pais que moram na zona urbana (valor p <0,001). O estudo mostrou também que a realização de um estudo de avaliação dos serviços usados de Atenção Primária à Saúde utilizando a ferramenta PCATool-Brasil nesta pequena cidade rural requereu um investimento de 1.241 horas trabalhadas (e orçamento correspondente), e precisou também de profissionais de saúde e gestores motivados para executa-la. / This study evaluated Primary Health Care services that children aged 0 to 12 used in a small city, the Municipality of Joanopolis, in the State of São Paulo, from the point of view of the legal responsibles and of the health professionals. The interviewed legal responsibles (the parents) evaluate the health services for their children as 5,62/10 (General Primary Health Care Score), which is lower than the established cut-off point of 6,60. The parents refer they are unsatisfied with the attributes of accessibility, long-term person care, integrated care- provided services, family and community oriented care. If we consider the Essential Primary Health Care Score the mean is 6,92. The interviewed health professionals consider the services as inadequate: the General Score for PHC is 5,52 and the Essential Score is 5,67. The only attribute they consider adequate is accessibility. There is a discrepancy between the scores the parents and the health professionals attribute to the accessibility of health services for children in Joanopolis. The actual study results, in a small city, are comparable with the results from published studies in big urban centers: in both scenarios the family and community oriented care is considered inadequate, which leads us to the question about what kind of PHC we are talking in Brazil. This research studied the dimension of access to health services in details. It was observed that almost a third of the studied children live in rural zone areas: even with an existing geographic barrier the rural children were able to access the PHC-services in this study. Children of all age ranges were able to access PHC-services in this study: the normal distribution of the age of the studied children is an indicator of access to health services, even if the realized access was studied. The parents living in rural areas consider the quality of provided services less times as “very good” compared with parents living in urban areas (P value <0,001). The study also showed that carrying out an evaluation of used Primary Health Care services using the PCATool-Brasil in this small rural city needed an investment of 1.241 working hours (and corresponding budget), as well as motivated health professionals and managers to perform the study / BV UNIFESP: Teses e dissertações

Dada a complexidade epidemiológica do câncer de mama e a escassez de estudos sistemáticos sobre este assunto na região norte do Brasil, este trabalho consiste no primeiro levantamento epidemiológico e assistencial em saúde tomando como base a assistência ao câncer de mama no norte do Tocantins, entre 2010 e 2015, tendo como referência o Hospital Regional de Araguaína. Os objetivos foram: verificar a qualidade das informações cadastradas no SIS-RHC quanto à completude do preenchimento dos dados referentes às mulheres com câncer de mama; avaliar a variação temporal dos percentuais de casos em estádios precoce e tardio da doença no momento do diagnóstico; analisar o tempo decorrido para se conseguir a primeira consulta, o diagnóstico e o tratamento e, analisar a associação entre as variáveis sociodemográficas com o estadiamento do tumor no momento do diagnóstico (precoce e tardio). Foram excluídas as variáveis com grau de incompletude acima de 20%. Verificou-se que: a variável ocupação teve 35,1% de preenchimento incompleto e foi excluída da análise; escolaridade apresentou 10,6% de incompletude, alcoolismo 13,5% e tabagismo 12,8%; as demais variáveis apresentaram menos de 10% de incompletude; a maioria das pacientes se apresentou com doença avançada (51,1%); não houve diferença dos percentuais de pacientes com estádios precoces e tardios ao longo dos anos avaliados (p=0,757); a mediana do tempo para consulta foi de 158 dias e para tratamento foi de 182 dias; as mulheres com estadiamento precoce levaram mais tempo para iniciarem o tratamento comparativamente àquelas com estadiamento tardio (p=0,011); as mulheres de raça/cor preta (p=0,012), analfabeta (p=0,003) e de procedência do Pará (p=0,009) apresentaram maior porcentagem de estadiamento tardio no momento do diagnóstico. Assim, concluiu-se que as variáveis da base de dados são fontes de informação consideráveis; a maioria das mulheres foi diagnosticada com doença avançada e a evolução temporal da proporção de casos avançado e precoce não demonstrou mudanças variacionais ao longo dos anos; a qualidade do serviço ambulatorial do HRA para consultas em mastologia mostrou-se precária com tendência a priorizar o atendimento aos pacientes com doença avançada. Por fim, foi identificado associação de câncer de mama em estádio avançado nas mulheres de raça/cor preta, analfabetas e provenientes do estado do Pará. / Considering the epidemiological complexity of breast cancer and the few systematic studies on this subject in the North region of Brazil, this study is the first epidemiological and health care survey based on the assistance to breast cancer in the north of Tocantins, having as reference the Regional Hospital of Araguaína (RHA). The aims were: to verify the quality of the information of the variables registered in SIS-RHC regarding the completeness of the data on women with breast cancer; to evaluate the temporal variation of the percentages of cases in early and advanced stages of the disease at diagnosis; to evaluate the elapsed time to obtain the first consultation, the diagnosis and the treatment, and to analyze the association between sociodemographic variables with the tumor stage at diagnosis (early and advanced). This is an analytical study, with secondary data of breast cancer in women between 2000 and 2015 assisted at the RHA. Variables with a degree of incompleteness above 20% were excluded. It was verified that: the variable occupation was incomplete in 35.1% of the forms and was excluded from the analysis; schooling presented 10.6% of incompleteness, alcoholism 13.5% and smoking 12.8%; the other variables showed less than 10% of incompleteness; most of patients presented advanced disease (51.1%); there was no difference of the percentages of patients with early and late stages over the years assessed (p = 0.757); the median of time for consultation was 158 days and for treatment 182 days; women with early stage took more time to initiate treatment compared to those with advanced stage (p = 0.011); women of black race (p = 0.012) , illiterate (p = 0.003) and from the state of Pará (p = 0.009) had a higher percentage of advanced stage at the time of diagnosis. Thus, it was concluded that the database variables are considerable sources of information; most women were diagnosed with advanced disease and the temporal evolution of the proportion of advanced and early cases did not show variational changes over the years; the quality of the ambulatory service of the RHA for consultations on Mastology was shown to be precarious with tendency to prioritize care for patients with advanced disease. Finally, we identified an association of advanced stage breast cancer in women of black race, illiterate and that come from the state of Pará.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2016-02-04T08:29:45Z No. of bitstreams: 2 Dissertação - Júlio César Souza Silva - 2015.pdf: 13184287 bytes, checksum: 6bd7573091862b67f24c7e70517b6294 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-02-04T08:31:37Z (GMT) No. of bitstreams: 2 Dissertação - Júlio César Souza Silva - 2015.pdf: 13184287 bytes, checksum: 6bd7573091862b67f24c7e70517b6294 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2016-02-04T08:31:37Z (GMT). No. of bitstreams: 2 Dissertação - Júlio César Souza Silva - 2015.pdf: 13184287 bytes, checksum: 6bd7573091862b67f24c7e70517b6294 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2015-07-31 / This work aims to analyze the care in the Health Care Network in the light of the principles of the Unified Health System - SUS, under the perception of users in Goiânia, Goiás. This is a qualitative, exploratory and descriptive research. The survey sample consisted of 20 participants: hypertensive women attending SUS health units in Goiania, Go. Data collection occurred between December 2013 and December 2014. Research approved by the Ethics Research Committee at the Maternal Child Hospital. CEP-HMI, Opinion 29/2013 and meets regulatory guidelines and research involving human subjects standards, according to the 466/12 Resolution of the National Health Council. Results: The perception of hypertensive users in Goiania, Go, was inadequate in seven categories studied: the service does not occur Universal and integral manner, with emphasis on gaps in access to care; in relation to Equity, the singularities of each user are not observed leading him to turn to, in some cases to the judiciary for service to their health claims; the phone appointment of consultations (0800) at public health services frontally violates the principle of regionalization promoting the discontinuation of Clinical Follow-up and the principle of territoriality; the hierarchy has hardened approach which further limits access by users; social participation, in Goiania, lacks physical spaces and more stimuli, through the media; the scenario is unfavorable for good quality clinical practice, and for this reason it is necessary to strengthen pedagogical approaches in medical school, which reiterate the importance of care centered on the person, adopting humane attitude, ethics, based on high standards of excellence - empowerment Medical Education. The information enables managers reflect about actions to be developed and work out a plan to minimize the bottlenecks that hinder the quality of care. From this perspective, health professionals, multi-mode can plan simple actions of health education in the various spheres of primary health care aimed at health promotion. / Este trabalho visa analisar o atendimento na Rede de Atenção à Saúde na perspectiva dos princípios do Sistema Único de Saúde - SUS, sob a percepção de usuárias em Goiânia, Goiás. Trata-se de uma pesquisa qualitativa, de natureza exploratória e descritiva. A amostra da pesquisa se constituiu por 20 participantes: mulheres hipertensas atendidas em unidades de saúde do SUS em Goiânia, Go. A Coleta de dados ocorreu entre dezembro de 2013 a dezembro de 2014. Pesquisa aprovada pelo Comitê de Ética em Pesquisa do Hospital Materno Infantil CEP-HMI, Parecer 29/2013 e atende diretrizes e normas regulamentadoras de pesquisa envolvendo seres humanos, de acordo com a Resolução 466/12 do Conselho Nacional de Saúde. Resultados: A percepção das usuárias hipertensas em Goiânia, Go, revelou deficiências em sete categorias estudadas: o atendimento não ocorre de forma Universal e Integral, com ênfase em falhas no acesso ao atendimento; em relação à Equidade, as singularidades de cada usuário não são observadas levando-o a recorrer, em alguns casos, ao poder judiciário para obter atendimento aos seus pleitos de saúde; o tele agendamento (0800) transgride frontalmente o princípio da Regionalização promovendo a descontinuidade do Seguimento Clínico e o princípio da Territorialidade; a hierarquização possui abordagem enrijecida que limita ainda mais o acesso pelos usuários; a participação social, em Goiânia, carece de espaços físicos e mais estímulos, através dos meios de comunicação; o cenário é desfavorável para prática clínica de boa qualidade, e, por essa razão é necessário reforçar abordagens pedagógicas, na escola médica, que reiteram a importância do atendimento centrado na pessoa, adotando postura humanizada, ética, pautada em elevados padrões de excelência - Emponderamento da Educação Médica (Empowerment Medical Education). As informações permitem aos gestores refletirem acerca de ações a serem desenvolvidas e elaborar um planejamento para minimizar os gargalos que dificultam a qualidade da assistência. Nessa perspectiva, os profissionais de saúde, de modo multiprofissional podem planejar ações simples de educação em saúde nas diversas esferas da atenção básica que visem a promoção da saúde.

Este estudo teve por objetivo analisar a relação entre capacidade funcional e fragilidade ao acesso de idosos aos serviços de saúde oferecidos pela Estratégia Saúde da Família. Trata-se de um estudo transversal, descritivo, com amostra aleatória constituída por 128 idosos assistidos pela Estratégia Saúde da Família (ESF) em uma Unidade Básica de Saúde (UBS) de Embu das Artes, município da região metropolitana de São Paulo.Os instrumentos utilizados foram: Questionário para caracterização sóciodemográfica dos idosos; Questionário sobre acesso e utilização dos serviços de saúde; Índice de Katz e Escala de Lawton para avaliação da capacidade funcional e a Edmonton Frail Scale (EFS) para avaliação de fragilidade. Como resultados observou-se predomínio de idosos do sexo feminino, na faixa etária de 60 a 69 anos, de cor parda, com baixa escolaridade e de religião católica. Foi observado que 81,2% possuíam renda própria. A morbidade mais citada foi a hipertensão arterial. Quanto ao acesso 84,4% declararam utilizar exclusivamente serviços públicos de saúde e 48,4% referiram dificuldade de acesso aos serviços de saúde, tendo como principais causas barreiras arquitetônicas, citada por 13,3% e má qualidade dos serviços por 13,3%. A avaliação da capacidade funcional revelou que 68% apresentavam independência completa para as Atividades Básicas de Vida Diária(ABVD´s), nas Atividades Instrumentais de Vida Diária (AIVD´s) 27,3% apresentavam independência, 55,5% independência parcial e 17,2% dependência total. Com relação à fragilidade foi verificado que 48,5% eram não-frágeis, 21,4% eram aparentemente vulneráveis a fragilidade,13,6% apresentavam fragilidade leve, 6,8% fragilidade moderada e 9,7% fragilidade severa. Foi verificada associação significativa entre capacidade funcional e acesso, a maior parte dos idosos com algum tipo de dependência apresentou dificuldade de acesso. Não foi observado associação entre fragilidade e acesso. Espera-se que os resultados estimulem profissionais da Atenção Básica, especialmente da ESF a utilizarem estes instrumentos de rastreamento na avaliação dos idosos e reflitam se os serviços e a forma como são ofertados estão acessíveis aos idosos, considerando a condição funcional deste grupo etário. / The purpose of this study was to analyze the relation between the functional capacity and frailty of elderly individuals accessibility to the health service provided by the Family Health Strategy. This is a cross-sectional, descriptive study, which had a random sample comprised by 128 elderly individuals assisted by the Family Health Strategy (FHS) at a Primary Health Care Center in Embu das Artes, a city located in the metropolitan area of São Paulo. The instruments used were: Questionnaire for the socio-demographic characterization of the elderly; Questionnaire on the accessibility and utilization of health services; Katz Index and Lawtons Scale to evaluate functional capacity, and the Edmonton Frail Scale (EFS) to evaluate frailty. Results showed that most elderly participants were female, with 69 years of age, brown, with low educational level, and catholic. It was observed that 81.2% had their own income. The most referred morbidity was arterial hypertension. As for the accessibility, 84.4% reported using only public health services, and 48.4% referred facing difficulties regarding health service accessibility, mainly because of architectural barriers, as reported by 13.3%, and the poor quality of services, reported by 13.3%. The functional capacity evaluation revealed that 68% were fully independent for Activities of Daily Living (ADLs), in the Instrumental Activities of Daily Living (IADLs) 27.3% were independent, 55.5% partialy independnet, and 17.2% completely dependent. As for frailty, it was found that 48.5% were non-frail, 21.4% were apparently vulnerable to frailty, 13.6% presented mild frailty, 6.8% moderate frailty and 9.7% severe frailty. It was found there is a significant association between functional capacity and accessibility, the majority of the elderly with some form of dependence had accessibility difficulty. No association was observed between frailty and accessibility. The present study results could encourage primary health care professionals, especially those working with the FHS, to use these screening instruments to evaluate the elderly and analyze whether the services and how they are provided are accessible to the elderly, considering the functional condition of this specific age group.