Family health or traditional basic care? What is the view of the users, doctors, nurses and managers in São Paulo, Brazil?

The PROESF research, funded by the Brazilian Ministry of Health, plotted the base line of Primary Health Care in the largest Brazilian city, São Paulo, with a population of over 10 million inhabitants. The aim of this study is to present the perception of health professionals, managers and the public regarding Primary Health Care according to the forms of care currently offered: family health program, "traditional” and “mixed" basic care units.  To fulfill this objective the Primary Care Assessment Tool (PCAT) was used, duly adapted and validated for Brazil, to evaluate the aspects of Primary Health Care services.  Managers, doctors and nurses were interviewed from the 384 health care units in the city, as were a sample of users, totaling 1022 professionals and 559 users. When comparing scores given by the managers for the traditional units to those for exclusively family health care units, the latter reveal higher scores in relation to the majority of aspects. When comparing the different types of units according to the users’ opinions, the family health units only attain higher scores than those of mixed units (p<0.05) in the aspect of family guidance. Compared to the basic health care units, the family health units showed higher scores (p<0.05) in the aspects “way in”, “ties”, “family approach” and “community guidance” as well as a higher IAB score. Comparing the basic care units to the mixed units, the former present statistically significant lower results (p<0.05) for the aspects "way in", "ties", "range of services", "community guidance" and users' IAB score). The results indicate a very positive assessment by the users of those units which include family health services, whether they be exclusive family care units or “mixed” units. However, it is evident that, even in these units, the worst scoring aspects are community guidance and family approach.