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RESUMO Esta pesquisa qualitativa objetivou identificar como se dá a proteção social e a produção do cuidado a travestis e a mulheres trans em situação de rua nas políticas públicas de saúde e de assistência social no município de Belo Horizonte (MG), a partir da percepção dessas pessoas. Os instrumentais utilizados para coleta de dados foram observação participante, entrevistas semiestruturadas e em profundidade e técnica do grupo focal. Os dados demonstraram que as entrevistadas conhecem e acessam vários serviços do Sistema Único de Saúde (SUS) e do Sistema Único de Assistência Social (Suas). Entretanto, estes não estão alinhados às suas diversidades e singularidades e (re)produzem violências. A atitude de acolhimento de alguns profissionais dos serviços apareceu como indicativo de bom atendimento. Porém, foram relatadas situações de violações de direito a que estão submetidas no cotidiano dos serviços. As principais violências relatadas se relacionam com os critérios e regras de funcionamento, com a falta de privacidade, discriminação e assédio sexual. Este estudo reafirma a importância e a necessidade das políticas e serviços serem pensados e implementados na lógica da construção coletiva, de escuta e diálogo com esses sujeitos de direitos, respeitando as especificidades de suas trajetórias e demandas.

ABSTRACT This qualitative research aimed to identify how social protection and the production of care for transvestites and transgender women in homeless situation are given in the public policies of health and social assistance in the city of Belo Horizonte (MG), based on the perception of those people. The instruments used for data collection were participant observation, semi-structured and in-depth interviews, and the focus group technique. The data showed that the interviewees know and access various services of the Unified Health System (SUS) and the Unified Social Assistance System (Suas). However, these are not aligned with their diversity and singularities and (re)-produce violence. The embracing attitude of service professionals appeared as an indicative of good service. However, situations of violations of the right to which they are subjected in the daily life of the services have been reported. The main reported violence relates to the criteria and rules of operation, lack of privacy, discrimination, and sexual harassment. This study reaffirms the importance and necessity of policies and services to be thought and implemented in the logic of collective construction, listening and dialoguing with these subjects who have rights, respecting the specificities of their trajectories and demands.

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OBJECTIVE: to analyze service users' perception of health care provided by the teams participating in the National Program for Primary Care Access and Quality Improvement (PMAQ-AB) in Brazil. METHODS: this was a cross-sectional study using data from interviews with users of services provided by PMAQ-AB teams in 2012. Multinomial logistic regression was used to analyze the association between perception level (very good/good, regular, poor/very poor) and variables of four primary care attributes: accessibility, integrality, longitudinality and care coordination. RESULTS: out of 65,391 users, 78.9% evaluated care as very good/good, 19.0% as regular and 2.1% as poor/very poor. Associations with care by the same physician (OR 3.21; 95% CI 2.68, 3.83) and physical examination at consultation (OR 3.08; 95% CI 2.50, 3.79) were the most prominent. CONCLUSION: the majority of users evaluated care positively, however there is perception of care problems within the recommended attributes.

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Objetivo: analisar a percepção dos usuários sobre o cuidado prestado por equipes participantes do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) no Brasil. Métodos: estudo transversal com dados de entrevistas com usuários das equipes, em 2012. Empregou-se regressão logística multinomial para analisar a associação entre nível de percepção (muito bom/bom, regular, ruim/muito ruim) e variáveis de quatro atributos da atenção básica: acessibilidade, integralidade, longitudinalidade e coordenação do cuidado. Resultados: dos 65.391 entrevistados, 78,9% avaliaram o atendimento como muito bom/bom, 19,0% como regular e 2,1% como ruim/muito ruim. A avaliação muito bom/bom foi associada a questões sobre os quatro atributos estudados. Destacam-se as associações com atendimento pelo mesmo médico (OR 3,21; IC95% 2,68; 3,83) e realização do exame físico na consulta (OR 3,08; IC95% 2,50; 3,79). Conclusão: a maioria dos usuários avaliou positivamente o atendimento, contudo existe percepção de problemas no cuidado conforme os atributos recomendados.

Objetivo: analizar la percepción de los usuarios sobre el cuidado prestado por los equipos del Programa Nacional de Mejora del Acceso y de la Calidad de la Atención Básica (PMAQ-AB) en Brasil. Métodos: estudio transversal, con datos de entrevistas con usuarios de los equipos evaluados por el PMAQ-AB en 2012. Se empleó regresión logística multinomial para analizar la asociación entre nivel de percepción (muy bueno/bueno, regular, malo/muy malo) y variables de atributos de la AB: accesibilidad, integralidad, longitudinalidad y coordinación del cuidado. Resultados: de los 65.391 usuarios, 78,9% evaluaron la atención como muy bueno/bueno, 19,0% como regular y 2,1% como malo/muy malo. Se destacan las asociaciones con atención por el mismo médico (OR 3,21; IC95% 2,68; 3,83) y realización del examen físico en la consulta (OR 3,08; IC95% 2,50; 3,79). Conclusión: la mayoría de los usuarios evaluaron positivamente la atención, sin embargo existe percepción de problemas en el cuidado.

Objective: to analyze service users' perception of health care provided by the teams participating in the National Program for Primary Care Access and Quality Improvement (PMAQ-AB) in Brazil. Methods: this was a cross-sectional study using data from interviews with users of services provided by PMAQ-AB teams in 2012. Multinomial logistic regression was used to analyze the association between perception level (very good/good, regular, poor/very poor) and variables of four primary care attributes: accessibility, integrality, longitudinality and care coordination. Results: out of 65,391 users, 78.9% evaluated care as very good/good, 19.0% as regular and 2.1% as poor/very poor. Associations with care by the same physician (OR 3.21; 95% CI 2.68, 3.83) and physical examination at consultation (OR 3.08; 95% CI 2.50, 3.79) were the most prominent. Conclusion: the majority of users evaluated care positively, however there is perception of care problems within the recommended attributes.

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Information and Communication Technologies (ICTs) are means to handle information, streamline communication, and contribute to patient care. This article describes the incorporation of Information and Communication Technologies in primary care and its association with quality, based on the Brazilian National Program for the Improvement of Access and Quality in Primary Care (PMAQ in portuguese). This was a cross-sectional study with 17,053 teams. An Index of Incorporation of ICTs was created, which included: information infrastructure, systems, and utilization. Regression analysis was used to assess associations. Only 13.5% of the teams had a high degree of ICTs. The strongest association was seen in the utilization of information. ICTs can contribute to improving quality of primary care.

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Resumo: As Tecnologias de Informação e Comunicação (TIC) - meios para tratar informação e agilizar comunicação - contribuem para o cuidado. Este artigo descreve a incorporação de TIC na atenção básica e sua associação com a qualidade, utilizando Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ). É um estudo transversal. O universo englobou 17.053 equipes. Criou-se o Índice de Incorporação de Tecnologias de Informação e Comunicação (ITIC) englobando: infraestrutura, sistemas e utilização de informação. Para as associações, realizou-se análise de regressão. Somente 13,5% das equipes possuem grau alto de TIC. É na utilização da informação que se observou a maior força de associação. As TIC contribuem para a melhoria da qualidade da atenção básica.

Abstract: Information and Communication Technologies (ICTs) are means to handle information, streamline communication, and contribute to patient care. This article describes the incorporation of Information and Communication Technologies in primary care and its association with quality, based on the Brazilian National Program for the Improvement of Access and Quality in Primary Care (PMAQ in portuguese). This was a cross-sectional study with 17,053 teams. An Index of Incorporation of ICTs was created, which included: information infrastructure, systems, and utilization. Regression analysis was used to assess associations. Only 13.5% of the teams had a high degree of ICTs. The strongest association was seen in the utilization of information. ICTs can contribute to improving quality of primary care.

Resumen: Las Tecnologías de la Información y Comunicación (TIC), los medios para tratar información y agilizar la comunicación, contribuyen al cuidado de los pacientes. Este artículo describe la incorporación de las TIC en la atención básica y su asociación con la calidad, utilizando Programa Nacional para el Mejoramiento del Acceso y Calidad de Atención Primaria (PMAQ). Es un estudio transversal. El universo englobó a 17.053 equipos. Se creó el Índice de Incorporación de las Tecnologías de la Información y Comunicación (ITIC) englobando: infraestructura, sistemas y utilización de la información. Para las asociaciones, se realizó un análisis de regresión. Solamente un 13,5% de los equipos poseen un grado alto de TIC. Es en la utilización de la información donde se observó la mayor fuerza de asociación. Las TIC contribuyen a una mejora de la calidad de la atención primaria.

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OBJECTIVE: To provide an overview of the distribution of institutional support in primary care in Brazil and to identify associations between the activities of institutional support and the outcome of the certification of the National Programme for Improving Access and Quality in Primary Health Care (PMAQ). MATERIALS AND METHODS: A cross-sectional study was conducted through interviews with 16 960 professionals in Brazil in 2012.To examine the relationship between the received support and the quality of health care it was made a multiple binary logistic regression. RESULTS: A positive relationship between high-level support and certification in the sub-dimensions analyzed was observed: women and child care, diabetes mellitus/ hypertension and mental health.The support activities which contributed most were: self-assessment, shared assessment, targeted workshops and training. CONCLUSION: Institutional support activities have helped to improve the quality and access of the population to healthcare in the country.

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Resumen: Objetivo: Ofrecer un panorama de la distribución del apoyo institucional a la atención primaria en Brasil e identificar la relación entre actividades de apoyo institucional y los resultados de la certificación del Programa Nacional para Mejorar el Acceso y la Calidad de la Atención Primaria (PMAQ). Material y métodos: Se efectuó un estudio transversal mediante entrevistas con 16 960 equipos en Brasil, en 2012. Para examinar la relación entre apoyo recibido y la calidad de la atención, se efectuó una regresión logística binaria múltiple. Resultados: Se observó una relación positiva entre el alto apoyo y la certificación en las subdimensiones analizadas: atención de la mujer y niños, diabetes mellitus/ hipertensión y salud mental. Las actividades de apoyo que más contribuyeron fueron autoevaluación, evaluación compartida, talleres con objetivos específicos y formación permanente. Conclusiones: Las actividades de apoyo institucional ayudaron a mejorar la calidad y el acceso de la población a la asistencia sanitaria en Brasil.

Abstract: Objective: To provide an overview of the distribution of institutional support in primary care in Brazil and to identify associations between the activities of institutional support and the outcome of the certification of the National Programme for Improving Access and Quality in Primary Health Care (PMAQ). Materials and methods: A cross-sectional study was conducted through interviews with 16 960 professionals in Brazil in 2012.To examine the relationship between the received support and the quality of health care it was made a multiple binary logistic regression. Results: A positive relationship between high-level support and certification in the sub-dimensions analyzed was observed: women and child care, diabetes mellitus/ hypertension and mental health.The support activities which contributed most were: self-assessment, shared assessment, targeted workshops and training. Conclusion: Institutional support activities have helped to improve the quality and access of the population to healthcare in the country.

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