Parâmetros para dimensionamento de médicos na Estratégia de Saúde da Família.

Abstract

Proper planning of the workforce is imperative to the good outcomes that health systems want to achieve. In primary care, staffing physician is traditionally based on the ratio of professionals by population (eg, physician/inhabitants, physician/patient) or in the relationship between production and installed capacity. However, planning methods need to be evidence-based and use accurate data on health needs and human resources. Objective: to analyze the workload of the physician in family health units in Brazil. Method: Study exploratory-descriptive, with a field work and quantitative approach. Twenty-seven family health units (USF) were selected in twelve Brazilian municipalities evaluated with optimal performance by the National Program for Improvement of Access and Quality of Primary Care cycle 1 (PMAQ-AB) of the Department of Primary Care of the Ministry of Health (DAB-MS), configured as a national representative sample. We observed 47 physicians present at the USF, every 10 minutes during the typical working day. To identify the interventions/activities performed, a workload measurement instrument was elaborated and validated by specialists. Data analysis was performed by geographic region, PMAQ strata and day shifts. In addition, the parameters obtained in this study were applied in the Workload Indicators of Staffing Need (WISN) method, to size the quantity of physicians of a unit. Results: There were 8544 observations distributed among interventions, associated activities, personal activities, waiting time and absence. The most frequent direct interventions were consultation (62.95%) and meeting spontaneous demand (21.97%). The indirect interventions with the highest percentage were documentation (34.89%), information exchange on health care (24.69%) and student support (21.84%). The mean time of consultation was 15 minutes. The doctors are absent 54.05% of the time of their work day. Conclusion: The data made possible a national analysis of the activities developed by the doctors in the USF, as well as the distribution in the working day. The behavior was similar across the country, drawing attention to the percentage of absences of the professional studied. The results can then subsidize discussions about the physician's work process and the planning of human resources in primary health care.