Institutional and matrix support and its relationship with primary healthcare.
OBJECTIVE
To analyze whether the level of institutional and matrix support is associated with better certification of primary healthcare teams.


METHODS
In this cross-sectional study, we evaluated two kinds of primary healthcare support - 14,489 teams received institutional support and 14,306 teams received matrix support. Logistic regression models were applied. In the institutional support model, the independent variable was "level of support" (as calculated by the sum of supporting activities for both modalities). In the matrix support model, in turn, the independent variables were the supporting activities. The multivariate analysis has considered variables with p < 0.20. The model was adjusted by the Hosmer-Lemeshow test.


RESULTS
The teams had institutional and matrix supporting activities (84.0% and 85.0%), respectively, with 55.0% of them performing between six and eight activities. For the institutional support, we have observed 1.96 and 3.77 chances for teams who had medium and high levels of support to have very good or good certification, respectively. For the matrix support, the chances of their having very good or good certification were 1.79 and 3.29, respectively. Regarding to the association between institutional support activities and the certification, the very good or good certification was positively associated with self-assessment (OR = 1.95), permanent education (OR = 1.43), shared evaluation (OR = 1.40), and supervision and evaluation of indicators (OR = 1.37). In regards to the matrix support, the very good or good certification was positively associated with permanent education (OR = 1.50), interventions in the territory (OR = 1.30), and discussion in the work processes (OR = 1.23).


CONCLUSIONS
In Brazil, supporting activities are being incorporated in primary healthcare, and there is an association between the level of support, both matrix and institutional, and the certification result.
Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR.
Alaneir de Fátima
Ade F
dos Santos
Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR.
Antônio Thomaz Gonzaga da Matta
AT
Machado
Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR.
Clarice Magalhães Rodrigues
CM
dos Reis
Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR.
Daisy Maria Xavier
DM
Abreu
Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR.
Lucas Henrique Lobato
LH
de Araújo
Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR.
Simone Cristina
SC
Rodrigues
Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR.
Ângela Maria de Lourdes Dayrell
ÂM
de Lima
Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR.
Alzira de Oliveira
Ade O
Jorge
Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR.
Délcio
D
Fonseca Sobrinho
D001938:Brazil; D003430:Cross-Sectional Studies; D017598:Efficiency, Organizational; D006801:Humans; D007318:Inservice Training / Q000706:statistics & numerical data; D007324:Institutional Management Teams; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D011785:Quality Assurance, Health Care