Avaliação da qualidade do cuidado na saúde digital na atenção primária à saúde: construção, validação e aplicação de instrumento

Abstract

The use of Information and Communication Technologies in the healthcare sector has been steadily increasing worldwide, defining the emerging field of digital health. Particularly in Primary Health Care (PHC), these technologies have become essential for improving the quality of care. This study aims to develop and validate an indicator matrix for assessing the quality of digital healthcare in Brazilian PHC, as well as to evaluate the integration of digital technologies within PHC by identifying barriers and facilitators in a Brazilian capital city. The validation study was divided into three phases: instrument development, validity analysis, and a pilot study. The instrument was designed based on the PHC evaluation model, grounded in a comprehensive literature review. The validity analysis employed the Delphi technique, combined with the nominal group method and supported by evidence from existing literature. In the pilot study, audio-recorded interviews were conducted with key stakeholders in primary care. A survey was also administered, using a questionnaire developed through the validation study, involving physicians and nurses from Basic Health Units. The data analysis included descriptive statistics and association tests, supported by SPSS software, with a 5% significance level. The study resulted in the “QualiAPS Digital – Brazil” indicator matrix, composed of 37 indicators organized into three distinct components and their respective dimensions. The "Structure" component includes the "Resources" dimension; the "Processes" component encompasses the "Technical," "Organizational," and "Relational" dimensions; and the "Outcomes" component includes the "Short-Term Outcomes" and "Mid-Term Outcomes" dimensions. The overall values obtained for Content Validity Index (CVI) and Agreement Index (AI) during validation were 0.89 and 1.00, respectively. As a result, it was possible to design evaluation guidelines and suggest qualitative data collection techniques for assessing digital health in Brazilian PHC. Survey findings showed the presence of computers and the use of e-SUS/Electronic Citizen Health Record (PEC) in all units, with WhatsApp®, phone calls, and other digital media standing out as the main tools employed. Limited digital infrastructure, lack of adequate professional training, and absence of specific protocols for organizing digital actions were observed, with statistical associations found between these variables and the performance of digital health initiatives. Therefore, this study presents a validated instrument in terms of its relevance, content, and theoretical support for evaluating the quality of digital healthcare delivery. The findings also support recommendations for strengthening professional qualification policies and investments in infrastructure, aiming at the continuity and enhancement of Information and Communication Technology use in PHC. These results provide comparable insights for similar urban PHC contexts in Brazil and in countries with equivalent socioeconomic conditions and analogous public health systems. Further applications of the proposed tool may support decision-making by health managers and professionals in the pursuit of improving remote primary care services provided to the population.