Caracterização do processo de trabalho do cirurgiãodentista na estratégia de saúde da família do município de Parnamirim-RN

Family Health Strategy (FHS), founded in 1994 has appeared to play a strategic role in the SUS construction and consolidation. It has reaffirmed its Principles and Guidelines and has elected family as core of attention. The principle that has guided the work concerns the quality of the relationship between professional and family. Thus, the FHS has the family as a subject of health-disease process, and relations with its own characteristics and can be partners in building their health and improvement of quality of life of its members and the entire community. This study aims to characterize the surgeon-dentist (SD) working process in the family health strategy, from the knowledge of the SD integration with other team members; organization of services; development of shares, changes perceived by SDs, as well as knowing the surgeon-dentist profile who is part of this strategy. The collecting tool used was a semi-structured questionnaire, in which participated 30 professionals. As for profile, most professionals were women, completed the graduation in public university and did not have any training to work by joining the FHS. Almost all have other public or private working ties. They often carry out activities with students, and occasionally do home visits. In relation to team work, in activities such as home visits, school health, community activities, among others, they sometimes seek the cooperation of other members. The way of accessing for users in the most part has occurred through the schedule. The most frequently activities made to the Centro Especialidades Odontológicas (CEO), are in Endodontics and Prosthesis. The majority of them participate in team meetings, but they do not have frequency set to happen. As for the planning and programming of activities to be conducted, most said that individually develops them. Concerning the performance of their duties, most reported being satisfied, but that improvements could happen. Besides, they reported improvements in dental care following the inclusion of SD in the FHS in various aspects, such as access, organization, humanization, care and oral disease prevention. The professionals had poor integration with other team members, in addition to have a profile to more individualistic work, a fact seized by way of development and planning of actions. They work the actions in individual and curative way, in detriment promotion and collective ones. They work humanization, definition of territory and adscript population. Thus, it is concluded that the working process developed by SDs, includes the part which is advocated by FHS. This points out to a greater undertaking of this process aiming to detect the weakness met in order to reach the potential that the FHS represents in organization of basic attention

Gestão pública em saúde mental: um estudo em CAPS com gerência pública e privada do Rio Grande Do Norte

Currently, several models of management services from the public administration are in operation in Brazil following a global trend. Besides the traditional public management operated in SUS, there are ongoing experiments of privately management in the public health services. Accordingly, we have developed an investigation into two Psychosocial Care Centers operating between these two forms of financial resources management: the first is the CAPS II - PAR situated in the municipality of Parnamirim whose form is private and the second is the CAPS II West Christmas is that the municipal government. We seek to know the workings of services, planning forms and criteria for use of financial resources, identify differences between departments on ways to run and see how technicians and users participate in the planning and management of these resources. Documentary Research was conducted by the municipal Christmas and the financial administration of the CAPS service in Parnamirim. Were conducted an interview with manager (mental health coordinator of Natal) and another interview with an employee of planning department in the Health Department of Natal, an interview with the coordinator and financial administrator of CAPS - PAR and two groups of discussion taped conversation with semi structured script interviews with six technicians in CAPS PAR and six professionals crowded in CAPS - West.Differences were observed in the management of resources funded from four blocks of discussion and analysis of results, where the privately-run service for the direct management and bureaucracy without being discussed and planned spending on staff, as well as through meetings with users, the use of the financial resources available in box; already in service with municipal public administration there is a hierarchy, this answering the coordination of mental health and the local health department that centralizes resources and defines their spending. There are meetings with patients and families, but the demands are limited as to what can be sued because of the manager s authorization. Such differentiation would be related to differences in the articulation of public management with the different types of possible management in public services, where from the implementation of new public administration in the Brazilian s State Management Reform initiated in the second half of the 1990s, benefit management services with private regime, with autonomy and direct transfer of resources

O trabalho em equipe na atenção primária à saúde: situação de Portugal e do Brasil

Introdução: Na Atenção Primária à Saúde, nos contextos internacional e nacional, o trabalho em equipe tem sido reconhecido como estratégia decisiva para a organização de processos que visam à integralidade do cuidado, além de possibilitar melhorias na satisfação dos usuários com os serviços de saúde. Neste sentido, o objetivo, deste estudo, é analisar o trabalho em equipe na Atenção Primária à Saúde. Método: Trata-se de uma pesquisa em banco de dados secundários. Realizou-se três estudos: a) O trabalho em equipe na Atenção Primária à Saúde, em Portugal, pesquisa avaliativa, de natureza qualitativa, tipo estudo de caso descritivo, que representou um recorte dos resultados derivados da pesquisa integrada ao projeto “Implantação das Unidades de Saúde Familiar em Portugal”, que teve como procedimentos entrevistas semiestruturadas, roteiro de coleta de informações (check list) e análise documental. Foi realizada a estratégia de triangulação dos dados com análise de conteúdo; b) trabalho em equipe, acesso e qualidade na Atenção Primária à Saúde, no Brasil, estudo transversal, de abordagem quantitativa, realizado a partir dos dados obtidos da “Pesquisa de Avaliação Externa do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica”, no Brasil, em 2013. Amostra composta de 17202 profissionais e 65391 usuários. Utilizou-se entrevista estruturada, com análise estatística realizada pelas frequências absolutas e relativas das variáveis através do programa Statistical Package for Social Sciences. c) satisfação dos usuários com o trabalho em equipe na Atenção Primária à Saúde, no Brasil, estudo transversal, de abordagem quantitativa, realizado a partir dos dados obtidos da “Pesquisa de Avaliação Externa do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica”, no Brasil, em 2013. Amostra composta de 65391 usuários. Realizou-se análise estatística das frequências absolutas e relativas das variáveis através do programa Statistical Package for Social Sciences. Utilizou-se, ainda, o Teste X2 , com nível de significância de 5%; análise de regressão logística múltipla. O modelo final foi ajustado pelo teste de Hosmer/Lemeshow, o qual indicou um ajuste de 66%. Resultados: Sobre o trabalho em equipe na Atenção Primária à Saúde, em Portugal, destacou-se a formação das equipes de forma voluntária, por meio de afinidades pessoais, a existência de “carteira básica de serviços”, juntamente com x intervenções de vigilância, promoção da saúde e prevenção de doença, cuidados em situação de doença aguda, acompanhamento clínico de doença crônica e de patologia múltipla, cuidados domiciliares, interligação e colaboração em rede com outros serviços (cuidados hospitalares), sistemas informatizados nas unidades de saúde. Os dados revelaram dificuldades quanto ao atendimento domiciliar. No Brasil, foi destaque o processo de trabalho, com avanços relacionados a realização de planejamento e programação das ações e o apoio da gestão. Existência de território definido e de prontuários familiares. É destaque a agenda compartilhada e pactuada entre os profissionais. As equipes realizam acolhimento e reuniões, cujos temas, discutidos, giram em torno do processo de trabalho e planejamento. Os desafios, enfrentados, estão relacionados ao agendamento dos usuários; ao número de pessoas sob a responsabilidade das equipes; à existência de população descoberta nas áreas adscritas à Unidade de Saúde; à incipiência na ação intersetorial e ao pouco envolvimento da comunidade pelas equipes. Quanto aos fatores associados à satisfação do usuário foi marcante: a faixa etária; a escolaridade; a raça; se a falta de material prejudica o atendimento e se a equipe consegue marcar consulta para outros profissionais. Conclusões: Constatou-se o trabalho em equipe como elemento central no processo de mudança na Atenção Primária à Saúde, tanto no contexto de Portugal quanto no do Brasil, o qual ampliou o acesso e a qualidade na oferta de serviços de saúde e obteve, ainda, o reconhecimento social, mesmo que, em ambas as realidades, não tenha avançado na coordenação do cuidado e no estímulo à participação social. Os fatores, associados com a satisfação do usuário, estão relacionados diretamente ao cuidado prestado e refletem a expectativa, por parte do usuário, de resolução concreta de suas necessidades.

Planejamento em saúde no Brasil: convergências e divergências entre instâncias de gestão

Trata-se de uma investigação que busca revelar convergências e divergências no processo de planificação da Política Pública de Saúde, com foco primordial na participação dos organismos de representação social na consolidação do Sistema Único (SUS), destacando a Conferência Nacional de Saúde CNS, instância que deve ter participação obrigatória na formulação de recomendações para essa política estatal. Considera que a planificação reúne elementos de concepção jurídica, técnica e política para a elaboração dos documentos intitulados Planos Nacionais de Saúde PNS. A partir de pesquisa qualitativa de base documental e argumentação com apoio de Cartografia Simbólica, põe em exame o processo de elaboração e o teor presente nos relatórios da 12ª (2003), 13ª (2007) e 14ª CNS (2011), alinhando seus eixos, diretrizes e prioridades nos correspondentes PNS nos quadriênios 2004-2007, 2008-2011 e 2012-2015. A escolha desses instrumentos, na temporalidade sugerida, tem por esteio o período em que a implantação do sistema de Planejamento do SUS PlanejaSUS, orienta normativa e tecnicamente a elaboração do PNS, tendo como uma de suas referências o que foi emanado das conferências. Propõe-se verificar as tensões existentes entre momentos distintos da definição das prioridades elencadas nas políticas públicas de saúde à luz das contribuições teóricas sobre a concepção do Estado, numa visão contemporânea associada à sua dinâmica de atuação vinculada ao modo de produção e acumulação capitalista; sobre a metodologia do Planejamento Estratégico com base na participação de atores diversos; e ainda, na análise sobre a expressão desse participacionismo na ótica dos processos democráticos representativos no SUS. Na confecção dos mapas cartográficos foi proposta a correlação entre os conteúdos dos Relatórios das 12ª a 14ª conferências de saúde com o que está expresso nas prioridades constantes nos Planos Nacionais de Saúde (2004 a 2007, 2008 a 2011 e 2012 a 2015), verificando-se aproximações e distanciamentos existentes entre o que expressa a sociedade e a política governamental. Conclui-se que, do exame crítico entre as diretrizes e prioridades contidas no acervo documental existente e sua metodologia de construção, com fundamento na argumentação do aporte teórico trabalhado, são verificadas tensões e harmonizações que revelam pontos convergentes e dissonantes das pactuações e consensos entre os atores sociais representantes dos segmentos, no qual critério da representatividade condiciona a defesa de opiniões, interesses e prioridades, de modo diverso para os que estão implicados nesse processo de planificação

As práticas educativas na saúde da família: uma cartografia simbólica

This qualitative research aimed to understand the educational activities carried out in Family Health Units, of the municipality of Mossoró-RN. It was used symbolic cartography to organize and present data from reality. It started on the approach of Health Education and knowledge transformation practice, aiming at the development of autonomy and responsibility of individuals and healthcare, publicized by the appreciation of the interpersonal relations area established in services, such as educational emancipator practices contexts. Individual and collective interviews were realized, conducted with health professionals and users of ESF, about themes, activities, membership, the difficulties, the potential and the design of health education that permeate everyday Family Health Strategy. From what was apprehended, thematic maps were done with the analysis of educational practices of professionals belonging to the Family‟s Health. Links are built with the wires of conceptions of education reflected on themes and activities of family health teams. The storylines are rebinded by voices about the difficulties and the potential of educational processes for emancipator postures. For users, health education means proper care and information on disease prevention. Professionals understand that it is all information that is given to users, about health, social well-being, economic and general condition of human being as a way of preventing and treating disease. Mark printed on voices denote that activities and themes worked don‟t motivate users enough for their participation, being that physicians and dentists also get excluded themselves from educational practices. Elderly groups are those who get most involved with the activities. The size of the contained area and its seclusion from community make harder the access of users, as well as diminishing the quality of educational actions and links users-professionals. Therefore, the searching for medicines, medical consultations and wish to be well served are trademarks of voices from the users that interconnect with enlightening information and guidelines offered by professionals to users. It brings out practices that need to incorporate the social, the subjective and act with practices of prevention and health promotion, on the basis of lifestyles. The dialogical model, which needs to be approached since planning phase of health education actions could arouse interest of involved groups; promoting a relationship of dialogue and listening; discussing the local reality; stimulating practical methodological dialetics; promoting processes of deconstruction of concepts, values and attitudes, as more necessary than construction, using multiple languages. The defended thesis denotes paths to other studies aimed at understanding a dialogical template committed to exchanges of knowledge, and discover strategies that encourage formation of critical consciousness and the discovery of how is the training of new generations of healthcare professionals to belong to the project of society, in its technical, scientific, pedagogical, ethical, political and humanistic dimensions

Produção pesqueira artesanal: diagnóstico ergonômico e bases para um planejamento nutricional situado e a promoção da saúde dos jangadeiros

The traditional fishing with rafts is characterized by unpredictability, high stakes and inadequate work conditions. The extensive working hours, physical wear, inadequate nutrition, unsanitary conditions, lack of salvage equipment and instruments suitable working, added by the presence of changes in the nutritional status of fisherman, that contribute to the picture of insecurity in high seas, injuries and health. This study aimed to analyze the activity of the fisherman s from Ponta Negra, Natal / RN, and check the conditions of supply of these fishermen and their implications on health and development of their work. To this finality, was used a methodology based on the ergonomic work analysis employing techniques such as observational and interactional conversational action, listening to the answers, observation protocols, photographic and video records. The script conversational dynamic action was developed from literature searches about the artisanal fisheries, culture and food habits of this population, and analyzes the overall situation of focus and two reference situations. To collect data on the usual diet of fisherman as well as quantitative and qualitative analysis that was used for data analysis and 24h recall the Food Frequency Questionnaire (FFQ). The impact of this power to the health of fisherman was evaluated performing a nutritional assessment. The results revealed that the fishermen carry out their activities with poor working conditions, health and nutrition. Feeding practices of these fishermen undertake development work, making it even more stressful, as well contributing to the emergence of Chronic Noncommunicable Diseases. The management of the activity, as well as the current structure of the vessel, also contributes to the adoption of inappropriate feeding practices during the shipment of catch. The results of this indicate the need for adequate interventions in order to assist in recovery and / or maintenance of health of fisherman minimizing reflections of nutritional disorders for the development activity by improving the quality of life in this population

Saúde bucal no programa de saude da família: o caso do distrito sanitário norte em Natal - RN

The inclusion of the dentist in the Family Health Program (FHP) teams designates a reorganization of the mouth health care in your country and establishes a new scenario in Brazilian odontology, through of a new way to organize the basic health care, creating conditions to consolidate in mouth health practice actions, in the level of the basic attention, the validation of Unique Health System (UHS) constitutional principles. The purpose of this research is to verify if the actuation of mouth health teams (MHT) dentists, in Natal city north sanitary district, is tuned with FHP goals.The target research population was composed by all dentists working in Basic Health Units (BHU) of Natal north sanitary district. Fifth-eight questionnaires were applied and using open and closed questions we look for identify the functional characteristics of each BHU, the dentists professional attributions on each BHU, as well as the clinical procedures that they execute. This research also searched to identify the factors that facilitate and/or difficult the inclusion process and the dentists activities performance on these BHUs, as well as the necessary actions to north sanitary district MHTs to fulfill the objectives proposed by FHP. The results point that the inclusion of mouth health actions in north sanitary district FHPs brought the incorporation of new values to the used practices. Whoever, its necessary a more frequent evaluation of the carried actions, in a way they can be adapted to the real community necessities, and, is fundamental the data accompaniment, for that these serve of base for planning and redirecting activities, in a way that we do not have only a reproduction of traditional practices, fragmented and isolated, but a truly substitution of the traditional practices and a new way of promoting health

Meio ambiente e planejamento: a relação cidade-natureza nos Planos Urbanísticos da cidade de Natal no século XX

This research studies the relation between city and nature in the urbanity s plans from Natal RN, Brazil, during the 20th century. Investigates and analyses the main documents that bring environmental s ideas inside from the urbanity s plans of Natal; gives the historical and economical situation from the city in each period studied; features the urbanity s plans, using categories of analyses to comprehension of this instruments. Try to contribute in the bigger process of historical rescue of Natal, and stimulates new studies. It was used documental s research, and bibliographic material. It was identified four (04) kinds of plans: the ones that focus in health and aesthetic (1901, 1929, 1935) technology and science (1968), zoning and control (1974, 1984) and environment. The hints founded shows that environmental ideas were put inside of the plans by government demands, especially in 1994 s plan, almost always without popular contribution and without this population get understands its meanings and implications

Contra as Secas: a engenharia e as origens de um planejamento regional no nordeste brasileiro

Droughts surfaced in 1877 as a crucial problem for the birthing Brazilian nation. Engineers, who formed the country's technical and scientific elite, took it upon themselves to study, understand and fight the problem through planned actions of intervention on space. This work, based on proposals and discussions contained in engineering magazines and reports, aims to provide elements for the comprehension of how these systematized actions against droughts, in the Iate nineteenth and early twentieth century, contributed to spatial analysis and the formation of a (then-inexistent) regional and territorial planning discipline in Brazi!. Engineers, by taking up the position of masterminds in the country's modernization, guaranteed for themselves personal economic stability, social prestige and political power. By understanding nature, either as a resource to be exploited or an adversary to national progress, they contributed to the delimitation of the region now known as the Northeast. By seeking to understand the drought phenomenon, they created knowledge about the space they sought to intervene on; by constructing their projects amid political and economical difficulty, they changed the organizational structures of cities and country in the northeast. The proposals for açudes (Iarge water reservoirs) allowed the fixation of population and the resistance against droughts; the roads - railroads and automotive roadways - connected the sertão to the capitais and the coast, speeding up help to the affected populations during droughts and allowing the circulation of goods so as to strengthen the local economies in normal rimes. The adopted practices and techniques, adapted from foreign experience and developed through trial and improvement, were consolidated as an eminently spatial intervention course, even if a theoretical body of regional or territorial planning wasn't formed in Brazil. Regional Planning proper was first applied in the country in the Northeast itself, in the 1950s, based off an economical view of reality in order to achieve development. The engineer's work prior tothat date, however, cannot be dlsconsldered. It was proved that, despite facing financial and political hurdles, engineers had a profound commitment to the problem and intended to act systematically to transform the economical and social relations in the region, in order to be victorious in their struggle against droughts

Sanitarismo e planejamento urbano: a trajetória das propostas urbanísticas para Natal entre 1935 e 1969

The Escritório Saturnino de Brito (Saturnino de Brito Office), created in 1920 under the sanitaristic guidance of the engineer Saturnino de Brito, has a vast record of works throughout the whole national territory, even after the death of its founder, in 1929 at which point his son, and also engineer, Saturnino de Brito Filho, assumed the head of the company , with a compromise to continue his father s work and assure his administrative, technical and urbanistic principles up until the early 1980s, when that institution came to an end. The scarcity of theorical studies about this Office, alongside the importance of the contributions it made in countless cities, oriented the focus of this study on its performance in Natal, where it remained from 1935 to 1969, designing, executing and managing sanitationist works and the services associated with them and going through several political, economical, social, cultural and urbanistic contexts periodicized in this work into three moments. Thus, it is intended to analyze how the Saturnino de Brito Office behaved and adapted itself to the conjunctural changes that unfolded into each of these moments, and more specifically, to observe the forms of intervention adopted the principles, the instruments and the scope aiming to verify the transition of the sanitaristic set of urbanistic ideas into the urban planning as a development strategy on a local level

Apitidão funcional e comportamentos relacionados à saúde em mulheres idosas do município de Jequié-BA

The identification of the factors that interfere in the decline of functional conditions is useful in the planning of actions addressing the improvement in the conditions of the lives of elderly people. The purpose of this investigation was to analyze the relationship between social demographics and health aspects of the functional condition in elderly women of low income of the Brazilian northeast. This crosssectional study involved a representative sample of 222 women with an average age of 70 years (± 7.1), belonging to coexisting groups and that were resident in the urban area of the municipal district of Jequié /Bahia. In order to achieve this objective, a battery of physical tests of functional aptitude was carried out previously tested in pilot study, anthropometric measurements collected with a comparison of the measures referred to the reported weight and height as well as the application of an interview with questions containing subjects related to social demographic variables, clinical conditions and health, physical conditions and behaviors. Descriptive statistics Proceedings (frequency, average, standard deviation and percent distribution) were used for statistic analysis, and the calculation of the respective odds ratio by binary logistics regression, for the analysis of factors hierarchically grouped; p<0.05. The prevalence of 56% (n=122) of women considered with moderated or serious type of functional limitations was found, In which from multi-varied hierarchical analysis, significant association was verified with the age group over 80 years (p=0.02), conditions of widowhood (p=0.04), presence of arterial hypertension (p=0.001), and physical inactivity during leisure time (p=0.03). On the other hand for functional incapacities the prevalence was of 46.8% (n=104) being associated to the increase of the age (p=0.01), hospitalization (p=0.02), absence of physical activities along their lives (p=0.001) and the occurrence of alterations in the cognitive function (p=0.001). The normative table for the parameters of physical fitness generated conducive to health professionals in the diagnosis of health conditions and the prescription of physical exercises. The identified characteristics that are associated with the functional limitations / functional incapacities suggest a complex causal net in the determination of the functional condition in elderly women. However, actions addressed to the incentive of the practice of physical activities in the leisure time and the preservation of the cognitive function can contribute to a life with more quality for these people. This research was multidisciplinary approach to involve elements of psychology, nutrition and Physical Education in the elucidation of the object of study related to the functional condition of elderly women

Saúde bucal de idosos institucionalizados no Brasil

O propósito dessa investigação foi o de estudar as situações objetivas e de auto-percepção em saúde bucal de idosos residentes em Instituições de Longa Permanência de Idosos (ILPIS) distribuídos em 11 municípios pertencentes as 5 regiões geográficas do Brasil. Metodologia: Trata-se de estudo seccional através de um censo com idosos institucionalizados no Brasil. Foram avaliados 1192 indivíduos, residentes em 36 Instituições de Longa Permanência de Idosos (ILPIS), distribuídas em 11 municípios. Deste universo, 587 (49,2%) responderam ao GOHAI. Foi aplicado questionário com questões subjetivas e sobre o comportamento em saúde bucal, além de levantamento epidemiológico seguindo critérios da Organização Mundial da Saúde (OMS). Foram realizados os testes de Mann-Whitney, Kruskal-Wallis, Exato de Fisher, Qui-quadrado e Regressão logística múltipla. Resultados: A idade média foi de 74,98 (+ 9,5). Destes, 51,4% (302) eram do sexo masculino e 152 (25,9) apresentavam alguma dependência. A média do CPOD foi de 28,8 (+ 5,5) e 54,5% (320) dos idosos eram edêntulos. Constatouse que 54,2% (318) e 74,1% (435) não usam nenhum tipo de prótese superior e inferior, respectivamente. O CPI e PIP mostraram que 64,4% (378) apresentaram todos os sextantes excluídos. O GOHAI mostrou que 75% (440) dos indivíduos apresentava auto-percepção positiva em saúde bucal. As variáveis última visita ao dentista (RP ajust=4,058; IC=1,526-10,789), presença de problemas gengivais (RP ajust=5,703; IC=1,754-18,544) e opinião sobre os dentes, as gengivas ou prótese (RP ajust=19,514; IC=5,075-75,041) permaneceram significativas no modelo após regressão logística múltipla. Conclusões: Observou-se predomínio da auto-percepção positiva em saúde bucal em detrimento das precárias condições bucais. Assim, para a população institucionalizada, o presente estudo recomenda a aplicação de levantamentos epidemiológicos e de auto-percepção para assegurar adequado planejamento nas ações de saúde bucal

Financiamento e gasto público em saúde: o caso do Rio Grande do Norte

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Qualidade de vida, funcionalidade e morbidade referida : avaliação em idosos na atenção básica de saúde

Demographic and epidemiological transformations have led to an increase in elderly populations in the world, and chronic diseases become the main health problem in this population, with consequences for the independence and autonomy, and interfering in the lifestyle and daily activities, and may decrease the welfare and quality of life. So, there is an urgent need for multidisciplinary research on the quality of life, understood as a multidimensional and subjective concept, as well as the associated factors, such as health habits, presence of chronic conditions and functional capacity. Thus, In qualitative terms, the Article 1 provides an assessment and perception of the elderly about their quality of life. Article 2, in turn, presents the results of more extensive quantitative research, which can be seen that age, presence of chronic diseases and depression were associated with the quality of life. Thus, we discuss the need for action was planning and health strategies, with interdisciplinary approach, considering the environmental context and reality of family elders, promoting quality in the process of aging

Avaliação do cuidado na estratégia saúde da família em metrópoles do nordeste brasileiro

Objective: To evaluate the implementation of the Family Health Strategy (FHS) in Brazilian cities of the Northeast, expanding coverage, analyzing the progress, challenges and innovations. Methods: Multicentric Evaluation Research, Studies Baselines in urban centers, using as a case study method. Selected cases of Aracaju, being capital, advanced coverage with extended team, and Fortaleza, capital coverage incipient and minimal staff. In Fortaleza, purposive sample of 11 Units Primary (APS), 03 managers, 53 professionals and 109 users. In Aracaju, 09 units of APS, 02 managers, 36 professionals, and 90 users. Structured interviews for managers, and structured to professionals and users. Descriptive analysis focusing on the political and institutional dimensions, organization and comprehensive care. Results: There was consensus that the ESF is the preferred port users and acts as inducing changes in care. In the case of Fortaleza, the specificities were: care protocols and community activities aimed at chronic conditions (100%) , with greater participation of doctors and nurses (93%) ; conjunction with more complex services, but the teams reported difficulties with the examination center and experts, the long waits and poor access to local services were the main difficulties reported by users., As innovative practice, the therapeutic group of elderly caregivers mentioned by respondents; There was intersectoral initiatives and teams 87 % of users have participated in meetings about health problems. In the case of Aracaju, care protocols were directed to the lines of care and formulated locally, 85 % coverage of the population with FHS counterpart local financing; employees hired by public tender; 70 % of teams with expertise in public health center for continuing education acting; democratization in management; access technologies, welcoming and computerization in different integrated networks, and evaluation matrix. Conclusions: The ESF has promoted access to health care and inclusion of disadvantaged populations. Different perceptions and practices in the organization of care, with distinct trajectories of reorganization. In the case of Fortaleza, predominance of model programs valuing older, with evidence of advances in care practices and teamwork, but restricted to primary care practices and incipient in public policy perspective. In Aracaju, had network integration with technologies related to the family, in which the ESF is consolidated as public policy. It can be argued that the XII APS expanding coverage, exhibited efficacy, despite the challenges inherent to the different degrees of implementation