Implementation of integrative and complementary practices in primary health care: an evaluation study
DOI:
https://doi.org/10.29352/mill0228.43037Keywords:
Keywords: health evaluation; primary health care; complementary therapies; integrative medicineAbstract
Introduction: The World Health Organization recommends the implementation of Integrative and Complementary Health Practices in primary health care, and in Brazil, 29 modalities are available at this level of care.
Objective: To evaluate the degree of implementation of Integrative and Complementary Health Practices in Primary Health Care in Minas Gerais, Brazil.
Methods: Evaluation research, type 1-b: implementation analysis. The study was divided into three stages: elaboration and validation of the logical model and the analysis and judgment matrix; and evaluation of the implementation of Integrative and Complementary Health Practices in Primary Health Care in Minas Gerais through a cross-sectional study using 2018 secondary data.
Results: Of the 846 municipalities in Minas Gerais that participated in the study, most have not implemented Integrative and Complementary Health Practices (59,5%), and only two municipalities achieved adequate implementation. An association was observed between the variables: Primary Health Care coverage, Human Development Index, and population size with the degree of implementation of Integrative and Complementary Health Practices.
Conclusion: The verified degree of implementation denotes the need for professional training, availability of supplies and materials, provision of Integrative and Complementary Health Practices, health education and promotion actions, service organization, and management support as a way to contribute to implementation in the municipalities.
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Amado, D. M., Rocha, P. R. S., Ugarte, A. O., Ferraz, C. C., Lima, M. C., & Carvalho, F. F. B. (2018). Política Nacional de Práticas Integrativas e Complementares no Sistema Único de Saúde 10 anos: Avanços e perspectivas. Journal of Management & Primary Health Care, 8(2), 290–308. https://doi.org/10.14295/jmphc.v8i2.537
Antunes, P. C., & Fraga, A. B. (2021). Integrative mind-body practices: Concept proposal for the field of traditional and complementary medicine. Ciência & Saúde Coletiva, 26(9), 4217–4232. https://doi.org/10.1590/1413-81232021269.14082020
Barbosa, F. E. S., Guimarães, M. B. L., Santos, C. R., Bezerra, A. F. B., Tesser, C. D., & Sousa, I. M. C. (2020). Oferta de práticas integrativas e complementares em saúde na Estratégia Saúde da Família no Brasil. Cadernos de Saúde Pública, 36(1), 1–13. https://doi.org/10.1590/0102-311x00208818
Barros, L. C. N., Oliveira, E. S. F., Hallais, J. A. S., Teixeira, R. A. G., & Barros, N. F. (2020). Integrative and complementary practices in primary health care: Perceptions of service managers. Escola Anna Nery, 24(2), 1–8. http://dx.doi.org/10.1590/2177-9465-EAN-2019-0081
Basu, P., Tripathi, R., Mehrotra, R., Ray, K., Srivastava, A., & Srivastava, A. (2021). Role of integrative medicine in the continuum of care of breast cancer patients in the Indian context. Cancer Causes & Control, 32, 429–440. https://doi.org/10.1007/s10552-021-01399-0
Boccolini, P. M. M., Boclin, K. L. S., Sousa, I. M. C., & Boccolini, C. S. (2022). Prevalence of complementary and alternative medicine use in Brazil: Results of the National Health Survey, 2019. BMC Complementary Medicine and Therapies, 22(1), 1–11. https://doi.org/10.1186/s12906-022-03687-x
Ministério da Saúde. (2006a). Portaria nº 971, de 3 de maio de 2006. Aprova a Política Nacional de Práticas Integrativas e Complementares (PNPIC) no SUS. Diário Oficial da União. http://www.crbm1.gov.br/Portaria%20MS%20971%202006.pdf
Ministério da Saúde. (2006b). Portaria nº 1.600, de 17 de julho de 2006: Constituição do Observatório Aprova a constituição do Observatório de Medicina Antroposófica no SUS. Diário Oficial da União. https://encurtador.com.br/riRJ
Ministério da Saúde. (2015). Portaria nº 1.645, de 2 de outubro de 2015: PMAQ-AB. Diário Oficial da União. https://encurtador.com.br/GoBk
Ministério da Saúde. (2017a). PMAQ: Instrumento de avaliação externa. https://encurtador.com.br/oSYd
Ministério da Saúde. (2017b). Autoavaliação para Melhoria do Acesso e da Qualidade da Atenção Básica. https://encurtador.com.br/rYEN
Ministério da Saúde. (2017c). Portaria nº 849, de 27 de março de 2017: Inclusão de novas práticas na PNPIC. Diário Oficial da União. https://encurtador.com.br/FCyT
Ministério da Saúde. (2018a). Manual de implantação de serviços de práticas integrativas e complementares no SUS. https://encurtador.com.br/KvgT
Ministério da Saúde. (2018b). Retratos da Atenção Primária à Saúde. https://retratos.navi.ifrn.edu.br/#cards-category
Ministério da Saúde. (2018c). Portaria nº 702, de 21 de março de 2018. Diário Oficial da União. https://encurtador.com.br/PWCS
Ministério da Saúde. (2021). Portal e-Gestor AB. https://encurtador.com.br/ZOIc
Champagne, F., Brousselle, A., Hartz, Z., Contandriopoulos, A. P., Denis, J. L., & Brouselle, A. (2016). A avaliação no campo da saúde: Conceitos e métodos. In A. Brousselle et al. (Orgs.), Avaliação: Conceitos e métodos (pp. 41–60). Editora Fiocruz. https://www.redalyc.org/pdf/630/63023349030.pdf
Chen, Y. L., Hou, M. C., Lin, S. C., & Tung, Y. J. (2015). Educational efficacy of objective structured clinical examination on clinical training of traditional Chinese medicine: A qualitative study. Complementary Therapies in Clinical Practice, 21(3), 147–153. https://doi.org/10.1016/j.ctcp.2015.06.002
Chung, V. C. H., Ho, F. F., Lao, L., Liu, J., Lee, M. S., Chan, K. W., & Nilsen, P. (2023). Implementation science in traditional, complementary and integrative medicine. Phytomedicine, 109(1), 1–9. https://doi.org/10.1016/j.phymed.2022.154591
Donabedian, A. (1966). Evaluating the quality of medical care. Milbank Memorial Fund Quarterly, 44, 166–203.
Ee, C., Templeman, K., Grant, S., Avard, N., Manincor, M., & Hunter, J. (2020). Informing the model of care for an academic integrative health care center: A qualitative study of primary care stakeholder views. The Journal of Alternative and Complementary Medicine, 26(4), 300–315. https://doi.org/10.1186/s12906-019-2801-4
Fonseca, E. P., Cruz, A. J. S., Pereira-Junior, E. A., Palmier, A. C., & Abreu, M. H. N. G. (2024). The role of socioeconomic and health services organizational factors on infection control structure score, Brazil. Ciência & Saúde Coletiva, 29(1), 1–9. https://doi.org/10.1590/1413-81232024291.19572022
Garcia-Cerde, R., de Medeiros, P.F.P., Silva, L.F., Valente, J.Y., Andreoni, S., Sanchez, Z.M., et al. (2023). Use of integrative and complementary health practices by Brazilian population: results from the 2019 National Health Survey. BMC Public Health, 23, 1153. https://doi.org/10.1186/s12889-023-16083-y
Guimarães, E. A. A., Hartz, Z. M. A., Filho, A. I. L., Meira, A. J., & Luz, Z. M. P. (2013). Avaliação da implantação do Sistema de Informação sobre Nascidos Vivos em municípios de Minas Gerais, Brasil. Cadernos de Saúde Pública, 29(10), 2105–2118. https://doi.org/10.1590/0102-311X00116312
Hansen, K. A., Walsh, E. G., & Price, C. (2021). A call to action: Adoption of trauma informed care in complementary and integrative health services. The Journal of Alternative and Complementary Medicine, 27(2), 103–107. https://doi.org/10.1089/acm.2021.0018
Harasim, A. S., Krone, M., Tony, H.-P., Gawlik, M., Witte, T., Joos, S., et al. (2021). Use of complementary and alternative medicine in patients with primary immunodeficiency: A multicentric analysis of 101 patients. Journal of Clinical Immunology, 41(1), 585–594. https://doi.org/10.1007/s10875-020-00955-8
Instituto Brasileiro de Geografia e Estatística. (2010a). Índice de Desenvolvimento Humano – Minas Gerais. https://cidades.ibge.gov.br/brasil/mg/pesquisa/37/30255
Instituto Brasileiro de Geografia e Estatística. (2010b). Panorama: População – Minas Gerais. https://cidades.ibge.gov.br/brasil/mg/panorama
Losso, L. N., & Freitas, S. F. T. (2017). Avaliação do grau da implantação das práticas integrativas e complementares na atenção básica em Santa Catarina, Brasil. Saúde em Debate, 41(3), 171–187. https://doi.org/10.1590/0103-11042017s313
Lucas, A. S., Fagundes, M. L. B., Júnior, O. L. A., Menegazzo, G. R., & Giordani, J. M. A. (2022). Association between integrative and complementary health practices and use of dental services among older adults in Brazil: A cross-sectional study, 2019. Epidemiologia e Serviços de Saúde, 31(3), 1–10. https://doi.org/10.1590/S2237-96222022000300007
Macena, A., & Oliveira, V. E. (2022). Discretion and local health policy implementation: Street-level bureaucrats and integrative and complementary therapies in Santos’ local health units. Primary Health Care Research & Development, 23(34), 1–9. https://doi.org/10.1017/S1463423622000172
McIntyre, E., Oorschot, T., Steel, A., Leach, M. J., Adams, J., & Harnett, J. (2021). Conventional and complementary health care use and out-of-pocket expenses among Australians with a self-reported mental health diagnosis: A cross-sectional survey. BMC Health Services Research, 21(1), 1–19. https://doi.org/10.1186/s12913-021-07162-0
Medeiros, A., Amorim, M. M. A., & Lanza, F. M. (2025). Integrative and Complementary Practices in the Unique Health System: Implementation, advances and challenges. Medicina (Ribeirão Preto), 58(2), e-210651. https://doi.org/10.11606/issn.2176-7262.rmrp.2025.210651
Medeiros, A., & Lanza, F. (2025). Evaluative matrix of the implementation of Integrative and Complementary Health Practices in Primary Health Care services. Zenodo. https://doi.org/10.5281/zenodo.17063682
Melo, A. V. de., Sant’Ana, G. R. de., & Bastos, P. R. H. de O. (2022). Redes, atores e agenciamentos na constituição da Política de Práticas Integrativas e Complementares no Brasil. Ciência & Saúde Coletiva, 27(6), 2397–2406. https://doi.org/10.1590/1413-81232022276.16442021
Minas Gerais. Secretaria do Estado de Saúde. (2020). Ajuste do Plano Diretor de Regionalização de Saúde de Minas Gerais (PDR/MG). SES-MG.
Padilha, A., Massuda, A., Leônidas, F., & Davidian, A. (2025). Thirty-five years of Brazil’s Unified Health System (SUS): From Alma-Ata to the climate challenge. The Lancet Regional Health - Americas, 51, 101295. https://doi.org/10.1016/j.lana.2025. 101295
Pereira, E. C., Rocha, M. P., Fogaça, L. Z., & Schveitzer, M. C. (2022). Occupational health, integrative and complementary practices in primary care, and the COVID-19 pandemic. Revista da Escola de Enfermagem da USP, 56, e20210362. https://doi.org/10.1590/1980-220X-REEUSP-2021-0362
Santos, M. C., & Tesser, C. D. (2012). Um método para a implantação e promoção de acesso às práticas integrativas e complementares na atenção primária à saúde. Ciência & Saúde Coletiva, 17(11), 3011–3024. https://doi.org/10.1590/S1413-81232012001100018
Schwartz, M. R., Cole, A. M., Keppel, G. A., Gilles, R., Holmes, J., & Price, C. (2021). Complementary and integrative health knowledge and practice in primary care settings: A survey of primary care providers in the Northwestern United States. Global Advances in Health and Medicine, 10, 1–9. https://doi.org/10.1177/21649561211023377
Seifert, G., Jeitler, M., Stange, R., Michalsen, A., Cramer, H., Brinkhaus, B., et al. (2020). The relevance of complementary and integrative medicine in the COVID-19 pandemic: A qualitative review of the literature. Frontiers in Medicine, 7, 1-14. https://doi.org/10.3389/fmed.2020.587749
Silva, B. S., Guimarães, E. A. A., Oliveira, V. C., Cavalcante, R. B., Pinheiro, M. M. K., & Gontijo, T. L., et al. (2020). National immunization program information system: Implementation context assessment. BMC Health Services Research, 20(333), 1–10. https://doi.org/10.1186/s12913-020-05175-9
Silva, P. H. B., Barros, L. C. N., Barros, N. F., Teixeira, R. A. G., & Oliveira, E. S. F. (2021). Professional training in integrative and complementary practices: The meanings attributed by primary health care workers. Ciência & Saúde Coletiva, 26(2), 399–408. https://doi.org/10.1590/1413-81232021262.40732020
Silva, T. C., Nascimento, L. C., Silva, B. M., Tafner, D. P. O. V., Potrich, T., & Viegas, S. M. F. (2022). Technosociality in the COVID-19 pandemic and health promotion for users and families: A scoping review. Revista de Enfermagem da UFSM, 12(16), 1–23. https://doi.org/10.5902/2179769267246
Sousa, A. N. A., & Shimizu, H. E. (2021). Integrality and comprehensiveness of service provision in primary health care in Brazil (2012–2018). Revista Brasileira de Enfermagem, 74(2), 1–9. https://doi.org/10.1590/0034-7167-2020-0500
Sumiya, A., Santos, K. E., Machuca, L., Tavares, L. R., Marcos, V. M., Farhat, G., et al. (2022). Spatial distribution of integrative and complementary health practices in primary health care in Brazil. Revista Brasileira em Promoção da Saúde, 35(10), 1–10. https://doi.org/10.5020/18061230.2022.11945
Tesser, C. D., & Sousa, I. M. C. (2012). Atenção primária, atenção psicossocial, práticas integrativas e complementares e suas afinidades eletivas. Saúde e Sociedade, 21(2), 336–350. https://doi.org/10.1590/S0104-12902012000200008
Vitorino, S. A. S., Cruz, M. M., & Barros, D. C. (2017). Validação do modelo lógico teórico da vigilância alimentar e nutricional na atenção primária em saúde. Cadernos de Saúde Pública, 33(12), 1–23. https://doi.org/10.1590/0102-311X00014217
Zeliadt, S. B., Coggeshall, S., Gelman, H., Shin, M. H., Elwy, R., Bokhour, & B. G., Taylor, S.L. (2020). Assessing the relative effectiveness of combining self-care with practitioner-delivered complementary and integrative health therapies to improve pain in a pragmatic trial. Pain Medicine, 21(2), 100–109. https://doi.org/10.1093/pm/pnaa349
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