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Gautier S, Josseran L. How Primary Healthcare Sector is Organized at the Territorial Level in France? A Typology of Territorial Structuring. Int J Health Policy Manag 2024; 13:8231. [PMID: 39099503 PMCID: PMC11270609 DOI: 10.34172/ijhpm.2024.8231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 05/07/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Most the Organization for Economic Co-operation and Development (OECD) countries are currently facing the challenges of the health transition, the aging of their populations and the increase in chronic diseases. Effective and comprehensive primary healthcare (PHC) services are considered essential for establishing an equitable, and cost-effective healthcare system. Developing care coordination and, on a broader scale, care integration, is a guarantee of quality healthcare delivery. The development of healthcare systems at the meso-level supports this ambition and results in a process of territorial structuring of PHC. In France, the Health Territorial and Professional Communities (HTPC) constitute meso-level organizations in which healthcare professionals (HCPs) from the same territory gather. We conducted a study to determine, in a qualitative step, the key elements of the territorial structuring of PHC in France and, then, to develop, in a quantitative step, a typology of this structuring. METHODS A sequential-exploratory mixed-method study with a qualitative step using a multiple case approach and a quantitative step as a hierarchical clustering on principal components (HCPC) from a multiple correspondence analysis (MCA). RESULTS A total of 7 territories were qualitatively explored. Territorial structuring appears to depend on: past collaborations at the micro-level, meso-level coordination among HCPs and multiprofessional structures, diversity of independent professionals, demographic dynamics attracting young professionals, and public health investment through local health contracts (LHCs). The typology identifies 4 clusters of mainland French territories based on their level of structuring: under or unstructured (38.6%), with potential for structuring (34.7%), in the way for structuring (25.3%) and already structured territories (1.4%). CONCLUSION Interest in territorial structuring aligns with challenges in meso-level healthcare organization and the need for integrated care. Typologies of territorial structuring should be used to understand its impact on access, care quality, and medical resources.
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Affiliation(s)
- Sylvain Gautier
- Research Center in Epidemiology and Population Health, Primary Care and Prevention Team, Inserm U1018, Université Paris-Saclay, UVSQ, Villejuif, France
- Department of Hospital Epidemiology and Public Health, Raymond Poincaré Hospital, GHU Université Paris-Saclay, AP-HP, Garches, France
| | - Loïc Josseran
- Research Center in Epidemiology and Population Health, Primary Care and Prevention Team, Inserm U1018, Université Paris-Saclay, UVSQ, Villejuif, France
- Department of Hospital Epidemiology and Public Health, Raymond Poincaré Hospital, GHU Université Paris-Saclay, AP-HP, Garches, France
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Souza JS, Reis EA, Godman B, Campbell SM, Meyer JC, Sena LWP, Godói IPD. Users' Perceptions of Access to and Quality of Unified Health System Services in Brazil: A Cross-Sectional Study and Implications to Healthcare Management Challenges. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:721. [PMID: 38928967 PMCID: PMC11204194 DOI: 10.3390/ijerph21060721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024]
Abstract
Evaluating the access to and quality of healthcare services from the users' perspective is an important assessment process to identify priorities. This study assessed the profile of health service usage and the views of the Unified Health System (SUS) users about the access to and quality of SUS public health services. A cross-sectional study was conducted with participants from the Coastal Lowlands Region of the Rio de Janeiro State/Brazil, between August and November 2023. The association between categorical variables was analyzed using the Pearson Chi-Square test, using R software 4.3. A total of 200 individuals were interviewed using a 66-question survey instrument. Participants who reported using SUS services more frequently rated this system as essential (p-value = 0.031). However, overall, 64% of participants rated the quality of care to be very bad/bad and 34.9% rated access as very bad/bad. Access was considered poor by respondents who used public services rarely or sometimes (p-value = 0.002). In terms of accessing SUS services consultations provided by specialists (e.g., neurologists), these were available only in another municipality (p-value = 0.001). Many participants were SUS dependent for health services, and gaps and weaknesses were observed regarding users' perspectives of the access to and quality of SUS health care. Policymakers should prioritize evaluations and dialogue with the community to make SUS services responsive and to optimize value-for-money in health service planning.
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Affiliation(s)
- Jhoyce S. Souza
- Institute of Pharmaceutical Sciences, Federal University of Rio de Janeiro, Avenida Aluízio da Silva Gomes 50—Granja dos Cavaleiros, Macaé 27930-560, RJ, Brazil;
| | - Edna A. Reis
- Department of Statistics, Exact Sciences Institute, Federal University of Minas Gerais, Campus Pampulha, Avenida Antônio Carlos 6627, Belo Horizonte 31270-901, MG, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Department of Public Health and Pharmacy Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa; (S.M.C.); (J.C.M.)
| | - Stephen M. Campbell
- Department of Public Health and Pharmacy Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa; (S.M.C.); (J.C.M.)
- School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Johanna C. Meyer
- Department of Public Health and Pharmacy Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa; (S.M.C.); (J.C.M.)
| | - Luann W. P. Sena
- College of Public Health, Institute of Health and Biological Studies, Federal University of South and Southeast of Pará, Avenida dos Ipês, s/n, Cidade Universitária, Loteamento Cidade Jardim, Marabá 68508-970, PA, Brazil;
| | - Isabella P. D. Godói
- Institute of Pharmaceutical Sciences, Federal University of Rio de Janeiro, Avenida Aluízio da Silva Gomes 50—Granja dos Cavaleiros, Macaé 27930-560, RJ, Brazil;
- Health Technology Assessment Center—Management, Economics, Health Education and Pharmaceutical Services (GEESFAR/NATS/UFRJ), Federal University of Rio de Janeiro, Avenida Aluízio da Silva Gomes 50—Granja dos Cavaleiros, Macaé 27930-560, RJ, Brazil
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Genova A, Lombardini S. General practitioners in front of COVID-19: Italy in European comparative perspective. FRONTIERS IN SOCIOLOGY 2024; 9:1365517. [PMID: 38846342 PMCID: PMC11153776 DOI: 10.3389/fsoc.2024.1365517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/30/2024] [Indexed: 06/09/2024]
Abstract
COVID-19 has highlighted strengths and weaknesses in healthcare systems all over the word. Despite the differences in primary care models in Europe, this study investigates the state-of-the-art of general practitioners (GPs) before the COVID-19 pandemic spread as a result of the reform process of the previous two decades. The GPs numbers over 100,000 inhabitants has been considered as a proxy of public health investment in GPs. Is the number of GPs increased or decreased in the last 20 years of reform processes in European countries? The main hypothesis is that European healthcare systems would have increased the number of GPs coherently with WHO recommendations. Comparative data on the number of GPs per 100,000 inhabitants in 21 European countries are investigated between 1995 and 2014 (the last available data). Data show that the number of family doctors over 100,000 inhabitants in European countries has increased over the last 20 years, except for Italy, where it has strongly reduced. Primary care has had a crucial role in managing the pandemic. Results of this study suggest that a country such as Italy, which has not invested in family doctors in the last two decades, would have been less equipped to manage the COVID-19 pandemic.
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Affiliation(s)
- Angela Genova
- Department of Economics, Society, Politics, University of Urbino, Urbino, Italy
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Ashcroft R, Menear M, Dahrouge S, Silveira J, Emode M, Booton J, Bahniwal R, Sheffield P, McKenzie K. Nurturing an organizational context that supports team-based primary mental health care: A grounded theory study. PLoS One 2024; 19:e0301796. [PMID: 38687719 PMCID: PMC11060570 DOI: 10.1371/journal.pone.0301796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/23/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND The expansion of the Patient-Centred Medical Home model presents a valuable opportunity to enhance the integration of team-based mental health services in primary care settings, thereby meeting the growing demand for such services. Understanding the organizational context of a Patient-Centred Medical Home is crucial for identifying the facilitators and barriers to integrating mental health care within primary care. The main objective of this paper is to present the findings related to the following research question: "What organizational features shape Family Health Teams' capacity to provide mental health services for depression and anxiety across Ontario, Canada?" METHODS Adopting a constructivist grounded theory approach, we conducted interviews with various mental health care providers, and administrators within Ontario's Family Health Teams, in addition to engaging provincial policy informants and community stakeholders. Data analysis involved a team-based approach, including code comparison and labelling, with a dedicated data analysis subcommittee convening monthly to explore coded concepts influencing contextual factors. RESULTS From the 96 interviews conducted, involving 82 participants, key insights emerged on the organizational contextual features considered vital in facilitating team-based mental health care in primary care settings. Five prominent themes were identified: i) mental health explicit in the organizational vision, ii) leadership driving mental health care, iii) developing a mature and stable team, iv) adequate physical space that facilitates team interaction, and v) electronic medical records to facilitate team communication. CONCLUSIONS This study underscores the often-neglected organizational elements that influence primary care teams' capacity to deliver quality mental health care services. It highlights the significance of strong leadership complemented by effective communication and collaboration within teams to enhance their ability to provide mental health care. Strengthening relationships within primary care teams lies at the core of effective healthcare delivery and should be leveraged to improve the integration of mental health care.
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Affiliation(s)
- Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Menear
- Faculty of Medicine, Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
| | - Simone Dahrouge
- Faculty of Medicine, Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jose Silveira
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Monica Emode
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jocelyn Booton
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Peter Sheffield
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Kwame McKenzie
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Wellesley Institute, Toronto, Ontario, Canada
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Piotrowski A, Coenen J, Rupietta C, Basten J, Muth C, Söling S, Zimmer V, Karbach U, Kellermann-Mühlhoff P, Köberlein-Neu J. Factors facilitating the implementation of a clinical decision support system in primary care practices: a fuzzy set qualitative comparative analysis. BMC Health Serv Res 2023; 23:1161. [PMID: 37884934 PMCID: PMC10605331 DOI: 10.1186/s12913-023-10156-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Understanding how to implement innovations in primary care practices is key to improve primary health care. Aiming to contribute to this understanding, we investigate the implementation of a clinical decision support system (CDSS) as part of the innovation fund project AdAM (01NVF16006). Originating from complexity theory, the practice change and development model (PCD) proposes several interdependent factors that enable organizational-level change and thus accounts for the complex settings of primary care practices. Leveraging the PCD, we seek to answer the following research questions: Which combinations of internal and external factors based on the PCD contribute to successful implementation in primary care practices? Given these results, how can implementation in the primary care setting be improved? METHODS We analyzed the joint contributions of internal and external factors on implementation success using qualitative comparative analysis (QCA). QCA is a set-theoretic approach that allows to identify configurations of multiple factors that lead to one outcome (here: successful implementation of a CDSS in primary care practices). Using survey data, we conducted our analysis based on a sample of 224 primary care practices. RESULTS We identified two configurations of internal and external factors that likewise enable successful implementation. The first configuration enables implementation based on a combination of Strong Inside Motivation, High Capability for Development, and Strong Outside Motivation; the second configuration based on a combination of Strong Inside Motivators, Many Options for Development and the absence of High Capability for Development. CONCLUSION In line with the PCD, our results demonstrate the importance of the combination of internal and external factors for implementation outcomes. Moreover, the two identified configurations show that different ways exist to achieve successful implementation in primary care practices. TRIAL REGISTRATION AdAM was registered on ClinicalTrials.gov ( NCT03430336 ) on February 6, 2018.
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Affiliation(s)
- Alexandra Piotrowski
- Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal, Germany.
- Chair of General Practice II and Patient-Centeredness in Primary Care, Institute of General Practice and Primary Care, Faculty of Health, Witten/Herdecke University, Witten, Germany.
| | - Jana Coenen
- Jackstädt Center of Entrepreneurship and Innovation Research, University of Wuppertal, Wuppertal, Germany
| | - Christian Rupietta
- Jackstädt Center of Entrepreneurship and Innovation Research, University of Wuppertal, Wuppertal, Germany
- Queen's Business School, Queen's University Belfast, Belfast, UK
| | - Jale Basten
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Bochum, Germany
| | - Christiane Muth
- Department of General Practice and Family Medicine, Medical School OWL, Bielefeld University, Bielefeld, Germany
| | - Sara Söling
- Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal, Germany
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Department of Rehabilitation and Special Education, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Viola Zimmer
- Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal, Germany
| | - Ute Karbach
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Department of Rehabilitation and Special Education, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | | | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal, Germany
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Cui C, Lv B, Meng K. Associations Among Organizational Capabilities, Organizational Performance and the Medical Alliance Implementation Effect in Community Health Centers in China: A Moderated Mediation Model. Risk Manag Healthc Policy 2023; 16:1969-1983. [PMID: 37790984 PMCID: PMC10543936 DOI: 10.2147/rmhp.s425782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/13/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose Community health centers (CHCs) are an important part of the healthcare system worldwide. Based on the dual process model of organizational capabilities, this study explores the relationship between organizational capabilities and the organizational performance of CHCs, as well as the role played by the medical alliance implementation effect. Methods In this study, whole-group sampling was used to extract CHCs. All 135 CHCs in 8 of 16 districts of Beijing were selected as subjects. The organizational capabilities of the CHCs and the medical alliance implementation effect were evaluated using a questionnaire survey of 1957 managers and 3622 medical staff, respectively. A pathway analysis of the mediating role of the organizational capabilities of CHCs and the moderating role of the medical alliance implementation effect was conducted using Mplus 8.0. Results The development capabilities had a positive impact on basic capabilities (β = 0.878, P < 0.001), and core capabilities (β = 0.952, P < 0.001), but had no direct impact on organizational performance. Basic capabilities positively affected organizational performance (β = 1.163, P < 0.001), and core capabilities negatively affected organizational performance (β =- 0.886, P = 0.004). Both basic capabilities (β =1.022, P < 0.001) and core capabilities (β =- 0.843, P = 0.005) played a mediating role in the relationship between development capabilities and organizational performance. The moderating role of the medical alliance implementation effect was not significant. Conclusion This study found that strengthening the organizational capabilities of CHCs can effectively improve their performance, with the development of basic capabilities being a primary concern. The medical alliance implementation effect has not had a significant impact on organizational performance, and the cooperation between CHCs and high-level hospitals should be further promoted to give full play to the medical alliance's role and improve the organizational performance of CHCs.
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Affiliation(s)
- Chengsen Cui
- School of Public Health, Capital Medical University, Beijing, People’s Republic of China
- China Center for Health Development Studies, Peking University, Beijing, People’s Republic of China
| | - Bo Lv
- School of Public Health, Capital Medical University, Beijing, People’s Republic of China
| | - Kai Meng
- School of Public Health, Capital Medical University, Beijing, People’s Republic of China
- High Quality Development Research Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
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Burtin A, Clet E, Stevens N, Kervran C, Frevol M, Ratel R, Moysan P, Alla F. Factors associated with the implementation of the 5As model of smoking cessation support during pregnancy: A scoping review. Tob Induc Dis 2023; 21:110. [PMID: 37654503 PMCID: PMC10467347 DOI: 10.18332/tid/169623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/03/2023] [Accepted: 07/14/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION The prevalence of smoking among pregnant women is the highest in the European region, making smoking cessation a public health priority. In order to address this, pregnant smokers need to be better supported by their healthcare professionals in their attempts to quit smoking. The 5As model, which is a psychosocial intervention, seems to be effective in this specific population. The objective of this review is to identify the factors that act as barriers or facilitators to the implementation of the 5As model within prenatal practices. METHODS We conducted a scoping review of the literature on PubMed and Scopus databases, using the terms: 'smoking cessation', 'pregnan*', and ('5A' or '5As'). The identified factors were categorized using a theoretical framework of The European Observatory on Health Systems and Policies. RESULTS Among the 43 articles identified in the databases, 13 articles were included in this review. In total, we identified 48 factors. When necessary, we grouped them together, resulting in 12 sub-categories, which in turn were grouped into 9 categories. Those 9 categories were then classified into the 3 levels of the theoretical framework: the clinical level (motivation), the organizational level (healthcare pathway), and the health system level (political environment). CONCLUSIONS The factors identified are varied and numerous and are involved in each level of the theoretical framework.
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Affiliation(s)
- Adrianna Burtin
- Department of Methodology and Innovation in Prevention, Bordeaux University Hospital, Bordeaux, France
- Inserm UMR 1219-Bordeaux Population Health, University of Bordeaux, Bordeaux, France
| | - Estelle Clet
- Department of Methodology and Innovation in Prevention, Bordeaux University Hospital, Bordeaux, France
- Inserm UMR 1219-Bordeaux Population Health, University of Bordeaux, Bordeaux, France
| | - Nolwenn Stevens
- Inserm UMR 1219-Bordeaux Population Health, University of Bordeaux, Bordeaux, France
| | - Charlotte Kervran
- Inserm UMR 1219-Bordeaux Population Health, University of Bordeaux, Bordeaux, France
| | - Manon Frevol
- Department of Methodology and Innovation in Prevention, Bordeaux University Hospital, Bordeaux, France
| | - Rébecca Ratel
- Department of Methodology and Innovation in Prevention, Bordeaux University Hospital, Bordeaux, France
- Inserm UMR 1219-Bordeaux Population Health, University of Bordeaux, Bordeaux, France
| | - Perrine Moysan
- Inserm UMR 1219-Bordeaux Population Health, University of Bordeaux, Bordeaux, France
| | - François Alla
- Department of Methodology and Innovation in Prevention, Bordeaux University Hospital, Bordeaux, France
- Inserm UMR 1219-Bordeaux Population Health, University of Bordeaux, Bordeaux, France
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Al Janabi T. Barriers to the Utilization of Primary Health Centers (PHCs) in Iraq. EPIDEMIOLOGIA 2023; 4:121-133. [PMID: 37092458 PMCID: PMC10123605 DOI: 10.3390/epidemiologia4020013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 04/25/2023] Open
Abstract
Primary care has been viewed as a means to ensure equitable access to care, enhance efficiency within healthcare systems, and improve health service quality. In recent decades, Iraq has transformed its compromised health system, shifting the healthcare model from hospital-based to primary care through primary health centers (PHCs) and referral mechanisms. Based on an extensive literature review, this qualitative paper explores the healthcare utilization of PHCs in different regions of Iraq. It also identifies some barriers to PHC use and recommends evidence-based approaches for improving PHCs' performance. Some reported challenges to better utilizing PHCs were the poor quality of services, patient dissatisfaction, long walking distance to a health center, and limited availability and affordability of the medications. If Iraq is to use primary care as a tool in achieving sustainable development goals (SDGs), collaborative efforts addressing the facility-related factors should be a priority.
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Affiliation(s)
- Taysir Al Janabi
- New York Institute of Technology College of Osteopathic Medicine (NYITCOM), Glen Head, NY 11545, USA
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Barros RDD, Aquino R, Souza LEPF. Evolução da estrutura e resultados da Atenção Primária à Saúde no Brasil entre 2008 e 2019. CIENCIA & SAUDE COLETIVA 2022; 27:4289-4301. [DOI: 10.1590/1413-812320222711.02272022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/01/2022] [Indexed: 05/31/2023] Open
Abstract
Resumo Descreve a evolução da estrutura e resultados da Atenção Primária à Saúde (APS) no Brasil, entre 2008 e 2019. Foram calculadas a mediana de variáveis como: despesa per capita em APS por habitante coberto, cobertura da APS e as taxas de mortalidade e internações por condições sensíveis à atenção primária (CSAP) de 5.565 municípios brasileiros estratificados segundo porte populacional e quintil do Índice Brasileiro de Privação (IBP) e analisada a tendência mediana no período. Houve aumento de 12% na mediana da despesa em APS. A cobertura da APS expandiu, sendo que 3.168 municípios apresentaram 100% de cobertura em 2019, contra 2.632 em 2008. A mediana das taxas de mortalidade e internações por CSAP aumentou 0,2% e diminuiu 44,9% respectivamente. A despesa em APS foi menor nos municípios com maior privação socioeconômica. Quanto maior o porte populacional e melhores as condições socioeconômicas dos municípios, menor a cobertura da APS. Quanto maior a privação socioeconômica dos municípios, maiores foram as medianas das taxas de mortalidade por CSAP. Este estudo demonstrou que a evolução da APS foi heterogênea e está associada tanto ao porte populacional como às condições socioeconômicas dos municípios.
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Barros RDD, Aquino R, Souza LEPF. Evolution of the structure and results of Primary Health Care in Brazil between 2008 and 2019. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-812320222711.02272022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract This paper describes the structure and results of Primary Health Care (PHC) in Brazil between 2008 and 2019. The medians of the following variables were calculated: PHC spending per inhabitant covered, PHC coverage, and rates of mortality and hospitalizations due to primary care sensitive conditions (PCSC), in 5,565 Brazilian municipalities stratified according to population size and quintile of the Brazilian Deprivation Index (IBP), and the median trend in the period was analyzed. There was a 12% increase in median PHC spending. PHC coverage expanded, with 3,168 municipalities presenting 100% coverage in 2019, compared to 2,632 in 2008. The median rates of PCSC mortality and hospitalizations increased 0.2% and decreased 44.9%, respectively. PHC spending was lower in municipalities with greater socioeconomic deprivation. The bigger the population and the better the socioeconomic conditions were in the municipalities, the lower the PHC coverage. The greater the socioeconomic deprivation was in the municipalities, the higher the median PCSC mortality rates. This study showed that the evolution of PHC was heterogeneous and is associated both with the population size and with the socioeconomic conditions of the municipalities.
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Organization of primary care. Prim Health Care Res Dev 2022; 23:e49. [PMID: 36047002 PMCID: PMC9472237 DOI: 10.1017/s1463423622000275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Strong primary care does not develop spontaneously but requires a well-developed organizational planning between levels of care. Primary care-oriented health systems are required to effectively tackle unmet health needs of the population, and efficient primary care organization (PCO) is crucial for this aim. Via strong primary care, health delivery, health outcomes, equity, and health security could be improved. There are several theoretical models on how primary care can be organized. In this position paper, the key aspects and benchmarks of PCO will be explored based on previously mentioned frameworks and domains. The aim of this position paper is to assist primary care providers, policymakers, and researchers by discussing the current context of PCO and providing guidance for implementation, development, and evaluation of it in a particular setting. The conceptual map of this paper consists of structural and process (PC service organization) domains and is adapted from frameworks described in literature and World Health Organization resources. Evidence we have gathered for this paper shows that for establishing a strong PCO, it is crucial to ensure accessible, continuous, person-centered, community-oriented, coordinated, and integrated primary care services provided by competent and socially accountable multiprofessional teams working in a setting where clear policy documents exist, adequate funding is available, and primary care is managed by dedicated units.
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