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Bonfim S, Massago M, de Carvalho Dutra A, Arruda MHB, Oliveira FS, Thomaz ÉBAF, de Souza EM, Nihei OK, de Andrade L. Hospitalizations for Cardiovascular Diseases Sensitive to Primary Health Care in Paraná State, Brazil: A Bayesian Spatiotemporal Model. Ann Fam Med 2024; 22:140-148. [PMID: 38527827 PMCID: PMC11237202 DOI: 10.1370/afm.3083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 10/01/2023] [Accepted: 11/29/2023] [Indexed: 03/27/2024] Open
Abstract
PURPOSE To analyze spatiotemporal trends in hospitalizations for cardiovascular diseases (CVD) sensitive to primary health care (PHC) among individuals aged 50-69 years in Paraná State, Brazil, from 2014 to 2019 and investigate correlations between PHC services and the Social Development Index. METHODS We conducted a cross-sectional ecological study using publicly available secondary data to analyze the municipal incidence of hospitalizations for CVD sensitive to PHC and to estimate the risk of hospitalization for this group of diseases and associated factors using hierarchical Bayesian spatiotemporal modeling with Markov chain Monte Carlo simulation. RESULTS There was a 5% decrease in the average rate of hospitalizations for PHC-sensitive CVD from 2014 to 2019. Regarding standardized hospitalization rate (SHR) according to population size, we found that no large municipality had an SHR >2. Likewise, a minority of these municipalities had SHR values of 1-2 (33%). However, many small and medium-sized municipalities had SHR values >2 (47% and 48%, respectively). A greater Social Development Index value served as a protective factor against hospitalizations, with a relative risk of 0.957 (95% credible interval, 0.929-0.984). CONCLUSIONS The annual risk of hospitalization decreased over time; however, small municipalities had the greatest rates of hospitalization, indicating an increase in health inequity. The inverse association between social development and hospitalizations for CVD sensitive to PHC raises questions about intersectionality in health care.
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Affiliation(s)
- Samile Bonfim
- Postgraduate Program in Health Sciences, State University of Maringá, Maringá, Paraná, Brazil
| | - Miyoko Massago
- Postgraduate Program in Health Sciences, State University of Maringá, Maringá, Paraná, Brazil
| | | | | | - Fernanda Silva Oliveira
- Postgraduate Program in Health Sciences, State University of Maringá, Maringá, Paraná, Brazil
| | | | | | - Oscar Kenji Nihei
- Center for Education, Linguistics and Health, Western Paraná State University, Foz do Iguaçu, Paraná, Brazil
| | - Luciano de Andrade
- Postgraduate Program in Health Sciences, State University of Maringá, Maringá, Paraná, Brazil
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Bomfim RA, Leite HQNC, Zafalon EJ, De-Carli AD, Santos MLDMD. Attributes of primary health care in Mato Grosso do Sul state: PCAT-Brazil paired for users and health professionals, 2018. BMC Health Serv Res 2022; 22:972. [PMID: 35906576 PMCID: PMC9338599 DOI: 10.1186/s12913-022-08363-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The objective of the present study was to analyse the quality of adults and older adults health care in Primary Health Care (PHC) services in the State of Mato Grosso do Sul, 2018. METHODS A quantitative survey was carried out in which the municipalities participating in the study included the four macro-regions following the Director Regional Plan (DRP). In this study, the quality of care was verified using the validated version of the PCAT-Br for adult and older adults users over 18 years of age and professionals. The professional's and users' views were compared between PHC attributes in the State of Mato Grosso do Sul. We performed the paired student t-test. STATA v.14.2 software (College Station, TX, USA) was used for the analyses. Sensitivity analysis was done to compare socio-demographic characteristics. RESULTS Eight hundred twenty-five users and 424 professionals participated in the study. According to users, the Accessibility attribute had the worst performance in all macro-regions (mean score PCAT = 3.58). There were significant differences between the perception of users and professionals (PCAT = 5.32 for users and PCAT = 7.11 for professionals) in all attributes evaluated. CONCLUSIONS There was a difference in users' and professionals' perceptions between PHC attributes. Therefore, it is necessary to strengthen PHC care networks in the State, mainly considering the users' perspectives.
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Affiliation(s)
- Rafael Aiello Bomfim
- School of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Brazil.
| | | | - Edilson José Zafalon
- School of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
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Jantsch AG, Burström B, Nilsson GH, Ponce de Leon A. Residency training in family medicine and its impact on coordination and continuity of care: an analysis of referrals to secondary care in Rio de Janeiro. BMJ Open 2022; 12:e051515. [PMID: 35168968 PMCID: PMC8852675 DOI: 10.1136/bmjopen-2021-051515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To measure the effect that residency training in family medicine (RTFM) has on continuity and coordination of care. DESIGN Observational cohort study using electronic health records. SETTING Rio de Janeiro, Brazil, public primary care system. PARTICIPANTS 504 940 patients, 633 generalists (physicians without RTFM) and 204 family physicians (FP-doctors with 2 years of RTFM) from one health district between January 2015 and December 2018. INTERVENTION Two years of RTFM. MAIN OUTCOME MEASURES Relative risks of patients being referred to secondary care for outpatient consultations and diagnostics tests; and having a follow-up medical consultation in primary care within 3 and 6 months after being referred. RESULTS We examined 2 414 508 medical consultations and 284 754 referrals to secondary care. FPs were less likely to request ambulatory care services (including surgical specialties), but were more likely to request ophthalmology, physiotherapy, rehabilitationand surgical evaluations for their patients. Patients referred to secondary care by FPs were more likely to have a follow-up visit in primary care for almost every service requested. If all medical consultations were performed by FPs, a 37.6% (95% CI 32.4% to 42.4%) increased demand for rehabilitation services would be noticed. Oppositely, 1532 (95% CI 1458 to 1602) fewer requests for dermatology would happen every year. CONCLUSIONS RTFM improves coordination and continuity of care by making FPs more competent to retain those health conditions that can be properly managed in primary care and making FPs more competent to detect health conditions that require specific biomedical technologies and skills, increasing the demand for those services. Besides, it increases the chances of patients having follow-up visits in primary care. Policy-makers in low-income and middle-income countries must consider investing in RTFM to make primary care systems more comprehensive, with better coordination and continuity of care.
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Affiliation(s)
- Adelson Guaraci Jantsch
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Maracanã, Brazil
| | - Bo Burström
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar H Nilsson
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Stockholm, Sweden
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Chueiri PS, Gonçalves MR, Hauser L, Wollmann L, Mengue SS, Roman R, Rodrigues Agostinho Rech M, Soares MDAV, Pertile J, Harzheim E. Reasons for encounter in primary health care in Brazil. Fam Pract 2020; 37:648-654. [PMID: 32297637 DOI: 10.1093/fampra/cmaa029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Primary health care (PHC) delivery in Brazil has improved in the last decades. However, it remains unknown whether the Family Health Strategy teams are meeting the health needs of the population. OBJECTIVES To describe the reasons for encounter (RFEs) in PHC in Brazil and to examine variations in RFEs according to sex, age and geographic region. METHODS This descriptive study is part of a national cross-sectional study conducted in 2016. The sample was stratified by the number of PHC physicians per geographic region. Physicians who had been working for at least 1 year in the same PHC unit were included. For every participating physician, 12 patients aged ≥18 years who had attended at least two encounters were included. Patients were asked about their RFEs, which were classified according to the International Classification of Primary Care. RESULTS In 6160 encounters, a total of 8046 RFEs were coded. Seven reasons accounted for 50% of all RFEs. There was a high frequency of codes related to test results, medication renewal and preventive medicine. RFEs did not vary significantly by sex or geographic region, but they did by age group (P < 0.001). The rates of prescriptions, requests for investigations and referrals to specialized care were 71.1%, 42.8%, and 21.3%, respectively. CONCLUSION This novel study opened the 'black box' of RFEs in PHC in Brazil. These findings can contribute to redefining the scope of PHC services and reorienting work practices in order to improve the quality of PHC in Brazil.
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Affiliation(s)
- Patricia S Chueiri
- School of Medicine, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo
| | | | - Lisiane Hauser
- Postgraduate Program in Epidemiology, TelessaudeRS, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre
| | - Lucas Wollmann
- Community Health Services, Grupo Hospitalar Conceição, Porto Alegre
| | - Sotero Serrate Mengue
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre.,Postgraduate Program in Epidemiology, TelessaudeRS, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre
| | - Rudi Roman
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre.,Postgraduate Program in Epidemiology, TelessaudeRS, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre
| | | | | | - Jamily Pertile
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre
| | - Erno Harzheim
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre.,Secretary of Primary Health Care, Ministry of Health, Brasília, Brazil
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Jantsch AG. Pesquisa científica, atenção primária e medicina de família. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2020. [DOI: 10.5712/rbmfc15(42)2466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Apesar do grande crescimento da nossa especialidade nos últimos 30 anos, ainda estamos muito aquém de atender à demanda brasileira por médicos de família. Atualmente representamos apenas 1,4% do total de médicos especialistas no Brasil e menos de 5% do total de vagas de residência no país são destinados à medicina de família e comunidade (MFC). Com 70% da nossa população coberta pela Estratégia de Saúde da Família, apenas uma parcela pequena conta com um médico de família treinado por um programa de residência em MFC. Infelizmente temos poucas evidências mostrando o impacto do treinamento em MFC no cuidado das pessoas e muito do que sustentamos no nosso discurso como diferenciais da nossa prática carece de provas científicas. Isso perpetua uma noção comum entre formuladores de políticas e gestores de que a atenção primária à saúde (APS) é uma área de atuação desprovida de desafios, sem complexidades e possível de ser realizada por qualquer médico sem treinamento especializado. Se a MFC pretende se firmar como a especialidade médica responsável pela APS no Brasil e no mundo, precisa avançar no desenvolvimento de habilidades para a pesquisa, para poder estudar o universo da MFC e da APS com a profundidade e o rigor que a complexidade destas disciplinas demanda. Desenvolver o potencial para a pesquisa representa um passo importante do projeto profissionalizante da nossa especialidade e do amadurecimento da APS. Ao questionarmos nossa prática e ao perguntarmos o quanto realmente fazemos a diferença no cuidado dos nossos pacientes estaremos ampliando a base de evidências da nossa especialidade e demonstrando o quanto a APS se torna mais abrangente ao ter um médico treinado em MFC. Este ensaio aborda as dificuldades da MFC em mostrar seu valor e a sua importância para os sistemas de saúde; e apresenta o papel vital que a pesquisa científica deve ter no enfrentamento destes desafios.
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do Nascimento DDG, de Moraes SHM, Santos CADST, de Souza AS, Bomfim RA, De Carli AD, Kodjaoglanian VL, dos Santos MLDM, Zafalon EJ. Impact of continuing education on maternal and child health indicators. PLoS One 2020; 15:e0235258. [PMID: 32589647 PMCID: PMC7319283 DOI: 10.1371/journal.pone.0235258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/11/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study investigated whether the presence of care workers who completed a specialization course on family health was associated with improved care and maternal and child health indicators in municipalities in the state of Mato Grosso do Sul, Brazil. METHODS Negative binomial regression models with fixed effects were used for the 79 municipalities in the state of Mato Grosso do Sul, with repeated observations for the period 2009-2015. For our reference, the parameter "number of professionals who completed the course" calculated the proportion of professionals who completed the course, and was divided by the total number of primary health care professionals in the municipality to create a ratio. The cutoff points used represented tertile distribution: T3: high (0.35-1.00), T2: intermediate (0.02-0.33) and T1: low (0.00-0.01); to avoid biased results, the analysis was also performed for the years prior to the beginning of the course in question (2009 and 2010). RESULTS During the study period, enrollment of pregnant women, exclusive breastfeeding for children under 4 months, and up-to-date vaccinations in children younger than 1 year to 23 months increased (high to intermediate categories) in municipalities where professionals who completed the specialization course worked. Growth in the intermediate ratio was also observed in indicators related to cervical cancer screening and new diagnoses of congenital syphilis in infants under one year of age. CONCLUSIONS The presence of care workers who completed a specialization course on family health was seen to be associated with improved care and indicators for maternal and child health in municipalities in the state of Mato Grosso do Sul, Brazil. These findings reaffirm the importance and effectiveness of policies on training and continuing education for the Brazilian Unified Health System.
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Affiliation(s)
| | | | | | - Albert Schiaveto de Souza
- Biosciences Institute, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Rafael Aiello Bomfim
- Post-doctoral Researcher at The School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Alessandro Diogo De Carli
- Faculty of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | | | | | - Edilson José Zafalon
- Faculty of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
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Zhao F, Doroshenko O, Lekhan VN, Kriachkova LV, Goroshko A. Assessment of appropriateness of hospitalisations in Ukraine: analytical framework, method and findings. BMJ Open 2019; 9:e030081. [PMID: 31818835 PMCID: PMC6924815 DOI: 10.1136/bmjopen-2019-030081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This article reviews the applicability of a customised version of the Appropriateness Evaluation Protocol (AEP) to evaluate the magnitude of inappropriate hospitalisations in two regions of Ukraine. DATA AND METHODS The original AEP was modified to develop a customised tool, which included criteria for the appropriateness of hospitalisation and duration of inpatient stay. The customisation of the tool followed the Delphi procedure. We randomly selected 381 medical records to test the feasibility and reliability of the method and 800 medical records to evaluate the scope of inappropriate hospitalisations. We used descriptive and analytical statistics, receiver operating characteristic curve analysis and Cohen's kappa to check the consistency between the findings of primary reviewers and experts. RESULT We observed high levels of agreement in conclusions of primary reviewers (reference standard) and experts during testing of the reliability and validity of the method. The external validity check showed that the use of the tool by different experts provided high accuracy: 95.1 sensitivity, 76.6 specificity and area under ROC-curve (AUC)=0.948 (р<0.001) for analysis of the appropriateness of admissions; 95.3 sensitivity, 84.7 specificity and AUC=0.900 (р=0.001) for the duration of hospitalisations. Cohen's kappa coefficient (κ) indicated agreement in expert evaluations of 0.915 (95% СІ 0.799 to 1.000) and 0.812 (95% СІ 0.749 to 0.875), respectively.We found that over one-third of admissions (38.1%; 95% СІ 33.9 to 43.5) and over half of total bed-days were unnecessary (57.4%; 95% СІ 56.4 to 58.5). The highest levels of stay were observed in hospitals' general medicine departments (64.6%; 95% СІ 63.0 to 66.3)compared with other departments included in the analysis. CONCLUSION The proposed method is robust in assessing the appropriateness of hospitalisations and duration of inpatient stays. The quantified levels of unnecessary hospital care indicate the need for improving efficiency and quality of care and optimising the excessive hospital capacities in Ukraine.
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Affiliation(s)
- Feng Zhao
- HNP, World Bank Group, Washington, District of Columbia, USA
| | | | - Valery N Lekhan
- Department of Social Medicine and Health Management, Dnipropetrovsk Medical Academy (DMA), Dnipro, Ukraine
| | - Lilia V Kriachkova
- Department of Social Medicine and Health Management, Dnipropetrovsk Medical Academy (DMA), Dnipro, Ukraine
| | - Alona Goroshko
- Department for Development of Benefits Package, National Health Service of Ukraine, Kyiv, Ukraine
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Melo Neto AJD, Barreto DDS. Programa Médicos pelo Brasil: inovação ou continuidade? REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2019. [DOI: 10.5712/rbmfc14(41)2162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Apesar do lançamento do Programa Médicos pelo Brasil (PMB) alardear a ideia de inovação, este artigo evidencia o processo de continuidade do programa atual em relação ao Programa Mais Médicos (PMM). O PMB se estrutura nos acertos do PMM para montar o seu arcabouço de funcionamento e tenta superar problemas existentes no programa anterior. A principal proposta do PMB é a carreira médica para atuação na Atenção Primária à Saúde (APS), sem, no entanto, apresentar outros elementos importantes para a fixação profissional. Desta forma, apresenta-se como uma política mais frágil que seu antecessor, com foco apenas no provimento de médicos, correndo o risco de não atingir os objetivos a que se propôs enquanto política pública. Além disso, através da proposta de criação da Agência para o Desenvolvimento da Atenção Primária à Saúde (Adaps), o programa abre margem para a privatização dos serviços de APS e do Sistema Único de Saúde como um todo.
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Hospitalization of the aged due to stroke: An ecological perspective. PLoS One 2019; 14:e0220833. [PMID: 31390380 PMCID: PMC6685616 DOI: 10.1371/journal.pone.0220833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/24/2019] [Indexed: 12/05/2022] Open
Abstract
Contextual variables have been associated with the incidence of stroke, but their association with hospitalization of older persons remains unclear. This study evaluated the association between social context variables and hospitalization of 60 years old and older patients due to stroke in Rio de Janeiro, Brazil. An ecological cross-sectional study was conducted, with secondary data from the Brazilian Hospital Information System from 2006 to 2014. Hospitalization rates were calculated and categorized by tertiles. For subsequent analyzes, the polar extremes method was used to select the groups with extremes values. After that, Student t or Mann-Whitney tests were used to compare the contextual variables and the hospitalization rates clusters. Then, a Binary Logistic Regression analysis was used to assess the association between hospitalization rates clusters and the contextual variables. The total number of hospitalizations was 82 796; the hospitalization rate varied in extremes groups from the lowest (3.49) to the highest (11.95) (p<0.001). The highest rates group was positively associated with the proportion of elderly (p<0.001), the illiteracy rate of the aged (p = 0.01), primary care coverage (p<0.001) and ambulatory care for hypertension and diabetes, while the income ratio showed negative association with the highest rates of hospitalization (p = 0.01). In the multivariate analysis, only the proportion of elderly (OR = 1.55; 95%CI 1.07–2.25), primary care coverage (OR = 1.05; 95%CI 1.01–1.11) and income ratio (OR = 0.82; 95%CI 0.67–0.99) maintained the association. In conclusion, contextual variables in the three dimensions studied were associated with the rate of hospitalization of aged due to stroke in the municipalities in Rio de Janeiro State. Transitional care and other improvements in both the health care and social services are demanded.
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Moraes dos Santos ML, Zafalon EJ, Bomfim RA, Kodjaoglanian VL, Mendonça de Moraes SH, do Nascimento DDG, Santos CADST, de Souza AS, De-Carli AD. Impact of distance education on primary health care indicators in central Brazil: An ecological study with time trend analysis. PLoS One 2019; 14:e0214485. [PMID: 30913272 PMCID: PMC6435161 DOI: 10.1371/journal.pone.0214485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/13/2019] [Indexed: 11/26/2022] Open
Abstract
Objective The objective of this study was to verify whether the inclusion of professionals who completed a specialized distance learning course in family health teams is associated with rates of hospitalization for primary healthcare-sensitive conditions and better monitoring of chronic conditions in municipalities within the state of Mato Grosso do Sul, Brazil. Methods Negative binomial regression models with fixed effects were used for the 79 municipalities in the state, with repeated observations for the selected years (2009–2015). For our reference, the parameter “Municipality Ratio” was the number of professionals who completed the course divided by the total number of PHC professionals in the municipality. This ratio has been cumulative over the years. No reference values were found in the scientific literature, so three cutoff points were used for tertile distribution: T3:high (0.35–1.00), T2:intermediate (0.02–0.33), and T1:Low (0.00–0.01). In order to avoid capturing biased results, the analysis was also performed for the years before the specialization course was offered (2009 and 2010). Results Indicators of the share of hospitalizations for primary care-sensitive conditions (overall rate and specific rates for asthma, gastroenteritis, and heart failure) decreased during the study period when related to a high and intermediate proportion of professionals who completed the specialization course, and the same was seen for indicators of chronic conditions (diabetic and hypertensive patients) who were registered, monitored and group care. Conclusion The specialization course impacted important indicators related to the attributions of primary health care professionals, considering that decreases in hospitalizations for primary care sensitive causes (overall rate of sensitive causes, specific rates for asthma, gastroenteritis and heart failure) were seen in the territories where professionals who completed this course worked, along with increased registration and monitoring of diabetic and hypertensive patients.
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Affiliation(s)
- Mara Lisiane Moraes dos Santos
- Integrated Health Institute, Federal University of Mato Grosso do Sul, Post graduate program stricto sensu in Family Health, Campo Grande, Mato Grosso do Sul, Brazil
| | - Edilson José Zafalon
- Faculty of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Rafael Aiello Bomfim
- Post-Doctoral researcher at Public Health School–University of São Paulo, São Paulo, Brazil
- Faculty of Dentistry, Federal University of Mato Grosso do Sul, Professor at Post graduate program stricto sensu in Family Health and stricto sensu in Dentistry, Campo Grande, Mato Grosso do Sul, Brazil
- * E-mail:
| | | | | | | | | | - Albert Schiaveto de Souza
- Biosciences Institute, Federal University of Mato Grosso do Sul, Post graduate program stricto sensu in Family Health, Campo Grande, Mato Grosso do Sul, Brazil
| | - Alessandro Diogo De-Carli
- Faculty of Dentistry, Federal University of Mato Grosso do Sul, Professor at Post graduate program stricto sensu in Family Health and stricto sensu in Dentistry, Campo Grande, Mato Grosso do Sul, Brazil
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Massuda A, Titton CMS, Poli P. Remembering Alma-Ata: challenges and innovations in primary health care in a middle-income city in Latin America. Rev Panam Salud Publica 2018; 42:e157. [PMID: 31093185 PMCID: PMC6386186 DOI: 10.26633/rpsp.2018.157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 08/10/2018] [Indexed: 11/26/2022] Open
Abstract
The year 2018 is an opportune time to explore health system reforms and primary health care (PHC) in Brazil, given the anniversaries of the Alma-Ata Declaration (40 years) and of the Constitution of Brazil (30 years), the basis of the Unified Health System (SUS). In this context, health system analysis in the municipal setting is an important instrument for acknowledging achievements and innovations, as well as weaknesses and threats. Due to the principle of decentralization of SUS, municipalities have assumed a leadership role in health policy development and implementation. The cities also come first in expressing the failures of the health system and the consequences of austerity measures. Thus, analysis of health system transformations at the municipal level are fundamental to studying PHC achievements and gaps. This report identifies the challenges and innovations of PHC implementation in Curitiba, beginning with a brief history of the city's health system development. The city was a pioneer in linking urban planning with health system design, improving access to health care, and obtaining better health outcomes over the past 30 years. This report covers those years, as well as the challenges and strategies implemented during the most recent political cycle (2013 – 2016). There are substantial lessons that can be garnered from the experience of this middle-income city in Latin America, lessons that may be useful as the region moves toward the Sustainable Development Goal of Universal Health Coverage by 2030.
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Affiliation(s)
- Adriano Massuda
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | | | - Paulo Poli
- Departamento de Saúde Coletiva, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
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