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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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Bezinelli LM, Eduardo FDP, Palacio DDC, Heller D, Ramos DVR, Cavalcante DDFB, Vasques MT, Cesar PF, Monte JCM, Campos AH, Corrêa L. Special care in dental curriculum: A transversal axis for integrating oral health with systemic health. SPECIAL CARE IN DENTISTRY 2023; 43:776-784. [PMID: 36468289 DOI: 10.1111/scd.12754] [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: 05/05/2022] [Accepted: 06/23/2022] [Indexed: 12/07/2022]
Abstract
AIMS Distance between dentistry and medicine is a traditional and historical obstacle that affects multiple levels of the health system, especially the health policies to improve health service quality. Changes in dental education, especially involving the adoption of integrative health models in professional development, are considered essential for reducing this gap. We aimed to show a dental curriculum focused on special care as a tool for medicine-dentistry integration. METHODS In this study, we present a new proposal for an undergraduate dental curriculum in which topics related to special care are addressed transversally and are the core for interdisciplinary integration of oral health with systemic health. We also describe how themes related to dental home care and hospital dentistry were included in this course as basic professional competencies. RESULTS AND CONCLUSION This initiative is aligned with the global trend to adopt educational systems that contribute to the reduction of health care inequalities and improve health service quality.
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Affiliation(s)
| | | | | | - Débora Heller
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Post Graduate Program in Dentistry, Cruzeiro do Sul University, São Paulo, Brazil
- Department of Periodontology, UT Health San Antonio, San Antonio, Texas, USA
| | | | | | | | - Paulo Francisco Cesar
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | | | - Luciana Corrêa
- School of Dentistry, University of São Paulo, São Paulo, Brazil
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Andrade AO, de Jesus SR, Mistro S. Hospitalizations in Brazil according to National Health Survey estimates, 2013 and 2019. Rev Saude Publica 2023; 57:73. [PMID: 37878859 PMCID: PMC10547397 DOI: 10.11606/s1518-8787.2023057004395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/04/2022] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE To compare the profile and prevalence of hospitalizations in Brazil based on estimates from the National Health Survey (PNS), 2013 and 2019. METHODS A cross-sectional study that used data from the 2013 PNS and the 2019 PNS. The outcome was having been hospitalized for 24 hours or more in the last 12 months. We calculated the proportion of the population in different categories of age group, presence or absence of chronic diseases, and perception of health status. We estimated the total number of hospitalizations and the proportion corresponding to each category of age group, chronic disease, and perceived health status. We calculated the prevalence of hospitalization according to geographic, socioeconomic, and health conditions. We compared the estimates of two editions of the PNS using Student's t-test for independent samples. We considered significant differences when the p-value was less than 0.01. And finally, we compared hospitalization estimates with administrative data to assess data consistency. RESULTS We observed that the proportion of chronically ill people in the population increased from 15.04% to 31.48%. This group was responsible for 36.76% of the total number of hospitalizations in 2013 and 57.61% in 2019. The prevalence of hospitalizations increased significantly between the two surveys and the increases were higher in the Southeast region and among people who have private health insurance. A discrepancy was found between administrative data and survey estimates. Obstetric hospitalizations and health insurance hospitalizations were underestimated. CONCLUSION There was an increase in overall hospitalization rates in the period between the PNS 2013 and PNS 2019, especially among people with better access to health services. The hospitalization profile also changed-in the 2013 PNS, hospitalizations of people without chronic diseases predominated. This was reversed in PNS 2019.
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Affiliation(s)
- André Oliveira Andrade
- Universidade Federal da BahiaInstituto Multidisciplinar em SaúdePrograma de Pós-Graduação em Saúde ColetivaVitória da ConquistaBABrazilUniversidade Federal da Bahia. Instituto Multidisciplinar em Saúde. Programa de Pós-Graduação em Saúde Coletiva. Vitória da Conquista, BA, Brazil
- Universidade Estadual do Sudoeste da BahiaDepartamento de Ciências da SaúdeVitória da ConquistaBABrazilUniversidade Estadual do Sudoeste da Bahia. Departamento de Ciências da Saúde. Vitória da Conquista, BA, Brazil
| | - Sandra Rêgo de Jesus
- Universidade Federal da BahiaInstituto Multidisciplinar em SaúdeVitória da ConquistaBABrazilUniversidade Federal da Bahia. Instituto Multidisciplinar em Saúde. Vitória da Conquista, BA, Brazil
| | - Sostenes Mistro
- Universidade Federal da BahiaInstituto Multidisciplinar em SaúdePrograma de Pós-Graduação em Saúde ColetivaVitória da ConquistaBABrazilUniversidade Federal da Bahia. Instituto Multidisciplinar em Saúde. Programa de Pós-Graduação em Saúde Coletiva. Vitória da Conquista, BA, Brazil
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Ferreira-Batista NN, Teixeira AD, Diaz MDM, Postali FAS, Moreno-Serra R, Love-Koh J. Is primary health care worth it in the long run? Evidence from Brazil. HEALTH ECONOMICS 2023; 32:1504-1524. [PMID: 37010114 DOI: 10.1002/hec.4676] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 02/15/2023] [Accepted: 03/03/2023] [Indexed: 06/04/2023]
Abstract
This paper assesses whether Brazilian primary health care is worth it in the long-run by estimating the accumulated costs and benefits of its flagship, the Family Health Strategy program (ESF). We employ an alternative strategy centered on years of exposure to the program to incorporate its dynamics. We also account for the program's heterogeneity with respect to the remuneration of ESF health teams and the intensity of coverage across Brazilian municipalities, measure by the number of people assisted by each ESF team, on average. To address heterogeneity in professional earnings, this paper employs, for the first time, a dataset containing the remuneration of professionals allocated to all ESF teams nationwide. The benefits are measured by the avoided deaths and hospitalizations due to causes sensitive to primary care. Results suggest that the net monetary benefit of the program is positive on average, with an optimum time of exposure of approximately 16 years. Significant heterogeneities in cost-benefit results were found since costs outweigh benefits in localities where the coverage is low intensive. On the other hand, the benefits outweigh the costs by 22.5% on average in municipalities with high intensive coverage.
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Affiliation(s)
| | | | | | | | | | - James Love-Koh
- Centre for Health Economics, University of York, York, UK
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Machline-Carrion MJ, Girotto AN, Nieri J, Pereira PM, Monfardini F, Forestiero F, Raupp P, Roveda F, Santo K, Berwanger O, Santos RD. Assessing statins use in a real-world primary care digital strategy: a cross-sectional analysis of a population-wide digital health approach. LANCET REGIONAL HEALTH. AMERICAS 2023; 23:100534. [PMID: 37497398 PMCID: PMC10366451 DOI: 10.1016/j.lana.2023.100534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/19/2023] [Accepted: 06/01/2023] [Indexed: 07/28/2023]
Abstract
Background The digitization of the primary care system provides an opportunity to evaluate the current use of statins in secondary prevention populations (myocardial infarction or stroke). Methods We conducted a cross-sectional study (ClinicalTrials.gov, NCT05285085), analysing anonymised data routinely collected by community health workers (CHW) in Brazil between May 2016 and September 2021 to assess the proportion of self-reported statins use and associated factors. Findings From the 2,133,900 individuals on the database, 35,103 (1.6%), mean age 66.2 years (SD14.6), 49.5% (17,382/35,103) male sex, 50.5% (17,721/35,103) female sex, and 29.6% (10,381/34,975) Caucasians, had a previous myocardial infarction (MI) (n = 11,628; 33.1%) or stroke (n = 25,925; 73.9%). Approximately 50% (17,020/35,103) were from the Northeast region, 78.7% (27,605) from urban zones, and 39.4% (13,845) with social development index (SDI) >0.7. Overall, 6.7% (2346) and 0.6% (212) reported statins and high dose statins use, respectively. Age over 60 years old (OR 1.32 [95% CI 1.19-1.47), living in the Southern region (OR 4.53 [95% CI 3.66-5.60]), having a previous diagnosis of MI (OR 4.53 [95% CI 3.66-5.60]), heart failure (OR 2.29 [95% CI 1.13-1.47]), diabetes (OR 1.50 [95% CI 1.37-1.64]), dyslipidaemia (OR 2.90 [95% CI 2.55-3.29]), chronic kidney disease (OR 1.27 [95% CI 1.08-1.48]) and use of anti-hypertensives (OR 5.47 [95% CI 4.60-6.47]) were associated with statin use. Interpretation The analysis of a real-world database from a digitized primary care system, allowed us to identify a very low use of statins in secondary prevention Brazilian patients, mostly influenced by socio-demographic factors and co-morbidities. Funding Novartis Biociências, Brazil.
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Affiliation(s)
| | | | - Josué Nieri
- Academic Research Organization (ARO), Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
| | | | - Frederico Monfardini
- Academic Research Organization (ARO), Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
| | | | | | | | - Karla Santo
- Academic Research Organization (ARO), Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
| | - Otávio Berwanger
- Academic Research Organization (ARO), Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
- The George Institute for Global Health, London, United Kingdom
- Imperial College London, London, United Kingdom
| | - Raul D. Santos
- Academic Research Organization (ARO), Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
- Lipid Clinic Heart Institute InCor University of Sao Paulo Medical School Hospital, São Paulo, SP, Brazil
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Gastos com internações por condições sensíveis à atenção primária: estudo ecológico. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Diaz MDM, Teixeira AD, Postali FAS, Ferreira-Batista NN, Moreno-Serra R. Assessment of the Association between the Brazilian Family Health Strategy and Adult Mortality. Health Policy Plan 2022; 37:461-471. [DOI: 10.1093/heapol/czac011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 12/27/2021] [Accepted: 01/28/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
This study aimed to analyse a wide range of related health problems that respond favourably to efficient primary care treatment among adults. We evaluate the direct association of the Family Health Strategy (ESF) in Brazil on mortality of adults aged 25–64 years related to conditions for which access to effective primary care can reduce the likelihood of more severe outcomes. Additionally, we discussed heterogeneous effects associated with different intensities of the programme. To address these issues, we estimated a model with variation at the municipal level of the ESF expansion, including municipal-fixed effects, municipal specific trends and year-fixed effects. Our results show that a higher intensity of ESF is associated with reduced mortality by all conditions sensitive to primary care and for some diseases, especially after some years: avoidable conditions, asthma, heart failure, cerebrovascular diseases and gastrointestinal ulcer, infectious gastroenteritis and complications, diseases of the lower airways, hypertension, and diabetes.. As a public policy view, these results help understand how a nationwide primary care strategy can help mitigate mortality and emphasise the role of having sufficient health teams to attend to the population.
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Postali FAS, Diaz MDM, Ferreira-Batista NN, Teixeira AD, Moreno-Serra R. Primary care coverage and individual health: evidence from a likelihood model using biomarkers in Brazil. BMC Health Serv Res 2021; 21:1300. [PMID: 34863160 PMCID: PMC8642960 DOI: 10.1186/s12913-021-07329-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background Although the use of biomarkers to assess health outcomes has recently gained momentum, literature is still scarce for low- to middle-income countries. This paper explores the relationship between primary care coverage and individual health in Brazil using a dataset of blood-based biomarkers collected by the Brazilian National Health Survey. Both survey data and laboratory results were crossed with coverage data from the Family Health Strategy (ESF) program, the most important primary care program in Brazil; the coverage measures aim to capture both direct (household) and indirect (spill-over) effects. Methods The empirical strategy used a probit model to estimate the relationship between ESF program coverage and the likelihood of abnormal biomarker levels while controlling for a rich set of individual and household characteristics based on data from the national survey. Results Household ESF coverage was associated with a lower likelihood of abnormal results for biomarkers related to anemia (marginal effect between − 2.16 and − 2.18 percentage points), kidney failure (between − 1.01 and − 1.19 p.p.), and arterial hypertension (between − 1.48 and − 1.64 p.p). The likelihood of abnormal levels of white blood cells and thrombocytes was negatively related to primary care coverage (marginal effect between − 1.8 and − 2 p.p.). The spillover effects were relevant for kidney failure and arterial hypertension, depending on the regional level. Although not sensitive to household coverage, diabetes mellitus was negatively associated with the state supply of primary care, and abnormal cholesterol levels did not present any relationship with ESF program coverage. Conclusions The presence of spillover effects of ESF program coverage regarding these conditions reveals that the strengthening of primary care by increasing the household registration and the regional density of ESF teams is an efficient strategy to address important comorbidities. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07329-9.
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Affiliation(s)
| | - Maria Dolores Montoya Diaz
- Department of Economics, University of Sao Paulo, Avenida Prof. Luciano Gualberto, 908, São Paulo, SP, 5508-010, Brazil
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Santos SC, Villela PB, Oliveira GMMD. Mortality Due to Heart Failure and Socioeconomic Development in Brazil between 1980 and 2018. Arq Bras Cardiol 2021; 117:944-951. [PMID: 34644789 PMCID: PMC8682101 DOI: 10.36660/abc.20200902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/02/2020] [Indexed: 01/14/2023] Open
Abstract
Fundamento Estudos sobre mortalidade por Insuficiência Cardíaca (IC) no Brasil e Regiões Geográficas (RG) são escassos. Objetivo Analisar a evolução temporal das taxas de mortalidade por IC por sexo e faixa etária no Brasil, RG e Unidades da Federação (UF), de 1980 a 2018, e associações com o Índice de Desenvolvimento Humano Municipal (IDHM). Métodos Estudo de séries temporais dos óbitos por IC, por sexo e faixas etárias, no Brasil, RG e UF, de 1980 a 2018. Os óbitos e a população foram retirados do DATASUS para estimar taxas de mortalidade por 100.000 habitantes, brutas e padronizadas (método direto, população brasileira do ano 2000). Foram calculadas médias móveis de três anos das taxas padronizadas. Os IDHM das UF de 1991 e 2010 foram obtidos do Atlas Brasil. Empregou-se o coeficiente de correlação de Pearson, com 5% de significância. Resultados A mortalidade por IC diminuiu no Brasil a partir de 2008, atingindo ao final de 2018 patamar semelhante nas RG e UF, sendo maior nos homens durante quase todos os períodos e faixas etárias, exceto naqueles acima de 60 anos, a partir de 1995, na região Sul. Observou-se relação inversa entre o IDHM e a redução das taxas de mortalidade (0,73). Conclusão Houve redução das taxas de mortalidade por IC no Brasil progressivamente de 2008 até 2018, com patamares semelhantes em 2018 nas RG e UF, com maiores taxas no sexo masculino. Essas reduções parecem relacionadas com o IDHM em 2010, mais do que o aumento percentual ao longo do tempo.
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Affiliation(s)
| | - Paolo Blanco Villela
- Universidade Federal do Rio de Janeiro - Cardiologia, Rio de Janeiro, RJ - Brasil
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10
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Campelo Barroso Carneiro VC, Ribeiro de Oliveira PDT, Rassy Carneiro S, Cardoso Maciel M, da Silva Pedroso J. Evidence of the effect of primary care expansion on hospitalizations: Panel analysis of 143 municipalities in the Brazilian Amazon. PLoS One 2021; 16:e0248823. [PMID: 33831030 PMCID: PMC8031449 DOI: 10.1371/journal.pone.0248823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/06/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The Family Health Strategy (FHS) became consolidated as a primary care model and gatekeeper for the Unified Health System (Sistema Único de Saúde, SUS) in the Brazil and it is considered one of the largest primary health care programmes in the world. Its rapid expansion allowed the SUS to meet the changing health care needs of the population remote localities of Brazilian municipalities. METHODS In the present study, exploratory data analysis was performed using modelling to provide a general overview of the study and to delineate possible structural characteristics of the cross-sectional time-series data. Panel regression methods were used to assess the association between FHS coverage and ambulatory care-sensitive hospitalizations (ACSH rates) in the municipalities of Pará, in the Brazilian Amazon, from 2008 to 2017. RESULTS The results showed strong evidence for the association between FHS coverage and ACSH rates, including reductions of 22% in preventable hospitalizations and 15% in hospital expenses that were directly linked to the 40% increase in FHS population coverage during the evaluated period. This expansion of primary care has mainly benefitted areas that are difficult to access and populations that were previously deprived of health care in the vast Amazon territory. CONCLUSIONS The findings of this study show that the increase of the expansion of primary care reduces the preventable hospitalization and the hospital expenses. This reinforces the need for public protection of the health of populations at risk and the positive impacts of primary care in the Brazilian Amazon.
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Affiliation(s)
| | | | - Saul Rassy Carneiro
- João de Barros Barreto University Hospital, Federal University of Pará, Belém, Pará, Brazil
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Özçelik EA, Massuda A, McConnell M, Castro MC. Assessing the performance of beneficiary targeting in Brazil's More Doctors Programme. Health Policy Plan 2021; 36:149-161. [PMID: 33448298 PMCID: PMC7996646 DOI: 10.1093/heapol/czaa137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 12/30/2022] Open
Abstract
Many countries employ strategies that rest on the use of an explicitly defined set of criteria to identify underserved communities. Yet, we know relatively little about the performance of community-level targeting in large-scale health programmes. To address this gap, we examine the performance of community targeting in the More Doctors Programme (MDP). Our analysis covers all 5570 municipalities in the period between 2013 and 2017 using publicly available data. We first calculate the rate at which vulnerable municipalities enrolled in the MDP. Next, we consider two types of mistargeting: (1) proportion of vulnerable municipalities that did not have any MDP physicians (i.e. under-coverage municipalities) and (2) proportion of MDP enrolees that did not fit the vulnerability criteria (i.e. non-target municipalities). We found that almost 70% of vulnerable municipalities received at least one MDP physician between 2013 and 2017; whereas non-target municipalities constituted 33% of beneficiaries. Targeting performance improved over time. Non-target municipalities had the highest levels of socioeconomic development and greater physician availability. The poverty rate among under-coverage municipalities was almost six times that in non-target municipalities. Under-coverage municipalities had the lowest primary care physician availability. They were also smaller and more sparsely populated. We also found small differences in the political party alignments of mayors and the President between under-coverage and non-target municipalities. Our results suggest that using community-level targeting approaches in large-scale health programmes is a complex process. Programmes using these approaches may face substantial challenges in beneficiary targeting. Our results highlight that policymakers who consider using these approaches should carefully study various municipal characteristics that may influence the implementation process, including the level of socioeconomic development, health supply factors, population characteristics and political party alignments.
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Affiliation(s)
- Ece A Özçelik
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Adriano Massuda
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
- Department of Administration, São Paulo School of Business Administration, Fundação Getulio Vargas, Avenue Nove de Julho, 2029, São Paulo 01313-902, Brazil
| | - Margaret McConnell
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Marcia C Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
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Özçelik EA, Massuda A, McConnell M, Castro MC. Impact of Brazil's More Doctors Program on hospitalizations for primary care sensitive cardiovascular conditions. SSM Popul Health 2020; 12:100695. [PMID: 33319027 PMCID: PMC7725939 DOI: 10.1016/j.ssmph.2020.100695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 11/18/2022] Open
Abstract
Globally, cardiovascular diseases are the leading cause of disease burden and death. Timely and appropriate provision of primary care may lead to sizeable reductions in hospitalizations for a range of chronic and acute health conditions. In this paper, we study the impact of Brazil's More Doctors Program (MDP) on hospitalizations due to cerebrovascular disease and hypertension. We exploit the geographic variation in the uptake of the MPD and combine coarsened exact matching and difference-in-difference methods to construct valid counterfactual estimates. We use data from the Hospital Information System in Unified Health System, the MDP administrative records, the Brazilian Regulatory Agency, the Ministry of Health, and the Brazilian Institute of Geography and Statistics, covering the years from 2009 to 2017. Our analysis resulted in estimated coefficients of -1.47 (95%CI: -4.04,1.10) for hospitalizations for cerebrovascular disease and -1.20 (95%CI: -5.50,3.11) for hypertension, suggesting an inverse relationship between the MDP and hospitalizations. For cerebrovascular disease, the estimated MDP coefficient was -0.50 (95%CI: -2.94,1.95) in the year of program introduction, -5.21 (95%CI: -9.43,-0.99) and -8.21 (95%CI: -13.68,-2.75) in its third and fourth year of implementation, respectively. Our results further suggest that the beneficial impact of MDP on hospitalizations due to cerebrovascular disease became discernable in urban municipalities starting from the fourth year of implementation. We found no evidence that the MDP led to reductions in hospitalizations due to hypertension. Our results highlight that increased investment in resources devoted to primary care led to improvements in hospitalizations for selected cardiovascular conditions. However, it took time for the beneficial effects of the MDP to become discernable and the Program did not guarantee declines in hospitalizations for all cardiovascular conditions, suggesting that further improvements may be needed to enhance the beneficial impact of the MDP on the level and distribution of population health in Brazil.
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Affiliation(s)
- Ece A. Özçelik
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Adriano Massuda
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
- São Paulo School of Business Administration, Fundação Getulio Vargas, São Paulo, Brazil
| | - Margaret McConnell
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Marcia C. Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
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Alves KCG, Guimarães RA, de Souza MR, de Morais Neto OL. Performance of family health teams for tackling chronic diseases in a state of the Amazon. PLoS One 2020; 15:e0241765. [PMID: 33156831 PMCID: PMC7647065 DOI: 10.1371/journal.pone.0241765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 10/20/2020] [Indexed: 11/21/2022] Open
Abstract
The most common cause of death worldwide is noncommunicable diseases. A cross-sectional study was conducted to evaluate the adequacy of the work process among family health teams and compare differences in regional adequacy in the state of Tocantins, in the Amazonian Region, Brazil. Categorical principal components analysis was used, and scores of each principal component extracted in the analysis were compared among health regions in Tocantins. A post hoc analysis was performed to compare the heath region pairs. The adequacy of family health teams’ work process was evaluated with respect to the Strategic Action Plan to Tackle NCDs. The results showed that the family health teams performed actions according to the Strategic Action Plan to Tackle NCDs. However, overall, the adequacy percentages of these actions according to the axes of the Plan are very uneven in Tocantins, with large variations among health regions. The family health teams in the Bico do Papagaio (Region 1), Médio Norte Araguaia (Region 2), Cantão (Region 4) and Capim Dourado (Region 5) regions have adequacy percentages ≥ 50% with the Strategic Action Plan to Tackle NCDs, whereas all other regions have percentages <50%. Health teams perform surveillance actions, health promotion, and comprehensive care for NCDs in accordance with the guidelines of the Strategic Action Plan to Tackle NCDs. The challenge of NCDs in primary care requires a care model that is tailored to users’ needs and has the power to reduce premature mortality and its determinants.
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Affiliation(s)
| | - Rafael Alves Guimarães
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Marta Rovery de Souza
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
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14
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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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Kessler M, Lima SBSD, Weiller TH, Lopes LFD, Ferraz L, Eberhardt TD, Soares RSDA, Trindade LDL. Longitudinalidade do cuidado na atenção primária: avaliação na perspectiva dos usuários. ACTA PAUL ENFERM 2019. [DOI: 10.1590/1982-0194201900026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo: avaliar a longitudinalidade do cuidado na Atenção Primária à Saúde (APS) na perspectiva dos usuários, verificando a associação com o porte populacional, índice de desenvolvimento humano e cobertura de Estratégia Saúde da Família (ESF) entre os municípios de uma Regional de Saúde no Sul do Brasil. Método: estudo transversal, realizado com 1.076 usuários adultos da APS de 32 municípios da 4ᵃ Coordenadoria Regional de Saúde do Rio Grande do Sul, de fevereiro a junho de 2015. Os dados foram coletados com o instrumento Primary Care Assessment Tool versão adulto e analisados com o programa Statistical Package for the Social Sciences. Para a comparação de médias utilizou-se o teste Mann-Whitney e Kruskal Wallis. Resultados: o grau de afiliação foi avaliado com alto escore (8,6; IC95%:8,5-8,8) e a longitudinalidade obteve um escore insatisfatório (6,4; IC95%:6,3-6,5). As fragilidades relacionadas ao atributo foram a relação interpessoal entre o usuário e profissional; o reconhecimento do usuário em sua integralidade e o preparo dos profissionais para auxiliar os usuários. A longitudinalidade foi melhor avaliada nos municípios com menor porte populacional, menor índice de desenvolvimento humano e com maior cobertura de ESF. Conclusão: a longitudinalidade é insatisfatória e revela a necessidade de reorientação da APS e da formação profissional, contudo a maior cobertura da ESF sugere que esse modelo assistencial contribui para qualificar esse atributo.
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