Resolution, access, and waiting time for specialties in different models of care (original) (raw)
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Brazilian Specialists’ Perspectives on the Patient Referral Process
Healthcare, 2017
Since 1988, healthcare has been considered a citizen's right in Brazil. The Sistema Único de Saúde (SUS), has undergone development and expansion to ensure universal health coverage for the Brazilian public, the world's fifth largest population. The coordination of effective communications between primary care physicians, specialists and patients is a significant challenge, particularly the referral process. Our study objective was to understand the facilitators and barriers associated with referral process communications between primary care physicians and regional university hospital specialists in the State of Sao Paulo. This paper reports specialists' perspectives of the referral process. This was a phenomenological study that employed a qualitative research method with three components (description, reduction and comprehension). We conducted focus groups with 54 hospital residents from different specialties (surgery, medicine, obstetrics/gynecology, pediatrics) from July to October 2014. The main results showed lack of an adequate referral-return referral process resulting in treatment delays and inappropriate use of emergency services. Communications were impeded by lack of integrated, computerized booking and standardized referral-return referral processes; underlying lack of trust in primary care physicians; and patients' inappropriate use of healthcare services. Although computerized systems will facilitate communications between primary and specialty care, other strategies are needed to promote collaboration between services, and ensure appropriate utilization of them.
Main characteristics of patients of primary health care services in Brazil
Revista de saude publica, 2017
To characterize patients of primary health care services according to demographic and socioeconomic aspects, habits and lifestyle, health condition, and demand for health services and medicines. This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services), a cross-sectional study carried out between 2014 and 2015. Interviews were conducted with patients over the age of 17 years, with a standardized questionnaire, in primary health care services of a representative sample of cities, stratified by regions of Brazil. The analysis was performed for complex samples and weighted according to the population size of each region. A total of 8,676 patients were interviewed, being 75.8% women, most of them aged from 18 to 39 years; 24.2% men, most of them aged from 40 to 59 years; 53.7% with elementary school; 50.5% reported to be of mixed...
Utilização de serviços médicos no sistema público de saúde no Sul do Brasil
Revista de Saúde Pública, 2011
OBJECTIVE: To estimate the prevalence and analyze factors associated with the utilization of medical services in the public health system. METHODS: Cross-sectional population-based study with 2,706 individuals aged 20-69 years carried out in Pelotas, Southern Brazil, in 2008. A systematic sampling with probability proportional to the number of households in each sector was adopted. The outcome was defi ned by the combination of the questions related to medical consultation in the previous three months and place. The exposure variables were: sex, age, marital status, level of schooling, family income, self-reported hospital admission in the previous year, having a regular physician, self-perception of health, and the main reason for the last consultation. Descriptive analysis was stratifi ed by sex and the analytical statistics included the use of the Wald test for tendency and heterogeneity in the crude analysis and Poisson regression with robust variance in the adjusted analysis, taking into consideration cluster sampling. RESULTS: The prevalence of utilization of medical services in the three previous months was 60.6%, almost half of these (42.0%, 95%CI: 36.6;47.5) in public services. The most utilized public services were the primary care units (49.5%). In the adjusted analysis stratifi ed by sex, men with advanced age and young women had higher probability of using the medical services in the public system. In both sexes, low level of schooling, low per capita family income, not having a regular physician and hospital admission in the previous year were associated with the outcome. CONCLUSIONS: Despite the expressive reduction in the utilization of medical health services in the public system in the last 15 years, the public services are now reaching a previously unassisted portion of the population (individuals with low income and schooling).
Prevalence of having a regular doctor, associated factors, and the effect on health services utilization: a population-based study in Southern Brazil Prevalência do médico de referência, fatores associados e seu efeito na utilização de serviços de saúde: um estudo de base populacional no Sul do Brasil Abstract In order to assess the prevalence of having a regular doctor, associated factors, and the effects on health services utilization, a cross-sectional study was performed in Rio Grande, Brazil, from January to May 2000. A total of 1,260 individuals 15 years or over were interviewed. Adjusted prevalence ratios and 95% confidence intervals were calculated, using a Poisson regression model. Some 37% of the sample had a regular doctor. Adjusted analysis revealed a direct and linear association with income. Female gender, age, private health insurance coverage, and chronic health problems were also associated with the outcome. Having a regular physician was associated with a 51% increase in clinical breast examination and a 62% increase in cervical cancer screening during the previous year, as well as a 98% increase in prostate cancer screening in the previous year in men 40 years or over. The study concluded that the prevalence of having a regular doctor in Brazil is low and is directly associated with socioeconomic factors. Individuals with a regular physician tend to have better access to health services. The promotion of consultation with a regular doctor among the population may improve health care quality and health services access, particularly in the poorest groups. Resumo Com a finalidade de estudar a prevalência do médico de referência, os fatores associados e seu efeito na utilização de serviços de saúde, foi realizado um estudo transversal, na cidade de Rio Grande, Brasil, entre janeiro e maio de 2000. Um total de 1.260 pessoas com 15 anos ou mais foram entrevistados. Calcularam-se as razões de prevalência e os intervalos de confiança de 95%, utilizando o modelo de Poisson. A prevalência de médico de referência foi de 37%. A análise ajustada mostrou uma associação direta e linear com renda. Sexo feminino, idade, seguro de saúde e problema crônico de saúde também associaram-se com o desfecho. Ter um médico de referência provocou um aumento de 51% na probabilidade de realizar um exame clínico de mama, e de 62% de realizar a prevenção do câncer de colo, durante o último ano. Nos homens, aumentou a probabilidade de realizar um exame de próstata em 98%, para o mesmo período. Pode-se concluir que a prevalência do médico de referência no Brasil é baixa e associada diretamente aos fatores sócio-econômicos. Pessoas com esta caraterística tem melhor acesso a serviços de saúde. A promoção do médico de referência na população pode melhorar o acesso aos serviços de saúde e melhorar a qualidade da atenção, especialmente nos grupos mais pobres.
Ciência, Cuidado e Saúde, 2015
The purpose of this study is to analyze differences and similarities between the Family Health Strategy (FHS) program and the Traditional Basic Health Unit (TBHU) in the view of users and health professionals, in a municipality of about 220,000 inhabitants. For data collection, questionnaires prepared with Primary Care Assessment Tool (PCAT) components were answered by 142 TBHU and 147 FHS professionals and by 199 TBHU and 197 FHS users. A significance level α equal to 5% (p ≤ 0.05) was used for analysis, and the Wilcoxon test, for comparison. The FHS was better rated in the majority of the dimensions analyzed, in the view of users and professionals. In the professionals' opinion, the TBHU was better in access, whereas the entrance domain showed no statistically significant difference when compared with the evaluation done by FHS professionals. Access and services were better evaluated by TBHU users comparatively with FHS users. Nevertheless, both models have important challenges, despite the better results of the FHS.
The Program for the Improvement of Primary Care Access and Quality (PMAQ) in Brazil
Sociedade e Cultura, 2018
INTERVIEW WITH JAMES MACINKO - James Macinko is a Professor and researcher in public health policy and health systems research and equity, with extensive experience in primary care throughout the world, including the Brazilian Family Health Strategy. He is currently Professor of Health Policy and Management and Community Health Sciences at the UCLA Fielding School of Public Health. He previously held positions as Associate Professor of Public Health and Health Policy at New York University and former director of the NYU MPH program. He was a Robert Wood Johnson Foundation Health and Society Scholar at the University of Pennsylvania from 2006 to 2008 and a Fulbright Scholar in Brazil in 2002. He has worked and still works on several collaborative projects with Brazilian public health researchers and has been involved in both formal and informal consultations with the Department of Basic Care at the Brazilian Ministry of Health (DAB/MoH). This includes his participation in an international seminar on the PMAQ organized by the DAB/MoH and official support to lead the edition of JACM’s supplementary number on PMAQ, published in 2017.
Quality and effectiveness of different approaches to primary care delivery in Brazil
BMC health services research, 2006
Since 1994, Brazil has developed a primary care system based on multidisciplinary teams which include not only a physician and a nurse, but also 4-6 lay community health workers. This system now consists of 26,650 teams, covering 46% of the Brazilian population. Yet relatively few investigations have examined its effectiveness, especially in contrast with that of the traditional multi-specialty physician team approach it is replacing, or that of other existing family medicine approaches placing less emphasis on lay community health workers. Primary health care can be defined through its domains of access to first contact, continuity, coordination, comprehensiveness, community orientation and family orientation. These attributes can be ascertained via instruments such as the Primary Care Assessment Tool (PCATool), and correlated with the effectiveness of care. The objectives of our study are to validate the adult version of this instrument in Portuguese, identify the extent (quality)...
Revista de Pesquisa: Cuidado é Fundamental Online, 2016
Objetivo: Compreender, na percepção dos profissionais e gestores da Atenção Primária à Saúde (APS), o sistema de referência e contrarreferência na atenção à saúde e o suporte às decisões dos profissionais da APS.Métodos: Estudo qualitativo, delineado pelo Estudo de Casos Múltiplos Holísticos, fundamentado na Sociologia Compreensiva do Cotidiano com 41 participantes. Resultados: O suporte às decisões dos profissionais da APS ao encaminhar os usuários é dependente do fluxo e da regulação das demandas referenciadas; do tempo de espera do usuário para o atendimento; pode ser prejudicado pelos encaminhamentos desnecessários e ilegíveis e pela visão dos profissionais sobre o sistema.Conclusão: A Saúde é um processo social, de construção coletiva, e que precisa vencer o paradigma assistencialista e curativista, o consumo excessivo de consultas com elevado índice de encaminhamentos.
The Journal of ambulatory care management
The objective of this study was to examine the experience of primary care center (PCC) users in Brazil, classified according to the quality of its structure, in relation to the aspects of accessibility, continuity, and acceptability. The source of information was the National Program to Improve Access and Quality of Primary Care in 2013-2014. A total of 109 919 interviewees in 24 055 PCCs comprised the sample. Results show that the structure of a PCC was associated with better indicators of accessibility (oral health and medicines) and continuity of care (patient navigation in the health system). No association was found between indicators of accessibility and the PCC structure.