Major Expansion Of Primary Care In Brazil Linked To Decline In Unnecessary Hospitalization

Abstract

In 1994Brazil launched what has since become the world's largest community-based primary health care program. Under the Family Health Program, teams consisting of at least one physician, one nurse, a medical assistant, and four to six trained community health agents deliver most of their services at community-based clinics. They also make regular home visits and conduct neighborhood health promotion activities. This study finds that during 1999-2007, hospitalizations in Brazil for ambulatory care-sensitive chronic diseases, including cardiovascular disease, stroke, and asthma, fell at a rate that was statistically significant and almost twice the rate of decline in hospitalizations for all other causes. In municipalities with high Family Health Program enrollment, chronic disease hospitalization rates were 13 percent lower than in municipalities with low enrollment, when other factors were held constant. These results suggest that the Family Health Program has improved health system performance in Brazil by reducing the number of potentially avoidable hospitalizations.

Risco de interpretação falaciosa das internações por condições sensíveis à atenção primária em contextos locais, Itaboraí, Rio de Janeiro, Brasil, 2006-2011

“…An important contribution by this study and that corroborates other recent studies is the need for caution when interpreting results and making inferences associating a reduction in admissions for PCSCs with success in primary care interventions such as the FHS, although more robust ecological studies may be relevant and efficient in more global evaluations 19,20 . In more localized studies, it is essential to grasp contextual issues, sometimes highly specific, that can help explain the event.…”

“…Brazil has also seen analytical ecological studies that have associated the decline in admissions for PCSCs with the expansion of primary care by the Family Health Strategy (FHS) 19,20 , as well as descriptive studies on the correlation between the decline in the rates or proportions of admissions for PCSCs and the strategy's expansion in more limited geographic areas 21,22,23 .…”

Tipologia da estrutura das unidades básicas de saúde brasileiras: os 5 R

“…Há evidências de que a expansão da ESF teve impactos positivos sobre a saúde da população, com redução da mortalidade infantil 40 , da mortalidade cardio e cerebrovascular 41 e de internações por condições sensíveis à atenção primária 42 . E esses avanços foram implantados em cenário de carência estrutural, o que nos faz indagar o muito que poderá ser realizado com a reversão dos principais constrangimentos estruturais identificados.…”

A qualidade da Atenção Primária à Saúde na Rocinha – Rio de Janeiro, Brasil, na perspectiva dos cuidadores de crianças e dos usuários adultos

“…On the other hand, studies point to the heterogeneity of the quality of care provided by the ESF, which offers diversified portfolios of health services and actions to respond to the attribute of the sometimes insufficient comprehensiveness [5][6][7][8] . Some of these findings highlight better performance in mother and child health outcomes [9][10][11][12][13] , others point to reduced hospitalizations due to PHC-sensitive causes [14][15][16][17] , while others show a clinically insufficient performance.…”