Primary care and healthcare utilization among older Brazilians (ELSI-Brazil)

Abstract

OBJECTIVE To characterize healthcare access and utilization among older Brazilians.METHODS Data are from the baseline wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), which is a nationally representative, population-based cohort study of persons aged 50 years and older conducted in 2015/2016 (n = 9,412). The prevalence of barriers to primary care and number and type of doctor visits in the past 12 months are compared by three main sources of healthcare (private, Family Health Strategy, traditional public clinics). Two-part multivariable hurdle analyses assess the relation between healthcare utilization, primary care problems, and source of healthcare, while controlling for healthcare determinants.RESULTS Females comprised 54% of the sample, with a mean age of 63 years. There were no demographic differences by source of healthcare. Nearly 83% had at least one doctor visit in the past 12 months, with higher use among private health plan holders. Private health plan holders most frequently visited specialists, while those using the public system were more likely to visit a general practitioner. Primary care barriers averaged 3.5 out of 12 and were the highest among those using traditional health posts. A greater number of primary care problems was negatively associated with all types of healthcare utilization.CONCLUSIONS By international standards, access to basic healthcare among older Brazilians is relatively high. Nevertheless, different levels of primary care problems between the public and private sectors and resulting utilization patterns suggest the need to continue working to close remaining gaps.

AMPI-AB validity and reliability: a multidimensional tool in resource-limited primary care settings

“…According to international standards, Brazilian older adults have high access to primary care, however, many hospital admissions could be prevented by more effective prevention and treatment actions at this level of care [21]. Differences in the performance of primary care units are found and there is a continued need to update and adapt the model of healthcare delivery [21].…”

“…According to international standards, Brazilian older adults have high access to primary care, however, many hospital admissions could be prevented by more effective prevention and treatment actions at this level of care [21]. Differences in the performance of primary care units are found and there is a continued need to update and adapt the model of healthcare delivery [21]. Lowincome and lower-middle-income countries could benefit from the large-scale implementation of simple and short CGA instruments such as the AMPI-AB, that can be applied by any trained healthcare professionals, allowing the standardization of the assessment of older adults in primary care.…”

Aging and public health

“…High levels of social inequality are found in the majority of topics investigated, with the poorest or those with lower educational level affected most. Inequalities are observed in physical activity 7 , oral health status 8 , limitations to perform basic activities of daily living 9 , frailty 10 , adequate control of hypertension 11 , underutilization of medications due to financial reasons 12 , source of health care 13 , and capacity to work 14 . Social participation 15 and the fear of falling 16 are associated with the urban environment.…”

Incapacidade funcional em idosos cadastrados na Estratégia Saúde da Família nos municípios de São Paulo e Manaus: prevalência e fatores associados

“…Atualmente, três quartos da população brasileira acima de 49 anos têm pelo menos uma doença crônica (Macinko et al, 2018). Controlar as doenças crônicas se faz necessário como estratégia de prevenção, visto serem prevalentes na população idosa e poderem influenciar na incapacidade funcional dessa população (Sousa et al, 2009).…”

“…Em 2017, mais de 30 milhões de brasileiros tinham 60 anos ou mais (IBGE, 2018a) e aproximadamente dois terços tratavam seus problemas de saúde no SUS (Macinko et al, 2018). De acordo com a Política Nacional do Idoso, a Atenção Primária é a principal porta de entrada para os serviços públicos de saúde que, dentre outras prioridades, intervem nas condições de saúde que podem resultar em incapacidade funcional (Brasil, 2006a (Brasil, 2006b).…”