Maria Guadalupe Medina

Perfil do idoso em área metropolitana na regiäo sudeste do Brasil: resultados de inquérito domiciliar

A multicentre study concerned with the health needs of the elderly population living in urban areas and coordinated by the Panamerican Health Organization was undertaken in 6 Latin-American countries. In Brazil, 1,602 elderly residents (of 60 years of age and over) in the District of S. Paulo, constituting a multistage random sample stratified by socioeconomic status, participated in a household survey using a multidemensional functional assessment questionnaire. The results showed a highly deprived population (70% had a per capita income of less than US

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

100 per month), living mostly in multigenerational households (59% were living with children and/or grandchildren), with a high prevalence of chronic physical illnesses (only 14% referred no illness) and psychiatric disorders (27% were considered psychiatric cases), a high proportion of them showing a loss of autonomy (47% needed help in performing at least one of the activities of daily living). The results are put into perspective concerning future needs in terms of specialized health services and social support for the growing population of elderly people in Brazil.Trata-se de estudo multicentrico visando levantar as necessidades de saude da populacao de idosos residentes em zona urbana, conduzido em 6 paises na America Latina e coordenado pela Organizacao Panamericana da Saude. No Brasil, 1.602 idosos (60 anos e +) residentes no Distrito de Sao Paulo, participaram de inquerito domiciliar com questionario de avaliacao funcional multidimensional - amostra populacional aleatoria, em multiplos estagios, estratificada por nivel socioeconomico. Os resultados mostraram uma populacao bastante carente (70% tinha uma renda per capita de menos de 100 dolares por mes), vivendo predominantemente em domicilios multigeracionais (59% viviam com os filhos e/ou com netos), com alta prevalencia de doencas cronicas (somente 14% referiu nao ter nenhuma doenca) e disturbios psiquiatricos (27% foram considerados casos psiquiatricos), e com uma elevada proporcao de pessoas com perda de autonomia (47% precisavam de ajuda para realizar pelo menos uma das atividades da vida diaria). Os resultados sao analisados tendo em vista as demandas futuras por servicos de saude especializados e suporte social por parte da crescente populacao de idosos no Brasil.

Trends in primary health care-sensitive conditions in Brazil: the role of the Family Health Program (Project ICSAP-Brazil)

In 1994 Brazil launched what has since become the worlds 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.

Principais causas de internação por condições sensíveis à atenção primária no Brasil: uma análise por faixa etária e região

BackgroundThis study describes trends in hospital admission rates for primary healthcare-sensitive conditions (PHCSC) in Brazil. ObjectivesTo evaluate the impact of increased primary healthcare availability through the implementation of the Family Health Program (FHP) on PHCSC admissions rates at the national, regional, and state-levels between 1999 and 2007. Research DesignAn ecologic panel data study was used and a fixed effects multivariate negative binomial model was used to estimate the association of PHCSC admission rate and FHP controlling for other relevant covariates. ResultsIt was shown that, at the national level, PHCSC hospital admissions declined by 24%—over 2.5 times more rapidly than the decline in hospitalizations for all other (non-PHCSC) conditions. Greater reductions in the PHCSC admission rates when compared with the non-PHCSC admission rates were also observed when the data were divided by regions and states. Regression models showed that at the state level the greater the FHP coverage, the less was the PHCSC hospital admissions even when controlling for confounding variables. ConclusionsThe results of this study have important implications for the healthcare model in countries that base their national health systems on primary healthcare. This is the first study to evaluate the association between FHP coverage and PHCSC admissions rates in all the Brazilian states over a long and relevant period for the consolidation of FHP in the country.

Análisis multifactorial de los factores de riesgo de bajo peso al nacer en Salvador, Bahia

OBJETIVOS: analisar as tendencias das principais causas de internacoes hospitalares entre aquelas sensiveis a atencao primaria (ICSAP) no Brasil, por faixa etaria e regiao, no periodo de 1999 a 2006. METODOS: trata-se de um estudo ecologico misto das tendencias das tres principais causas de ICSAP em menores de vinte anos. Os dados secundarios foram provenientes do Sistema de Informacao Hospitalar (SIH-SUS) e do censo demografico do ano de 2001 e projecoes populacionais do Instituto Brasileiro de Geografia e Estatistica (IBGE). RESULTADOS: as tres principais causas de ICSAP, em menores de 20 anos, foram as gastroenterites, asma e as pneumonias bacterianas. Houve reducao das taxas de internacao por gastroenterites (-12,0%) e asma (-31,8%) e, incremento de 142,5% nas taxas de internacoes por pneumonias bacterianas, tendencias que ocorreram de forma distinta por faixa etaria e regiao. CONCLUSOES: a descricao das tendencias temporais revelou mudancas positivas na evolucao das taxas de internacoes por asma e gastroenterites infecciosas e negativas nas internacoes por pneumonia. Uma vez que estes problemas de saude constituem objeto de intervencao prioritaria na atencao primaria, tais achados evidenciam a necessidade de se aprofundar a analise e reflexao sobre os determinantes do perfil das internacoes hospitalares no pais.

The role of the Family Health Program in the organization of primary care in municipal health systems

El presente estudio constituye un analisis multifactorial de los factores de riesgo de bajo peso al nacer en un grupo de recien nacidos en una zona urbana del Brasil. Se incluyeron en el estudio un total de 1 023 nacidos vivos, dados a luz en cuatro maternidades de Salvador, Bahia, entre julio de 1987 y febrero de 1988. Las fuentes de informacion fueron las historias clinicas y las entrevistas con las madres en la maternidad. El analisis se realizo mediante regresion logistica. En el modelo final los factores de riesgo incluidos fueron los siguientes: edad materna menos de 21 anos o mas de 35; edad gestacional menos de 38 semanas; resultado desfavorable del embarazo anterior; intervalo intergenesico previo de 12 meses o menos; tabaquismo; e hipertension. Se presentan los valores del riesgo atribuible poblacional para los factores de riesgo incluidos en el modelo final. Esos factores deben emplearse para detectar a las gestantes con alto riesgo de dar a luz un nino de bajo peso, a las que debe brindarse mayor atencion prenatal.

Atenção primária à saúde: estrutura das unidades como componente da atenção à saúde

The contribution of primary care to population health and health systems organization has been well documented, but some authors have highlighted that in Third World countries it has gained more ground in discourse than in facts and practices, with different possible configurations. The objectives of the current study were to evaluate and correlate organizational and local contextual characteristics to the degree of implementation of primary care in two municipalities (counties) in the State of Bahia State, Brazil, that had adopted the Family Health Program (FHP) as the systems central thrust. The research was based on two case studies with interwoven levels of analysis, using as the point of departure the underlying goal-image of primary care in the definition of criteria and standards for degree of implementation. The total scores for Municipalities A and B were 66 and 81, respectively (maximum total score = 100), while differences were observed between the urban and rural teams. The political and institutional contexts helped explain differences in the degree of implementation of primary care, but regardless of the municipal context, the study showed the emergence of organizational innovations closely related to the FHP.

Acessibilidade a atenção básica em um distrito sanitário de Salvador

OBJECTIVES: to assess the structure of the primary health care units in two municipalities, comparing the Family Health Units(FHU) and the conventional units. METHODS: a quantitative cross-sectional study was carried out using structured interviews and observation of the work routine of the teams as data collection techniques. Three components were evaluated: the physical environment, material resources, and staff. RESULTS: the findings provided evidence of structural shortcomings in all three components, these being more serious in the Family Health Units. The shortcomings in terms of physical structure were more serious in municipality B, where the items under evaluation were fund in less than 70% of FHUs. In both municipalities, less than 50% of units had basic equipment. In municipality A, all the conventional units had doctors and nurses, while in municipality B, 27.3% of FHUs had no doctor. Shortcomings were revealed that jeopardize biosafety and there was an absence of structures that favor the development of the kind of collective intervention that is necessary for changing the model of care by placing more emphasis on health surveillance. CONCLUSIONS: although the chains of causation that link the structure of health services to their effects are complex and involve various factors, the study findings reiterate the need for more attention to be paid to structural components when evaluating health management.

Acessibilidade geográfica à atenção primária à saúde em distrito sanitário do município de Salvador, Bahia

The demand for and use of health services results from a set of determinants that include socioeconomic, demographic and health characteristics and organization of the supply of services. The scope of this paper is to define access to and use of the health services in two Family Health Units (FHUs) of the sanitary district of Liberdade, establishing the pattern of use and identifying factors related to socio-organizational and geographical access. A cross-sectional population-based survey was conducted on individuals aged between 20 and 75 resident in the area covered by the two FHUs. Access to health services was analyzed based on the socio-organizational and geographic characteristics and according to the demand for medical appointments. Over 50% of respondents sought the service of FHUs and of these 78.7% reported attending the appointment. With respect to organizational access, problems were encountered, such as long waiting times for consultation. Geographical barriers were ascertained in the use of FHUs, but these did not prevent the realization of medical consultation. The use of FHUs was higher among people with lower socioeconomic status.

Efeito da Estratégia Saúde da Família na vigilância de óbitos infantis

OBJECTIVES: to assess the geographical accessibility of primary health care for the population served by the Community Health Agents Program (PACS) and the Family Health Program (PSF) in one sanitary district in the city of Salvador, Brazil. METHODS: a evaluative cross-sectional study was carried out. The data were collected using interviews with health workers from the eleven PACS and PSF teams. Analysis of the data took two factors into account: access of the population and the logic of territorialization. RESULTS: the district has a relatively rugged landscape and all the teams reported the existence of geographical barriers in the area, in particular steps and steep hills. There was no difference in accessibility between the PACS and the PSF. The process of territorialization was unrelated to the concept of territory as a process. Some areas covered by the teams were located some distance from the UBS and this constituted a significant obstacle to access. CONCLUSIONS: the implantation of the PACS/PSF strategy in the district and the model of territorialization were not in line with the principles that should guide primary health care, resulting in geographical restrictions on access for the population served. It is recommended that the current territorial design be reviewed to ensure that it is more line with PSF guidelines and to enable better access to primary care.