Suele Manjourany Silva Duro

Socioeconomic inequalities in the access to and quality of health care services

OBJECTIVE To assess the inequalities in access, utilization, and quality of health care services according to the socioeconomic status. METHODS This population-based cross-sectional study evaluated 2,927 individuals aged ≥ 20 years living in Pelotas, RS, Southern Brazil, in 2012. The associations between socioeconomic indicators and the following outcomes were evaluated: lack of access to health services, utilization of services, waiting period (in days) for assistance, and waiting time (in hours) in lines. We used Poisson regression for the crude and adjusted analyses. RESULTS The lack of access to health services was reported by 6.5% of the individuals who sought health care. The prevalence of use of health care services in the 30 days prior to the interview was 29.3%. Of these, 26.4% waited five days or more to receive care and 32.1% waited at least an hour in lines. Approximately 50.0% of the health care services were funded through the Unified Health System. The use of health care services was similar across socioeconomic groups. The lack of access to health care services and waiting time in lines were higher among individuals of lower economic status, even after adjusting for health care needs. The waiting period to receive care was higher among those with higher socioeconomic status. CONCLUSIONS Although no differences were observed in the use of health care services across socioeconomic groups, inequalities were evident in the access to and quality of these services.OBJECTIVE To assess the inequalities in access, utilization, and quality of health care services according to the socioeconomic status. METHODS This population-based cross-sectional study evaluated 2,927 individuals aged ≥ 20 years living in Pelotas, RS, Southern Brazil, in 2012. The associations between socioeconomic indicators and the following outcomes were evaluated: lack of access to health services, utilization of services, waiting period (in days) for assistance, and waiting time (in hours) in lines. We used Poisson regression for the crude and adjusted analyses. RESULTS The lack of access to health services was reported by 6.5% of the individuals who sought health care. The prevalence of use of health care services in the 30 days prior to the interview was 29.3%. Of these, 26.4% waited five days or more to receive care and 32.1% waited at least an hour in lines. Approximately 50.0% of the health care services were funded through the Unified Health System. The use of health care services was similar across socioeconomic groups. The lack of access to health care services and waiting time in lines were higher among individuals of lower economic status, even after adjusting for health care needs. The waiting period to receive care was higher among those with higher socioeconomic status. CONCLUSIONS Although no differences were observed in the use of health care services across socioeconomic groups, inequalities were evident in the access to and quality of these services.

Estrutura e processo de trabalho na prevenção do câncer de colo de útero na Atenção Básica à Saúde no Brasil: Programa de Melhoria do Acesso e da Qualidade – PMAQ

Objectives: to outline and examine the adequacy of the structure and processes used by Access and Quality Improvement Program (PMAQ-AB) teams to prevent cervical cancer during basic care in Brazil. Methods: a cross-sectional study was carried out at all basic health units (BHUs), between 2012 and 2013. The prevalence of adequate structure (infrastructure and materials) and working processes for conducting the Pap test was calculated. The association of adequacy with characteristics of the units and their teams were measured using the prevalence ratio (PR) and confidence intervals of 95% (CI95%). Results: 38,812 BHUs and 17,202 healthcare teams were studied. The prevalence of adequate structure and working processes was 49% and 30%, respectively. The adequacy of structure and processes was associated positively with largely size of municipality and higher HDI. The prevalence of adequate structure was higher at units adopting the Family Health Strategy (PR=1.35; CI95%: 1.33-1.38) and the adequacy of their working processes was associated with having a registered population of <4,000 individuals and full minimal team. Conclusions: the structure and processes used to screen for cervical cancer need to be improved. Healthcare teams need to provide better quality intervention in relation to this program.

Consumo de carnes por adultos do sul do Brasil: um estudo de base populacional

This paper is the result of a cross-sectional population-based study that evaluated individuals aged 20 or more living in the urban area of Pelotas in the state of Rio Grande do Sul and sought to describe the frequency of meat consumption and the habit of eating meat with an excess of fat. It evaluated the consumption over the past year of red meat (including bone, steak and ground beef), white meats (chicken and fish) and viscera and processed meats. Of the 2,730 people interviewed, 99.1% (CI95% 98.7 - 99.5) consumed some type of meat over the past year, while around 32% reported daily consumption. The prevalence of consumption of red meat (99.3% CI95% 98.9 - 99.6) and white meat (99.4% CI95% 99.1 - 99.7) was similar. Chicken was the meat most consumed by interviewees (98.0% CI95% 97.4 - 98.5), while viscera were the least consumed (59.1% CI95% 56.4 - 61.7). The processed meats consumed by 85.5% (CI95% 83.7 - 87.2) of the respondents, presented the highest prevalence of daily consumption (16.6%). Meats with excess of fat were consumed by 52.3% (CI95% 49.8 - 54.8) of adults, especially men and people of lower education and economic status.

Perfil de utilização de serviços de saúde por crianças de zona urbana no Brasil: estudo transversal de base nacional

Objectives: to describe the pattern of use of health services by Brazilian children aged under five years. Methods: a population-based cross-sectional study was conducted in 2009 with children from 100 municipalities across five regions of Brazil. Use of the following types of health care was investigated: house-calls and outpatients doctor - previous three months - and emergency services and admission to hospital – previous twelve months. The independent variables were: sex, age, household income, level of schooling of mother, family receiving Family Grant Program benefits, having had an acute health problem, nutritional status, size of municipality, and region. Raw analyses and analyses adjusted for the association between the use of health services and economic status were carried out using Poissons regression as a robust adjustment of variance. Results: of the 6,360 children, 3,422 (54%) were attended by a physician, 506 (8%) received a housecall, 2,144 (34%) were attended by emergency services and 681 (11%) were hospitalized. Children from socioeconomic class A/B consulted a doctor more, received fewer house-calls, and used the emergency services more than children from classes C and D/E. There was no difference in the frequency of admission to hospital according to socioeconomic status. Conclusions: the findings point to significant inequalities in the use of health services by Brazilian children.

Utilização dos serviços de saúde por adolescentes: estudo transversal de base populacional, Pelotas-RS, 2012

OBJECTIVE: to describe the prevalence and characteristics of health service use by adolescents in the urban area of Pelotas-RS, Brazil. METHODS: a population-based cross-sectional study was conducted with 743 adolescents aged 10 to 19 years; the outcome was health service use in the thirty days preceding the interview. RESULTS: of the total sample, 23.0% (95%CI: 19.4;26.6) used health services; of these, 38% used private or health plan services and 32.2% used public health services; the SUS financed more than half (52.1%) of care; the main reasons for health service use was health problems (69.0%) and follow-up appointments (18.7%); the reasons for choosing the service were nearness to home (23.4%), preference for commonly used services (22.8%) and choice made by parents or guardians (21.1%). CONCLUSION: health service use was high and its characteristics can contribute to the planning of adolescent health care.

Social inequalities in care for the elderly with diabetes in Brazil

ABSTRACT Objective. To measure the prevalence of various care services offered to the elderly with diabetes mellitus in Brazil, and to assess the social inequalities in these services. Methods. This cross-sectional, population-based study was carried out in 2013. The care services offered were evaluated in terms of the following eight indicators: recommendations to lower carbohydrates, to measure blood glucose, and to examine the feet; requests made for blood tests, for glycated hemoglobin tests, and for glycemic curve tests; and whether service users had had their eyes or feet examined in the previous year. We used the slope index of inequality and the concentration index to assess the inequalities among wealth quintiles. Results. A total of 1 685 elderly persons with diabetes were evaluated. Overall, 41.7% of them had had their eyes examined in the preceding year, 35.4% had had their feet examined in the preceding year, and 10.9% had been offered all eight of the care services. The largest absolute differences (in percentage points) between the first (poorest) and fifth (richest) wealth quintiles in terms of the care services that were offered to the users were for: a recommendation to measure blood glucose (25.8), a glycated hemoglobin test request (27.4), a glycemic curve test request (31.9), having the eyes examined in the preceding year (29.3), and having the feet examined in the preceding year (27.0). Conclusion. There were notable inequalities in the prevalences of the care services. In the future, measurement of blood glucose and examination of the feet should be emphasized, especially for elderly persons in a lower socioeconomic level.

Utilization of Breast Cancer Screening in Brazil: An External Assessment of Primary Health Care Access and Quality Improvement Program

Abstract Breast cancer is the most frequent type of cancer in women and the second leading cause of cancer death after lung cancer in more developed countries and the leading cause of death in developing countries. The aim of this study was to analyze the association between three sets of variables and the utilization of breast cancer screening among women attending primary health care centers participating in the Primary Care Access and Quality Improvement Program in Brazil. A survey of 65,391 women was conducted across Brazil in 2012. The primary outcomes were percentage of women who never had a clinical breast examination and percentage of women who never had a mammography. Crude and adjusted analyses performed using Poisson regression assessed the association of these outcomes with service organization variables, as well as with socioeconomic and demographic variables. Results showed that 37.7% of women never had a clinical breast examination and 30.3% never had a mammography. Never having had both screening procedures decreased as the Human Development Index increased. Never having had a clinical breast examination increased with increasing population size and increasing municipal family health strategy coverage. The proportion of women never having had a clinical breast examination was highest in the northern region. White women and those who had a partner had greater utilization of screening. Women who had paid work and lived in families with higher per capita income had greater utilization of clinical breast examination. The proportion of women who never had a mammography was highest for women living in households with six or more people and receiving the Bolsa Família benefit. Women with lower per capita family income had higher utilization of mammography. Appropriate structures and work processes were associated with greater utilization of mammography. Investments in primary health care structure and teamworking processes are essential to improve the utilization of screening, prevention, and early diagnosis of breast cancer in Brazil.

Adolescent use of health services: a population-based cross-sectional study Pelotas-RS, Brazil, 2012

OBJECTIVE: to describe the prevalence and characteristics of health service use by adolescents in the urban area of Pelotas-RS, Brazil. METHODS: a population-based cross-sectional study was conducted with 743 adolescents aged 10 to 19 years; the outcome was health service use in the thirty days preceding the interview. RESULTS: of the total sample, 23.0% (95%CI: 19.4;26.6) used health services; of these, 38% used private or health plan services and 32.2% used public health services; the SUS financed more than half (52.1%) of care; the main reasons for health service use was health problems (69.0%) and follow-up appointments (18.7%); the reasons for choosing the service were nearness to home (23.4%), preference for commonly used services (22.8%) and choice made by parents or guardians (21.1%). CONCLUSION: health service use was high and its characteristics can contribute to the planning of adolescent health care.

Uso de servicios de salud por adolescentes: estudio transversal de base poblacional Pelotas-RS, 2012

OBJECTIVE: to describe the prevalence and characteristics of health service use by adolescents in the urban area of Pelotas-RS, Brazil. METHODS: a population-based cross-sectional study was conducted with 743 adolescents aged 10 to 19 years; the outcome was health service use in the thirty days preceding the interview. RESULTS: of the total sample, 23.0% (95%CI: 19.4;26.6) used health services; of these, 38% used private or health plan services and 32.2% used public health services; the SUS financed more than half (52.1%) of care; the main reasons for health service use was health problems (69.0%) and follow-up appointments (18.7%); the reasons for choosing the service were nearness to home (23.4%), preference for commonly used services (22.8%) and choice made by parents or guardians (21.1%). CONCLUSION: health service use was high and its characteristics can contribute to the planning of adolescent health care.