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1.
Rev Panam Salud Publica ; 43: e47, 2019.
Artigo em Português | MEDLINE | ID: mdl-31139211

RESUMO

Objective: To present a methodology for the empirical evaluation of primary health care (PHC) through the construction of digital representations of potential PHC coverage areas. Methods: In this methodological study, potential areas were constructed by combinatorial analysis between census tracts and the location of basic health units with working PHC teams in Brazil. Six rules were used to parameterize the algorithm for the construction of potential areas. Thus, six restrictions were applied to enable the model: the selection of census tracts near the basic health unit; contiguous sectors; mutually exclusive sectors; sectors located in the same municipality of basic health units; sum of 4 500 users per health team in each unit; and volume of population ascribed proportional to the number of PHC teams allocated to the unit. Based on 316 594 census tracts and 39 758 basic health units, a neighborhood matrix was developed. To that matrix, a graph algorithm was applied to test combinations of sectors that simultaneously met the stipulated rules. Results: A total of 1 901 114 arcs were defined, connecting 30 351 census tracts, allowing the construction of 26 907 potential areas. Based on these results, intra-municipal analyses can be performed to monitor PHC indicators. Customizable algorithm parameters can be adjusted to accommodate different sets of rules which may be adapted to different countries. Conclusions: The use of geoprocessing approaches creates conditions for the assessment of PHC impact, based on secondary databases at various levels, such as intra-municipal, basic health unit, and even at the team level.

2.
Rev Panam Salud Publica ; 43, may 2019https://doi.org/10.26633/RPSP.2019.47.
Artigo em Português | PAHO-IRIS | ID: phr-50987

RESUMO

[RESUMO]. Objetivo. Apresentar metodologia para avaliação empírica da atenção primária à saúde (APS) por meio da construção de representações digitais das áreas de cobertura potencial das equipes da APS. Métodos. Estudo de natureza metodológica. As áreas potenciais foram construídas por análise combinatória entre setores censitários e localização das unidades básicas de saúde (UBS) que apresentavam equipes de APS no Brasil. Foram utilizadas seis regras para parametrizar o algoritmo de construção das áreas potenciais. Assim, foram estipuladas seis restrições que viabilizaram o modelo utilizado: seleção de setores censitários próximos à UBS; setores contíguos; setores mutuamente excludentes; setores localizados no mesmo município da UBS; somatório de 4 500 usuários por equipe de saúde em cada UBS; e volume de população adscrita proporcional ao número de equipes de APS alocadas na UBS. A partir de 316 574 setores censitários e 39 758 UBS, foi desenvolvida uma matriz de vizinhança sobre a qual iterou um algoritmo de grafo que testava combinações de setores que atendessem simultaneamente as regras estipuladas. Resultados. Foram definidos 1 901 114 de arcos ligando 3 351 setores censitários, permitindo a construção de 26 907 áreas potenciais. A partir desse resultado é possível fazer análises inframunicipais no que tange ao monitoramento de indicadores da APS. Os parâmetros customizáveis do algoritmo podem ser ajustados para contemplar diferentes conjuntos de regras e adaptados para diferentes países. Conclusões. O uso de abordagens amparadas em geoprocessamento pode criar condições para avaliação do impacto da APS, levando-se em conta bases de dados secundárias e com nível de análise inframunicipal, de UBS e até mesmo de equipes.


[ABSTRACT]. Proposal for a methodology to estimate the potential coverage of primary care teams Objective. To present a methodology for the empirical evaluation of primary health care (PHC) through the construction of digital representations of potential PHC coverage areas. Method. In this methodological study, potential areas were constructed by combinatorial analysis between census tracts and the location of basic health units that presented PHC teams in Brazil. Six rules were used to parameterize the algorithm for the construction of potential areas. Thus, six restrictions were applied to enable the model: the selection of census tracts near the UBS; contiguous sectors; mutually exclusive sectors; sectors located in the same municipality of basic health units; the sum of 4 500 users per health team in each unit; and volume of population ascribed proportional to the number of PHC teams allocated to the unit. Based on 316 594 census tracts and 39 758 basic health units, a neighborhood matrix was developed. To that matrix, a graph algorithm was applied to test combinations of sectors that simultaneously met the stipulated rules. Results. A total of 1 901 114 arcs were defined, connecting 3 351 census tracts, allowing the construction of 26 907 potential areas. Based on these results, intra-municipal analyses can be performed to monitor PHC indicators. Customizable algorithm parameters can be adjusted to accommodate different sets of rules which may be adapted to different countries. Conclusions. The use of geoprocessing approaches creates conditions for the assessment of PHC impact, based on secondary databases at various levels, such as intra-municipal, basic health unit, and even at the team level.


[RESUMEN]. Propuesta de una metodología para estimar el área de cobertura potencial de los equipos de atención primaria Objetivo. Presentar una metodología para la evaluación empírica de la atención primaria de salud (APS) a través de la construcción de representaciones digitales de las áreas de cobertura potencial de los equipos de APS. Método. Estudio de tipo metodológico. Las áreas potenciales se construyeron mediante un análisis combinatorio entre los sectores censales y la localización de las unidades básicas de salud que presentaban equipos de APS en Brasil. Se utilizaron seis reglas para parametrizar el algoritmo de construcción de las áreas potenciales. Así, se estipularon seis restricciones que viabilizaron el modelo utilizado: selección de sectores censales cercanos a la unidad básica de salud; sectores contiguos; sectores mutuamente excluyentes; sectores ubicados en el mismo municipio de la unidad básica de salud; suma de 4 500 usuarios por equipo de salud en cada unidad básica de salud; y volumen de población adscrita proporcional al número de equipos de APS asignados en la unidad básica de salud. A partir de 316 574 sectores censales y 39 758 unidades básicas de salud se desarrolló una matriz de vecindad sobre la cual se aplicó un algoritmo gráfico que evaluaba las combinaciones de sectores que cumplían simultáneamente las reglas estipuladas. Resultados. Se definieron en total 1 901 114 arcos, que conectaron 3 351 sectores censales, lo que permitió la construcción de 26 907 áreas potenciales. Sobre la base de estos resultados, se pueden realizar análisis intramunicipales para monitorear los indicadores de APS. Los parámetros modificables del algoritmo se pueden ajustar para adaptarse a diferentes conjuntos de reglas y a diferentes países. Conclusiones. El uso de enfoques basados en geoprocesamiento puede crear condiciones para la evaluación del impacto de la APS conforme a bases de datos secundarias y a nivel intramunicipal, de la unidad básica de salud e incluso a nivel de equipo.


Assuntos
Atenção Primária à Saúde , Diagnóstico da Situação de Saúde , Sistemas de Informação Geográfica , Análise Espacial , Atenção Primária à Saúde , Assistência à Saúde , Diagnóstico da Situação de Saúde , Sistemas de Informação Geográfica , Análise Espacial , Atenção Primária à Saúde , Atenção à Saúde , Diagnóstico da Situação de Saúde , Sistemas de Informação Geográfica , Análise Espacial
3.
BMC Cancer ; 17(1): 706, 2017 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-29084516

RESUMO

BACKGROUND: Oral cancer is a potentially fatal disease, especially when diagnosed in advanced stages. In Brazil, the primary health care (PHC) system is responsible for promoting oral health in order to prevent oral diseases. However, there is insufficient evidence to assess whether actions of the PHC system have some effect on the morbidity and mortality from oral cancer. The purpose of this study was to analyze the effect of PHC structure and work processes on the incidence and mortality rates of oral cancer after adjusting for contextual variables. METHODS: An ecological, longitudinal and analytical study was carried out. Data were obtained from different secondary data sources, including three surveys that were nationally representative of Brazilian PHC and carried out over the course of 10 years (2002-2012). Data were aggregated at the state level at different times. Oral cancer incidence and mortality rates, standardized by age and gender, served as the dependent variables. Covariables (sociodemographic, structure of basic health units, and work process in oral health) were entered in the regression models using a hierarchical approach based on a theoretical model. Analysis of mixed effects with random intercept model was also conducted (alpha = 5%). RESULTS: The oral cancer incidence rate was positively association with the proportion of of adults over 60 years (ß = 0.59; p = 0.010) and adult smokers (ß = 0.29; p = 0.010). The oral cancer related mortality rate was positively associated with the proportion of of adults over 60 years (ß = 0.24; p < 0.001) and the performance of preventative and diagnostic actions for oral cancer (ß = 0.02; p = 0.002). Mortality was inversely associated with the coverage of primary care teams (ß = -0.01; p < 0.006) and PHC financing (ß = -0.52-9; p = 0.014). CONCLUSIONS: In Brazil, the PHC structure and work processes have been shown to help reduce the mortality rate of oral cancer, but not the incidence rate of the disease. We recommend expanding investments in PHC in order to prevent oral cancer related deaths.


Assuntos
Promoção da Saúde/métodos , Neoplasias Bucais/epidemiologia , Saúde Bucal/normas , Atenção Primária à Saúde/normas , Adulto , Idoso , Brasil/epidemiologia , Feminino , Geografia , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/mortalidade , Análise Multivariada , Saúde Bucal/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Fatores de Risco , Fumantes/estatística & dados numéricos , Taxa de Sobrevida
4.
Int J Equity Health ; 16(1): 149, 2017 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-28830521

RESUMO

BACKGROUND: Unequal distribution of emergency care services is a critical barrier to be overcome to assure access to emergency and surgical care. Considering this context it was objective of the present work analyze geographic access barriers to emergency care services in Brazil. A secondary aim of the study is to define possible roles to be assumed by small hospitals in the Brazilian healthcare network to overcome geographic access challenges. METHODS: The present work can be classified as a cross-sectional ecological study. To carry out the present study, data of all 5843 Brazilian hospitals were categorized among high complexity centers and small hospitals. The geographical access barriers were identified through the use of two-step floating catchment area method. Once concluded the previous step an evaluation using the Getis-Ord-Gi method was performed to identify spatial clusters of municipalities with limited access to high complexity centers but well covered by well-equipped small hospitals. RESULTS: The analysis of accessibility index of high complexity centers highlighted large portions of the country with nearly zero hospital beds by inhabitant. In contrast, it was possible observe a group of 1595 municipalities with high accessibility to small hospitals, simultaneously with a low coverage of high complexity centers. Among the 1595 municipalities with good accessibility to small hospitals, 74% (1183) were covered by small hospitals with at least 60% of minimum emergency service requirements. The spatial clusters analysis aggregated 589 municipalities with high values related to minimum emergency service requirements. Small hospitals in these 589 cities could promote the equity in access to emergency services benefiting more than eight million people. CONCLUSIONS: There is a spatial disequilibrium within the country with prominent gaps in the health care network for emergency services. Taking this challenge into consideration, small hospitals could be a possible solution and foster equity in access to emergency and surgical care. However more investments in are necessary to improve small hospitals capabilities to fill this gap.


Assuntos
Serviços Médicos de Emergência , Disparidades em Assistência à Saúde , Hospitais/estatística & dados numéricos , Brasil , Análise por Conglomerados , Estudos Transversais , Humanos , Análise Espacial
5.
J Ambul Care Manage ; 40 Suppl 2 Supplement, The Brazilian National Program for Improving Primary Care Access and Quality (PMAQ): S24-S34, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28252500

RESUMO

Cervical cancer is a common neoplasm that is responsible for nearly 230 000 deaths annually in Brazil. Despite this burden, cervical cancer is considered preventable with appropriate care. We conducted a longitudinal ecological study from 2002 to 2012 to examine the relationship between the delivery of preventive primary care and cervical cancer mortality rates in Brazil. Brazilian states and the federal district were the unit of analysis (N = 27). Results suggest that primary health care has contributed to reducing cervical cancer mortality rates in Brazil; however, the full potential of preventive care has yet to be realized.


Assuntos
Mortalidade/tendências , Atenção Primária à Saúde , Neoplasias do Colo do Útero/mortalidade , Brasil/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Programas de Rastreamento , Medicina Preventiva , Qualidade da Assistência à Saúde
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