Efectos combinados de la ampliación de la atención primaria de salud y de las transferencias condicionadas de dinero en efectivo sobre la mortalidad infantil en Brasil, 1998 - 2010

OBJETIVOS: Examiné los efectos combinados del acceso a la atención primaria mediante el Programa de Salud Familiar (PSF) y las transferencias condicionadas de dinero en efectivo del Programa Bolsa Familia (PBF) sobre la mortalidad infantil posneonatal (MIPN) en Brasil. MÉTODOS: Empleé un análisis ecológico longitudinal usando datos en panel de 4 583 municipios brasileños de 1998 al 2010, con 54 253 observaciones en total. Estimé modelos de regresión de efectos fijos por mínimos cuadrados ordinarios, con la tasa de MIPN como la variable dependiente y el PSF, el PBF y sus interacciones como las principales variables independientes de interés. RESULTADOS: La asociación de una mayor cobertura del PSF con una menor tasa de MIPN se volvió más fuerte conforme aumentaba la cobertura del PBF. En los promedios de todas las demás variables, cuando la cobertura de PBF era 25%, la MIPN predicha fue 5,24 (intervalo de confianza [IC] de 95% = 4,95, 5,53) para una cobertura del PSF de 0%, y de 3,54 (IC de 95% = 2,77, 4,31) para una cobertura del PSF de 100%. Cuando la cobertura del PBF era de 60%, la MIPN predicha fue 4,65 (IC de 95% = 4,36, 4,94) para una cobertura del PSF de 0%, y de 1,38 (IC de 95% = 0,88, 1,89) para una cobertura del PSF de 100%. CONCLUSIONES: El efecto del PSF depende de la ampliación del PBF. Para las poblaciones empobrecidas y subatendidas, la combinación de intervenciones tanto del lado de la oferta como del lado de la demanda podría ser necesaria para mejorar los resultados en salud

Serie sobre hospitalizaciones evitables y fortalecimiento de la atención primaria en salud: El caso de Paraguay

La transición demográfica y epidemiológica que experimenta Paraguay hace que sea necesario preparar de la mejor su sistema de atención primaria para enfrentar contra la carga asociada a la mayor incidencia de enfermedades crónicas no transmisibles. La metodología de hospitalizaciones por condiciones sensibles de atención primaria es una alternativa viable para determinar el impacto de la atención primaria en el uso de los servicios de salud del país. Se realizó la primera aproximación general de ese tipo usando datos administrativos de hospitalizaciones y de Encuestas de Hogares. Los hallazgos del estudio muestran un incremento general de las hospitalizaciones de este tipo en los últimos años, impulsado por enfermedades asociadas a la gastroenteritis, y que parece estar más relacionado con ciertos grupos de edad y a la condición de aseguramiento de salud a nivel regional.

Measurement of Primary Care: Report on the Johns Hopkins Primary Care Assessment Tool

Renewed interest in the Primary Health Care-PHC agenda is a common element of the majority of recent health system reforms throughout Latin America and the Caribbean-LAC. Strengthening of PHC has been recognized as a promising solution to address the major challenges the Region's health systems face. As governments are making substantive long term investments in PHC oriented healthcare reforms, there is a requirement for accountability and increased transparency and reporting on the results of these initiatives. As a consequence, implementation of PHC strategies needs to be accompanied with mechanisms to collect data that will allow assessment of the extent to which primary care processes are being implemented and on their impact of quality, efficiency, cost, equity and consumer satisfaction. The Johns Hopkins Primary Care Assessment Tool or PCAT is amongst the instruments currently available to assess performance of PHC in several dimensions and from the perspective of users, practitioners, and systems. The purpose of this technical document is to provide a description of this instrument including its composition, measurement, functions, uses, and requirements to deploy the tool in practical applications and to discuss the challenges and opportunities to use the tool in the context of the LAC Region.

Gaps In Primary Care And Health System Performance In Six Latin American And Caribbean Countries

The rapid demographic and epidemiological transitions occurring in Latin America and the Caribbean have led to high levels of noncommunicable diseases in the region. In addition to reduced risk factors for chronic conditions, a strong health system for managing chronic conditions is vital. This study assessed the extent to which populations in six Latin American and Caribbean countries receive high-quality primary care, and it examined the relationship between experiences with care and perceptions of health system performance. We applied a validated survey on access, use, and satisfaction with health care services to nationally representative samples of the populations of Brazil, Colombia, El Salvador, Jamaica, Mexico, and Panama. Respondents reported considerable gaps in the ways in which primary care is organized, financed, and delivered. Nearly half reported using the emergency department for a condition they considered treatable in a primary care setting. Reports of more primary care problems were associated with worse perceptions of health system performance and quality and less receipt of preventive care. Urgent attention to primary care performance is required as the region’s population continues to age at an unprecedented rate

Primary care and multimorbidity in six Latin American and Caribbean countries

Objectives. To describe patterns of multimorbidity in six diverse Latin American and Caribbean countries, examine its effects on primary care experiences, and assess its influence on reported overall health care assessments. Methods. Cross-sectional data are from the Inter-American Development Bank's international primary care survey, conducted in 2013/2014, and represent the adult populations of Brazil, Colombia, El Salvador, Jamaica, Mexico and Panama. Robust Poisson regression models were used to estimate the extent to which those with multimorbidity receive adequate and appropriate primary care, have confidence in managing their health condition, and are able to afford needed medical care. Results. The prevalence of multimorbidity ranged from 17.5% in Colombia to 37.3% in Jamaica. Most of the examined conditions occur along with others, with diabetes and heart disease being the two problems most associated with other conditions. The proportions of adults with high out-of-pocket payments, problems paying their medical bills, seeing multiple doctors, and being in only fair/poor health were higher among those with greater levels of multimorbidity and poorer primary care experiences. Multimorbidity and difficulties with primary care were positively associated with trouble paying for medical care and managing one's conditions. Nonetheless, adults with multimorbidity were more likely to have received lifestyle advice and to be up to date with preventive exams. Conclusions. Multimorbidity is reported frequently. Providing adequate care for the growing number of such patients is a major challenge facing most health systems, which will require considerable strengthening of primary care along with financial protection for those most in need