Institute of Collective Health, Federal University of Bahia, Bahia, Brazil.
J Epidemiol Community Health. 2010 Dec;64(12):1100-5. doi: 10.1136/jech.2009.097220. Epub 2010 Aug 18.
Organisational barriers to primary healthcare are still relevant in developing countries. Although descriptive reports of some experiences focusing on improving accessibility have been published, few studies have evaluated specific interventions aimed at overcoming the organisational obstacles.
To evaluate the results of a project designed to improve accessibility to healthcare services in Salvador, Bahia, Brazil.
An evaluative, cross-sectional, ex post facto study that included a control group was carried out in a random sample of 710 users of 25 healthcare units of the primary municipal healthcare network. The association between the project implementation degree and outcome variables was measured by prevalence ratios (PR) and statistical inference was based on Taylor series 95% CIs.
Better access to primary healthcare was found in units in which the intervention had been implemented than in those in which it had not been implemented, particularly with respect to reducing avoidable queues, the waiting time for scheduling a consultation (PR=0.23; 95% CI 0.15 to 0.34); the time of arrival in the queue (PR=0.16; 95% CI 0.09 to 0.31) and the introduction of a system for scheduling appointments by telephone (PR=0.76; 95% CI 0.70 to 0.83).
Owing to the simplicity of the programme and the impact it achieved, it may be reproduced in other underdeveloped countries to improve access to healthcare services. In addition, some of the instruments may be used in routine programme evaluation.
在发展中国家，基层医疗的组织障碍仍然存在。虽然已经发表了一些描述性报告，重点介绍了改善可及性的经验，但很少有研究评估旨在克服组织障碍的具体干预措施。
评估旨在改善巴西巴伊亚萨尔瓦多医疗服务可及性的项目的结果。
在基层市级医疗网络的 25 个医疗单位的随机样本中进行了评估性、横断面、事后的研究，包括对照组。通过患病率比（PR）来衡量项目实施程度与结果变量之间的关联，统计推断基于泰勒级数 95%CI。
与未实施干预的单位相比，实施干预的单位中，基层医疗的可及性更好，特别是在减少可避免的排队等候、预约咨询的等待时间（PR=0.23；95%CI 0.15 至 0.34）、排队到达时间（PR=0.16；95%CI 0.09 至 0.31）和引入电话预约系统（PR=0.76；95%CI 0.70 至 0.83）方面。
由于该方案简单且效果显著，它可以在其他欠发达国家中复制，以改善医疗服务的可及性。此外，该方案中的一些工具可用于常规方案评估。
