家庭健康战略对巴西常规医疗服务来源的影响：来自2013年全国健康调查（PNS 2013）的数据。
The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013).
作者信息
Dourado Inês, Medina Maria Guadalupe, Aquino Rosana
机构信息
Institute of Collective Health/Federal University of Bahia, Brazil. Rua Basílio da Gama, s/n, Campus Universitário do Canela, 40110-040, Salvador, Bahia, Brazil.
出版信息
Int J Equity Health. 2016 Nov 17;15(1):151. doi: 10.1186/s12939-016-0440-7.
BACKGROUND
A usual source of care (USC) has been conceptualized as having a health provider or place available for patients to consult when sick or in need of medical care. Having a USC is a means to achieve longitudinality of care with Primary Health Care (PHC) providers. Brazil has made enormous progress in PHC and thus provides an important opportunity to investigate USC in a middle-income country context.
METHODS
This study uses data from a nationally representative household survey, the 2013 National Health Survey (n = 62,986), to describe the prevalence of having a USC in Brazil and to investigate to what extent the Family Health Strategy (FHS) has contributed to USC prevalence. Analyses include descriptive, bivariate and multivariable Poisson regression.
RESULTS
Show very high rates of people reporting any type of USC (74.4 %) and more than one third reporting PHC as their USC. Household enrolment in the FHS was positively associated with having any USC (PR:1.09; 95 % CI: 1.07-1.12) and a stronger association with having PHC as the regular source of care (PR:1.63;95 % CI:1.54-1.73). FHS enrolment was negatively associated with reporting emergency/urgent care facilities as one's USC (PR: 0.67; 95 % CI: 0.59-0.76). The association between the more consolidated FHS with having a USC was strongest in the poorest regions of the country (North, Northeast and Central-West). Having PHC as one's USC showed a positive dose-response relationship with the FHS in all regions, especially in the Central-West.
CONCLUSIONS
Our results have important implications for the health care model in Brazil and in other countries, especially those seeking to base their national health systems more strongly on primary health care. The study suggests expanding primary health care can increase the establishment of a USC which can help assure better monitoring of chronic conditions and attention to patient needs.
背景
常规医疗服务来源（USC）的概念是，当患者生病或需要医疗护理时，有可供其咨询的医疗服务提供者或场所。拥有常规医疗服务来源是实现与初级卫生保健（PHC）提供者进行纵向医疗服务的一种方式。巴西在初级卫生保健方面取得了巨大进展，因此提供了一个在中等收入国家背景下调查常规医疗服务来源的重要机会。
方法
本研究使用来自具有全国代表性的家庭调查——2013年全国健康调查（n = 62,986）的数据，来描述巴西拥有常规医疗服务来源的患病率，并调查家庭健康战略（FHS）在多大程度上促进了常规医疗服务来源的患病率。分析包括描述性、双变量和多变量泊松回归。
结果
结果显示，报告任何类型常规医疗服务来源的人群比例非常高（74.4%），超过三分之一的人报告将初级卫生保健作为其常规医疗服务来源。家庭加入家庭健康战略与拥有任何常规医疗服务来源呈正相关（PR：1.09；95%CI：1.07 - 1.
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