Cruz Maria Jesus Barreto, Santos Alaneir de Fátima Dos, Macieira César, Abreu Daisy Maria Xavier de, Machado Antônio Thomaz Gonzaga da Matta, Andrade Eli Iola Gurgel
Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil.
Cad Saude Publica. 2022 Feb 11;38(2):e00088121. doi: 10.1590/0102-311X00088121. eCollection 2022.
This study aimed to compare the results obtained with the coordination of care through the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB), with the parameters adopted by the Care Coordination Measures Atlas and the European Observatory on Health Systems and Policies. A cross-sectional study was performed using the dataset from the third cycle of the PMAQ-AB. Three typologies of coordination of care were created: PMAQ-AB, Atlas, and Observatory. Chi-square test was applied to compare proportions and Kruskal-Wallis and Nemenyi tests to verify and identify potential differences between the typologies. Significance was set at 5%. In all, 35,350 teams were assessed that performed some activity in care coordination. A significant difference was observed (p < 0.001) between levels of coordination, with a higher percentage between the high and medium levels in the three instruments, PMAQ-AB (56.07% and 38.35%), Atlas (52.63% and 40.66%), and Observatory (44.82% and 43.98%). In the comparison of the indicators, there was a significant difference (p < 0.001) between the typologies. For Brazil, in the PMAQ-AB typology, all the strata displayed a higher percentage between the high and medium levels; in the Atlas, stratum 1 stood out in the medium level (43.81%); the high level predominated in the Observatory. In the comparison of the indicators by strata, at least one stratum differed from the others (p < 0.001). Number 6 differed from the others (p < 0.001), and number 1 differed from all of them (p < 0.001) except number 2 (p > 0.05). The levels of coordination of care differed according to the instruments used. High and medium levels were identified, showing the need for additional studies.
本研究旨在比较通过巴西国家基本医疗服务可及性与质量提升计划（PMAQ-AB）实现的医疗协调结果，与《医疗协调措施地图集》以及欧洲卫生系统与政策观察站所采用的参数。使用PMAQ-AB第三轮数据集进行了一项横断面研究。创建了三种医疗协调类型：PMAQ-AB、地图集和观察站。应用卡方检验比较比例，应用克鲁斯卡尔-沃利斯检验和内曼-尼伊检验来验证和识别不同类型之间的潜在差异。显著性水平设定为5%。总共评估了35350个在医疗协调方面开展了某些活动的团队。观察到不同协调水平之间存在显著差异（p < 0.001），在三种工具（PMAQ-AB（56.07%和38.35%）、地图集（52.63%和40.66%）、观察站（44.82%和43.98%））中，高水平与中等水平之间的百分比更高。在指标比较中，不同类型之间存在显著差异（p < 0.001）。对于巴西，在PMAQ-AB类型中，所有层次在高水平与中等水平之间的百分比都更高；在地图集中，第1层次在中等水平方面较为突出（43.81%）；在观察站中高水平占主导。在按层次比较指标时，至少有一个层次与其他层次不同（p < 0.001）。第6项与其他项不同（p < 0.001），第1项与除第2项外的所有项都不同（p < 0.001）（第1项与第2项比较p > 0.05）。医疗协调水平因所使用的工具而异。确定了高水平和中等水平，表明需要进一步研究。
