Departments of Health Policy and Management and Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, California, United States of America.
Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States of America.
PLoS One. 2022 Jun 7;17(6):e0269686. doi: 10.1371/journal.pone.0269686. eCollection 2022.
The Brazilian Family Health Strategy (FHS) is strongly associated with better health system performance, but there are no nationally-representative data examining individual-level primary care experiences in the country. Here, we examine reports of primary care experiences among adults with different forms of healthcare coverage (FHS, "traditional" public health posts, and private health plans).
Data are from the 2019 National Health Survey that included a shortened version of the Primary Care Assessment Tool (PCAT). PCAT questions were administered to a subsample of randomly-selected adults who had a doctor visit within the past 6 months and sought care in a primary care setting (9677 respondents). We used linear regression to examine the association between type of healthcare coverage and PCAT scores adjusted for sex, age, socioeconomic status, health status, geographic region and state of residence.
Primary care experiences in the sample of Brazilians who had a doctor visit 6 months prior to the survey averaged a modest PCAT score of 57 out of 100. Regression models show that users of the FHS had superior primary care experiences, but with large variations across Brazilian regions and states. Individuals selected to respond to the PCAT questions were more likely to be female, older, and poorer, and to be in worse health than the general population.
Brazil's FHS is associated with modest, but higher-reported primary care experiences than both traditional public health posts and those who have a private health plan. Future iterations of the PCAT module could enhance generalizability by including individuals who had a doctor visit in the past 12 (instead of 6) months.
巴西家庭健康战略（FHS）与更好的卫生系统绩效密切相关，但没有全国代表性数据来检查该国个人层面的初级保健体验。在这里，我们研究了具有不同医疗保健覆盖形式（FHS、“传统”公共卫生岗位和私人健康计划）的成年人的初级保健体验报告。
数据来自 2019 年国家健康调查，其中包括初级保健评估工具（PCAT）的简化版本。PCAT 问题被随机选择的在过去 6 个月内看过医生并在初级保健机构寻求过护理的成年人亚组（9677 名受访者）。我们使用线性回归来检验医疗保健覆盖类型与 PCAT 评分之间的关联，该评分经过性别、年龄、社会经济地位、健康状况、地理位置和居住州的调整。
在调查前 6 个月接受过医生就诊的巴西人样本中，初级保健体验的平均 PCAT 评分为 57 分（满分 100 分）。回归模型表明，FHS 的使用者具有更好的初级保健体验，但巴西各地区和各州之间存在很大差异。被选中回答 PCAT 问题的人更有可能是女性、年龄更大、更贫穷，健康状况也比一般人群更差。
巴西的 FHS 与传统公共卫生岗位和私人健康计划相比，与适度但报告更高的初级保健体验相关。PCAT 模块的未来迭代可以通过包括在过去 12 个月内看过医生的个人来增强其普遍性。
