Universidade Federal de São Paulo, Department of Preventive Medicine - São Paulo (SP), Brazil.
Faculdade de Ciências Médicas da Santa Casa de São Paulo, Department of Public Health - São Paulo (SP), Brazil.
Rev Bras Epidemiol. 2022 Jul 6;25:e220017. doi: 10.1590/1980-549720220017. eCollection 2022.
To describe the performance of Primary Health Care, according to conglomerates of São Paulo cities that present homogeneous indicators.
This is a descriptive study, based on secondary data extracted from official sources of the Unified Health System, for the year 2018. An analysis matrix was created, with the proposition of performance (access, effectiveness and adequacy) and context indicators (population, health determinants and financing) selected and organized in dimensions and sub-dimensions. Cluster Analysis was used to identify the groups of homogeneous municipalities.
645 municipalities were divided in 6 conglomerates. Clusters 2 and 3 were formed predominantly by small municipalities with greater access to health; cluster 3 has less social vulnerability and greater investment in health. Clusters 1, 4 and 5 were formed by the largest municipalities with less access to health; cluster 4 presents greater social vulnerability, less coverage of private health plans and a greater percentage of health resources; cluster 5 was characterized by greater Gross Domestic Product per capita and greater coverage of private health plans. Cluster 6, formed by the city of São Paulo, was a particular case. Cluster 2 drew attention, as it was shown to have increased coverage, but signaled lower efficacy and adequacy levels. Cluster 3 had the best performance among all clusters.
These findings can support regional and municipal management, given the complexity of the territory of São Paulo, pointing to scenarios that demand broader public management initiatives.
根据具有同质指标的圣保罗市联合体，描述初级保健的表现。
这是一项描述性研究，基于从统一卫生系统官方来源提取的二手数据，研究对象为 2018 年的数据。创建了一个分析矩阵，提出了表现（可及性、有效性和适宜性）和背景指标（人口、健康决定因素和融资），并选择和组织成维度和子维度。聚类分析用于识别同质市群体。
645 个城市分为 6 个联合体。集群 2 和 3 主要由较小的城市组成，这些城市的健康可及性更高；集群 3 的社会脆弱性较低，对健康的投资更多。集群 1、4 和 5 由较大的城市组成，这些城市的健康可及性较低；集群 4 表现出更大的社会脆弱性，私人健康计划的覆盖率较低，健康资源的比例较大；集群 5 的特点是人均国内生产总值较高，私人健康计划的覆盖率较高。由圣保罗市组成的集群 6 是一个特殊情况。集群 2 引起了注意，因为它显示出覆盖率的增加，但表示效能和适宜性水平较低。所有集群中，集群 3 的表现最好。
这些发现可以支持区域和市级管理，考虑到圣保罗州的地域复杂性，这表明需要更广泛的公共管理举措。
