Lloyd-Sherlock Peter, Fialho de Carvalho Poliana, Giacomin Karla, Sempé Lucas
School of International Development, University of East Anglia, Norwich NR4 7TJ, United Kingdom.
Fiocruz, Belo Horizonte, Minas Gerais, Brazil.
Lancet Reg Health Am. 2023 Oct 28;27:100619. doi: 10.1016/j.lana.2023.100619. eCollection 2023 Nov.
In low and middle-income countries, there is growing interest in managing pressures on health services through community interventions for older people. Evidence on the effects of such interventions is scarce. We draw on qualitative data to examine these effects for a specific scheme, (PMC) in the Brazilian city of Belo Horizonte.
Building on quantitative findings reported elsewhere, we use qualitative data to develop and test theories of change. These include data from 50 meetings with policymakers, managers and staff in 30 health centres and social assistance posts. Data collection was embedded in key informant interaction and knowledge coproduction. Data include participant and non-participant observation, focus groups and semi-structured interviews with key informants, as well as older people and carers from seven families.
The data reveal three theories of change. Theory 1 is PMC maintains older people's health which reduces their need for inpatient or outpatient care. We find strong evidence to support this, through effects on use of medication, chronic disease management and risk prevention. Theory 2 is PMC promotes timely intervention by anticipating health problems, thus reducing demand for emergency and acute care. We find some evidence for this, but it was limited by limited availability of timely treatment or referral beyond PMC. Theory 3 is PMC facilitates hospital discharge. We find limited evidence for this, reflecting a lack of formal liaison between PMC and hospitals.
Schemes like PMC have potential to reduce pressures on health service utilisation by older people, if they are well articulated with wider health services.
Medical Research Council, Newton Fund and Brazilian Council of State Funding Agencies.
在低收入和中等收入国家，通过针对老年人的社区干预措施来应对卫生服务压力的兴趣日益浓厚。关于此类干预措施效果的证据很少。我们利用定性数据来研究巴西贝洛奥里藏特市一个特定项目（PMC）的这些效果。
基于其他地方报告的定量研究结果，我们使用定性数据来发展和检验变革理论。这些数据包括与30个卫生中心和社会援助岗位的政策制定者、管理人员及工作人员进行的50次会议的数据。数据收集嵌入关键信息提供者的互动和知识共同生产过程中。数据包括参与者和非参与者观察、焦点小组以及与关键信息提供者以及来自七个家庭的老年人和护理人员的半结构化访谈。
数据揭示了三种变革理论。理论1是PMC维持老年人的健康，从而减少他们对住院或门诊护理的需求。我们通过对药物使用、慢性病管理和风险预防的影响，找到有力证据支持这一点。理论２是PMC通过预测健康问题促进及时干预，从而减少对急诊和急性护理的需求。我们找到一些相关证据，但由于PMC之外及时治疗或转诊的可用性有限，其受到了限制。理论3是PMC促进医院出院。我们找到的相关证据有限，这反映出PMC与医院之间缺乏正式联络。
如果像PMC这样的项目能与更广泛的卫生服务有效衔接，就有可能减轻老年人对卫生服务利用的压力。
医学研究理事会、牛顿基金和巴西国家资助机构理事会。
