The impact of the Brazilian family health on selected primary care sensitive conditions: A systematic review

被引:71
作者
Bastos, Mayara Lisboa [1 ]
Menzies, Dick [2 ]
Hone, Thomas [3 ]
Dehghani, Kianoush [2 ]
Trajman, Anete [1 ,2 ,4 ]
机构
[1] Univ Fed Rio de Janeiro, Grad Internal Med Program, Rio De Janeiro, RJ, Brazil
[2] McGill Univ, Resp Epidemiol & Clin Res Unit, Montreal, PQ, Canada
[3] Imperial Coll, Sch Publ Hlth, Dept Primary Care & Publ Hlth, London, England
[4] Univ Estado Rio De Janeiro, Social Med Inst, Rio De Janeiro, RJ, Brazil
关键词
CASH TRANSFER PROGRAM; INFANT-MORTALITY; PERNAMBUCO STATE; BELO-HORIZONTE; PROJECT-ICSAP; HOSPITALIZATIONS; STRATEGY; QUALITY; EXPANSION; SERVICES;
D O I
10.1371/journal.pone.0182336
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background Brazil has the largest public health-system in the world, with 120 million people covered by its free primary care services. The Family Health Strategy (FHS) is the main primary care model, but there is no consensus on its impact on health outcomes. We systematically reviewed published evidence regarding the impact of the Brazilian FHS on selective primary care sensitive conditions (PCSC). Methods We searched Medline, Web of Science and Lilacs in May 2016 using key words in Portuguese and English, without language restriction. We included studies if intervention was the FHS; comparison was either different levels of FHS coverage or other primary health care service models; outcomes were the selected PCSC; and results were adjusted for relevant sanitary and socioeconomic variables, including the national conditional cash transfer program (Bolsa Familia). Due to differences in methods and outcomes reported, pooling of results was not possible. Results Of 1831 records found, 31 met our inclusion criteria. Of these, 25 were ecological studies. Twenty-one employed longitudinal quasi-experimental methods, 27 compared different levels the FHS coverage, whilst four compared the FHS versus other models of primary care. Fourteen studies found an association between higher FHS coverage and lower post-neonatal and child mortality. When the effect of Bolsa Familia was accounted for, the effect of the FHS on child mortality was greater. In 13 studies about hospitalizations due to PCSC, no clear pattern of association was found. In four studies, there was no effect on child and elderly vaccination or low-birth weight. No included studies addressed breast-feeding, dengue, HIV/AIDS and other neglected infectious diseases. Conclusions Among these ecological studies with limited quality evidence, increasing coverage by the FHS was consistently associated with improvements in child mortality. Scarce evidence on other health outcomes, hospitalization and synergies with cash transfer was found.
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页数:14
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