Access to emergency care services: a transversal ecological study about Brazilian emergency health care network

Rocha, Thiago Augusto Hernandes; Silva, N.C. da; Amaral, Pedro; Barbosa, Allan Claudius Queiroz; Rocha, Jorge Luiz da; Álvares, V. de S.; Almeida, Dante Grapiuna de; Thumé, Elaine; Thomaz, Érika Bárbara Abreu Fonseca; Queiroz, Rejane Christine de Sousa; Souza, Marta Rovery de; Lein, Adriana; Toomey, Nicole; Staton, Catherine A.; Vissoci, J.R.N.; Facchini, Luiz Augusto

doi:10.1016/j.puhe.2017.07.013

Cited by 27 publications

(28 citation statements)

References 20 publications

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“…The areas of Brazil with lower socioeconomic status remain challenging environments for healthcare, where there is a long history of difficulties with retention of healthcare professionals 18 19. Our findings align with studies of adult surgical workforce in Brazil which have shown inequities in the density of SAO professionals across the country, with rural regions disproportionately affected 26.…”

Section: Discussionsupporting

confidence: 82%

“…As surgical care is an essential component of functioning healthcare systems, there is a need to improve our understanding of the surgical workforce for children. Brazil has wide disparities in socioeconomic status and healthcare delivery 18 19. Our previous work has shown disparities in the density of delivery and infrastructure for surgical care for children per population unit across Brazil, with areas of higher socioeconomic status associated with increased delivery of surgical care 10.…”

Section: Discussionmentioning

confidence: 97%

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Towards defining the surgical workforce for children: a geospatial analysis in Brazil

et al. 2020

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ObjectivesThe optimal size of the health workforce for children’s surgical care around the world remains poorly defined. The goal of this study was to characterise the surgical workforce for children across Brazil, and to identify associations between the surgical workforce and measures of childhood health.DesignThis study is an ecological, cross-sectional analysis using data from the Brazil public health system (Sistema Único de Saúde).Settings and participantsWe collected data on the surgical workforce (paediatric surgeons, general surgeons, anaesthesiologists and nursing staff), perioperative mortality rate (POMR) and under-5 mortality rate (U5MR) across Brazil for 2015.Primary and secondary outcome measuresWe performed descriptive analyses, and identified associations between the workforce and U5MR using geospatial analysis (Getis-Ord-Gi analysis, spatial cluster analysis and linear regression models).FindingsThere were 39 926 general surgeons, 856 paediatric surgeons, 13 243 anaesthesiologists and 103 793 nurses across Brazil in 2015. The U5MR ranged from 11 to 26 deaths/1000 live births and the POMR ranged from 0.11–0.17 deaths/100 000 children across the country. The surgical workforce is inequitably distributed across the country, with the wealthier South and Southeast regions having a higher workforce density as well as lower U5MR than the poorer North and Northeast regions. Using linear regression, we found an inverse relationship between the surgical workforce density and U5MR. An U5MR of 15 deaths/1000 births across Brazil is associated with a workforce level of 5 paediatric surgeons, 200 surgeons, 100 anaesthesiologists or 700 nurses/100 000 children.ConclusionsWe found wide disparities in the surgical workforce and childhood mortality across Brazil, with both directly related to socioeconomic status. Areas of increased surgical workforce are associated with lower U5MR. Strategic investment in the surgical workforce may be required to attain optimal health outcomes for children in Brazil, particularly in rural regions.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 97%

Towards defining the surgical workforce for children: a geospatial analysis in Brazil

et al. 2020

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“…Reduced perinatal morbidity and mortality and PTB rates are some of the benefits from antenatal and intrapartum care specialized programs for twin pregnancies . Brazil, like many low‐ and middle‐income countries, seeks better coverage and regulation of neonatal intensive care services . Recognizing the burden of preterm twin pregnancies and its associated conditions is of great importance for the management of antenatal and intrapartum care and for the reduction of adverse perinatal and neonatal outcomes.…”

Section: Introductionmentioning

confidence: 99%

Maternal and perinatal outcomes and factors associated with twin pregnancies among preterm births: Evidence from the Brazilian Multicenter Study on Preterm Birth (EMIP)

Santana

Cecatti

Surita

et al. 2020

Intl J Gynecology & Obste

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Objective: To compare maternal and perinatal outcomes between twin and single preterm births (PTB) and associated factors. Methods:A cross-sectional multicenter study was conducted in Brazil with 4046 PTBs from April 2011 to July 2012. Causes of PTB, use of tocolytics, corticosteroids, and antibiotics in twin and single pregnancies, and factors possibly associated with twinning were evaluated using χ 2 tests. Maternal and perinatal outcomes were assessed with prevalence ratios (PR). Results:The main cause of PTB in twin pregnancy was spontaneous onset of preterm labor. Tocolytics were more frequently used in twins (26.9% vs 20.2%). Factors associated with PTB in twins were: maternal age >25 years (62.3% vs 53.4%); interpregnancy interval >3 years (39.0% vs 33.4%); no history of PTB (87.4% vs 79.6%); no previous maternal conditions (78.0% vs 73.3%); no alcohol abuse (88.5% vs 84.3%); no drug addiction (97.5% vs 94.5%); and >6 prenatal visits (46.5% vs 37.6%). Twin pregnancies run a 46% higher risk of cesarean delivery, while first and second twins face a 20% higher risk of low birth weight. Twin pregnancies run increased risks for admission to the NICU, cerebral hemorrhage, necrotizing enterocolitis, and any adverse perinatal outcome. Conclusion:Preterm twin birth is associated with low birth weight and worse neonatal outcomes. K E Y W O R D S

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“…These studies demonstrate how the probability of being hospitalized is inversely correlated with the distance between the city where a hospital is located and the patient’s hometown [ 10 ]. This is aggravated by the concentration of hospitals in more developed urban areas and access gaps in rural areas and the Amazon region, leading to the conclusion that distribution of emergency services in Brazil is not facilitating access to the population due to geographical barriers associated with great distances [ 11 ]. The literature about access to specific equipment in even scarcer.…”

Section: Introductionmentioning

confidence: 99%

Spatially balanced provision of health equipment: a cross-sectional study oriented to the identification of challenges to access promotion

Amaral

Rocha

Barbosa

et al. 2017

Int J Equity Health

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BackgroundAccess to health services is in part defined by the spatial distribution of healthcare equipment. To ensure equity in the provision of health services, it is important to examine availability across different health care providers taking into account population demand. Given the importance of the equitable provision of health equipment, we evaluate its spatial distribution in Brazil.MethodsThis study is classified as cross-sectional with an ecological design. We evaluate Brazilian data on distance to available health equipment considering: dialysis machines (385), magnetic resonance imaging (MRI) (257), hospital beds (3675) and bone densitometers (429). We define two distance thresholds (50 km and 200 km) from a municipality to the center of services provision. The balance between infrastructure capacity and potential demand was evaluated to identify a lack or surplus of health services.ResultsThe distribution of dialysis equipment and bone densitometers is not balanced across Brazilian states, and unmet demand is high. With respect to MRIs, the large capacity of this equipment results in a large excess of supply. However, this characteristic alone cannot account for excesses of supply of over 700%, as is the case of the Federal District when the range is limited to 50 km. At the same time, four states in the Northeastern region of Brazil show a net excess of demand. Some regions do not meet the standard amount of supply defined by Brazilian Ministry of Health. The quantity and distribution of hospital beds are not sufficient to provide full coverage to the population.ConclusionOur main focus was to evaluate the network of the provision of health equipment in Brazil, considering both private and public sectors conjointly. We take into account two main aspects of a spatially balanced health system: the regional availability of health equipment and the geographic distance between its demand and supply at the municipality level. Some regions do not meet the minimum requirement defined by the Brazilian Ministry of Health regarding the supply of health services.

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Access to emergency care services: a transversal ecological study about Brazilian emergency health care network

Cited by 27 publications

References 20 publications

Towards defining the surgical workforce for children: a geospatial analysis in Brazil

Towards defining the surgical workforce for children: a geospatial analysis in Brazil

Maternal and perinatal outcomes and factors associated with twin pregnancies among preterm births: Evidence from the Brazilian Multicenter Study on Preterm Birth (EMIP)

Spatially balanced provision of health equipment: a cross-sectional study oriented to the identification of challenges to access promotion

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