Brazilian Survey on Preventive Actions for the Population With Access to Primary Healthcare: Inefficient Spending in a Country in Economic Crisis

Abstract

Background: Cancer ranks second as a cause of death in Brazil. Although preventive practices are part of the daily routine of primary healthcare (PHC) teams, organized screening programs are lacking. This study aimed to evaluate the adequacy of preventive interventions in the main cancer types, as defined by the Brazilian government. Methods: We analyzed cross-sectional data from a larger project conducted in 2016 with PHC service users and physicians from all over Brazil, interviewed by trained research staff. The sample was stratified by the number of PHC physicians per geographic region, who were eligible for inclusion if they had been working in the same PHC unit for at least one year. Twelve adult patients with at least two encounters were included per participating physician. Only the data from service users were analyzed in this study. We evaluated the questions about preventive practices and calculated the following indicators: coverage, focus, screening errors, and screening ratio. National guidelines and international evidence were used as a comparison parameter. Results: The study population consisted of 6160 service users. The data indicate that the recommendations for cervical, breast, and prostate cancer screening and for treatment of tobacco dependence are not adequately followed. Coverage for breast and cervical cancer screening presented an overutilization bias, with rates 50% and 9% above the expected, respectively. The screening focus was also inadequate: 24%, 47%, and 54% of the screening tests for the three cancer types were performed in individuals outside the recommended age range. 31% of smokers were not approached for treatment. Conclusion: These findings indicate that the Brazilian population has been subjected to inadequate and potentially iatrogenic interventions in PHC. New policies based on stricter criteria of adequacy and increased use of the concept of quaternary prevention may improve the effectiveness and equity of the health system.

Atenção primária à saúde para o século XXI: primeiros resultados do novo modelo de financiamento

“…Ao longo de seus 27 anos, a ESF alcançou resultados importantes: redução da mortalidade infantil e de mortes evitáveis em adultos [1][2][3] . Apesar dos avanços, constata-se, principalmente na última década, dificuldade de atingir bons indicadores em ações fundamentais: oferta de cuidado a condições clínicas frequentes 4 ; imunização 5,6 ; controle de condições crônicas 7 , como diabetes, hipertensão, dislipidemia e doenças respiratórias; rastreamento do câncer 8 ; saúde mental 9 ; diminuição de internações por condições sensíveis; e diminuição da busca por serviços de urgências por motivos não caracterizados como urgentes 10,11 . Soma-se a esse cenário um histórico de fragilidade em garantir acesso [12][13][14][15][16][17] e uma limitada capacidade de incorporar tecnologias, além da baixa produtividade representada pelo reduzido número de consultas por médico/ano (1.470, contra 2.294 nos países da OCDE) 12 .…”