Primary Care and Care Continuity in the Context of a Health Crisis: Lessons Learned from the Brazilian Reality

Abstract

Introduction: Primary health care (PHC) is essential for achieving universal health coverage, especially in low- and middle-income countries, where it has been associated with curbing health inequalities and providing financial protection. It is distinguished from other care levels by its essential attributes: longitudinality, first-contact care, comprehensiveness, and care coordination across the network. PHCs played a crucial role during the COVID-19 pandemic, and providing continuous care while coordinating testing and contact tracing was challenging. It is necessary to adapt its operations to ensure care. This study explores the influence of essential PHC attributes and local organizational strategies on care continuity during the pandemic. Methods: A quantitative cross-sectional study was conducted with health managers from municipalities in the state of São Paulo in a sample stratified by population size. The survey was applied in 259 municipalities, and the weighted analysis considered 553 municipalities. We evaluated indicators related to care continuity in PHC, convergence with essential PHC attributes, local strategies such as telecare, and the adaptation of PHC units (UBSs) to an exclusive COVID-19 PHC service. Statistical analyses included Pearson’s correlation and multiple linear regression. Results: Care continuity in PHC was significantly associated with convergence of essential PHC attributes (r=0.453, p=0.000), PHC coverage, investment in telecare, and the transformation of UBS to care exclusively for COVID-19 patients. The regression model revealed that these variables significantly influenced care maintenance during the pandemic, and convergence of essential PHC attributes was the most relevant factor. Conclusion: Convergence in the essential attributes of comprehensive PHC was crucial for care continuity during the pandemic. Owing to the essential attributes of comprehensive PHC, continued strengthening of PHC is necessary to ensure the resilience of health systems, and we recommend future studies on the implementation of the essential attributes of comprehensive PHC.