Trends in the use of health services and their relationship with multimorbidity in Brazil, 1998–2013

Souza, Ana Sara Semeão de; Braga, José Ueleres

doi:10.1186/s12913-020-05938-4

Cited by 19 publications

(30 citation statements)

References 35 publications

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“…Increasing age, female gender, urban residency, and high per-capita expenditure were some of the significant factors of multimorbidity. Consistent with earlier studies [ 19 , 28 – 31 ], our findings suggest that the presence of multimorbidity was significantly associated with higher inpatient/outpatient care, as well as higher individual OOPE. Notably, our results from quantile regression analysis revealed a more detailed measure of the association between multimorbidity and OOPE that had not been revealed in earlier published studies that have used OLS or GLM in the analysis.…”

Section: Discussionsupporting

confidence: 92%

Effect of multimorbidity on utilisation and out-of-pocket expenditure in Indonesia: quantile regression analysis

Anindya

Atun

et al. 2021

BMC Health Serv Res

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Background Multimorbidity (the presence of two or more non-communicable diseases) is a major growing challenge for many low-income and middle-income countries (LMICs). Yet, its effects on health care costs and financial burden for patients have not been adequately studied. This study investigates the effect of multimorbidity across the different percentiles of healthcare utilisation and out-of-pocket expenditure (OOPE). Methods We conducted a secondary data analysis of the 2014/2015 Indonesian Family Life Survey (IFLS-5), which included 13,798 respondents aged ≥40 years. Poisson regression was used to assess the association between sociodemographic characteristics and the total number of non-communicable diseases (NCDs), while multivariate logistic regression and quantile regression analysis was used to estimate the associations between multimorbidity, health service use and OOPE. Results Overall, 20.8% of total participants had two or more NCDs in 2014/2015. The number of NCDs was associated with higher healthcare utilisation (coefficient 0.11, 95% CI 0.07–0.14 for outpatient care and coefficient 0.09 (95% CI 0.02–0.16 for inpatient care) and higher four-weekly OOPE (coefficient 27.0, 95% CI 11.4–42.7). The quantile regression results indicated that the marginal effect of having three or more NCDs on the absolute amount of four-weekly OOPE was smaller for the lower percentiles (at the 25th percentile, coefficient 1.0, 95% CI 0.5–1.5) but more pronounced for the higher percentile of out-of-pocket spending distribution (at the 90th percentile, coefficient 31.0, 95% CI 15.9–46.2). Conclusion Multimorbidity is positively correlated with health service utilisation and OOPE and has a significant effect, especially among those in the upper tail of the utilisation/costs distribution. Health financing strategies are urgently required to meet the needs of patients with multimorbidity, particularly for vulnerable groups that have a higher level of health care utilisation.

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Section: Discussionsupporting

confidence: 92%

Effect of multimorbidity on utilisation and out-of-pocket expenditure in Indonesia: quantile regression analysis

Anindya

Atun

et al. 2021

BMC Health Serv Res

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“…Moreover, multimorbidity appears 10 to 15 years early in people with lower socioeconomic levels, deepening health inequalities (Nguyen et al, 2019;OPS/OMS, 2019). The negative impact of multimorbidity not only decreases the quality of life at mid-life (Kanesarajah et al, 2018), it also leads to higher mortality rates (age at death: increased in 6,3 with four or more NCDs (Diane Zheng et al, 2021;Menotti et al, 2021) and greater healthcare services utilization, (de Souza and Braga, 2020;Heins et al, 2020;Leijten et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Impact of a patient-centered care model implemented in public health facilities in Chile: A real world evidence evaluation

Zamorano¹,

Varela²,

Tellez³

et al. 2022

J. Public Health Epidemiol.

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Health systems face multimorbidity as the leading cause of the burden of disease and demand for healthcare services. Although non-communicable diseases are well known, and countries in Latin America have implemented strategies to its approach, tackling multimorbidity is still a challenge and an emerging topic. In response to this, Centro de Innovación en Salud ANCORA UC, in association with Servicio de Salud Metropolitano Sur Oriente and the National Health Fund, implemented a pilot study a Multimorbidity Patient-Centered Care Model in the health network. The objective was to evaluate the health care services utilization and mortality. The authors performed a cohort study with adults with non-communicable diseases, stratified by ACG® System. Analysis used logistic regression, adjusted by confounding variables. The intervened group had a significantly lower incidence of hospital admissions, length of stay, number of consultancies to hospital emergency, and number of consultancies to primary care emergency than the control group. Further, it was associated with significantly less mortality (OR 0.54; 95% CI 0.47 -0.63). Barriers and facilitators proper from a complex intervention were approached. The model showed positive results in mortality and health services utilization. A description is provided to contribute to this emerging topic and facilitate its reproducibility.

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“…A nationwide study indicated that more than half of the Brazilian population reported being registered in a primary health unity, and that rural areas have a higher prevalence of linkage when compared to urban areas [28]. The evolution of indicators of installed capacity and use of services denotes a growing appreciation of primary care in Brazil [29,30].…”

Section: Discussionmentioning

confidence: 99%

Work Process of Primary Health care Teams in Brazil from Rural/Urban Municipal Typology: A National Evaluation Study

Lemos

Cunha

Pinheiro

et al. 2021

Preprint

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Background: In Brazil, primary health care assumes the challenge of organizing and articulating health care networks, based on the performance of multidisciplinary teams linked to basic health units. Given that there are limited studies on the organization of the work process of primary health care teams in Brazilian municipalities that consider the rural-urban typology proposed by the Brazilian Institute of Geography and Statistics, this study aims to analyze the work process of primary health care teams in Brazilian municipalities.Methods: Quantitative evaluation was conducted using secondary data from the third cycle of the National Program for Improving Access and Quality of Primary Care (PMAQ-AB) and the Rural/Urban Classification of the Brazilian Institute of Geography and Statistics. Overall, 37,350 teams that participated in all levels of the PMAQ-AB external evaluation were included. The descriptive analysis considered three axes: 1) territorialization, 2) action planning, and 3) monitoring and self-evaluation. Multiple correspondence analyses were used to verify the relationships between the variables and municipal classifications.Results: Teams from adjacent rural municipalities had the lowest percentage of uncovered population in the territory (21.0%), while those from urban municipalities had the highest percentage with reference population >3,500 people/team (43.0%). It was found that 5,446 (15.1%) teams did not carry out planning, and the highest percentage of teams that executed planning was in the urban strata (85.7%). Monitoring performance was observed in 87.9% of the teams, with approximation of the values among the municipal strata with similar characteristics of location; self-evaluation showed the highest percentage in the adjacent intermediate stratum (90.4%). It was possible to identify three groups of teams with distinct characteristics of territorialization and two groups in relation to planning, monitoring, and self-evaluation.Conclusion: The results suggest important differences in the work process of primary health care teams, which vary according to the characteristics of the municipalities in which they are located.

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Trends in the use of health services and their relationship with multimorbidity in Brazil, 1998–2013

Cited by 19 publications

References 35 publications

Effect of multimorbidity on utilisation and out-of-pocket expenditure in Indonesia: quantile regression analysis

Effect of multimorbidity on utilisation and out-of-pocket expenditure in Indonesia: quantile regression analysis

Impact of a patient-centered care model implemented in public health facilities in Chile: A real world evidence evaluation

Work Process of Primary Health care Teams in Brazil from Rural/Urban Municipal Typology: A National Evaluation Study

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