Use of electronic health records and primary health care accessibility according to data from the third cycle of the PMAQ-AB

Valdes, Gabriel; Souza, Albert Schiaveto de

doi:10.1590/1413-81232024291.04492023EN

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THEMATIC ARTICLE • Ciênc. saúde coletiva 29 (1) • Jan 2024 • https://doi.org/10.1590/1413-81232024291.04492023EN copy

Use of electronic health records and primary health care accessibility according to data from the third cycle of the PMAQ-AB

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The use of electronic health records (EHR) in primary healthcare (PHC) aims for better integration of services and care quality. One of most the critical points of Brazilian PHC is access. This article aims to analyze, through data from the third evaluation cycle of the Brazilian Program for Improving Access and Quality of Primary Care (PMAQ-AB), the relationship between the use of electronic health records and the parameters of access of the participant teams. Cross-sectional analytical study with secondary data. Data from 38,865 primary care teams, 30,346 health units and 140,444 interviewed users were evaluated. The use of EHR was associated with greater care for non-programmed demands (OR 1.664; 95%CI 1.485-1.866), risk and vulnerability assessment (OR 1.329; 95%CI 1.122-1.574) and use of protocols for clinical conducts (OR 1.656; 95%CI 1.530-1.793), in addition to a greater possibility of scheduling consultation by telephone (OR 3.179; 95%CI 3.030-3.335). Services using EHR are more likely to be the patients first contact (OR 1.226; 95%CI 1.171-1.283) and to be sought when facing urgent health problem (OR 1.198; 95%CI 1.161-1.236). The results point to a concrete possibility of improving access through computerization.

Key words:
Primary Health Care; Health Services Accessibility; Electronic Health Records

Geographic Characteristic	Computers in usable condition		Computers with internet access		Recording information %(n)
Geographic Characteristic	Mean	SD	Mean	SD	PEC	Other EHR	No EHR
Southeast	11,53	11,4	12,29	11,63	18.2 (2,269)	24.1 (3,002)	57.8 (7,211)
South	11.12	7.24	11.05	7.19	30.3 (1,686)	50.6 (2,813)	19.1 (1,059)
Midwest	7.41	6.66	7.25	6.1	40.6 (1,077)	20.4 (542)	39.0 (1,035)
North	5.06	4.73	6.08	5.39	21.5 (672)	1.1 (34)	77.4 (2,421)
North East	3.22	3.99	4.02	4.25	15.8 (2,222)	1.0 (138)	83.2 (11,713)
Capitals	19.14	13.07	19.29	13.23	14.6 (761)	39.5 (2,063)	45.9 (2,394)
Rural cities	5.67	5.9	6.66	6.1	21.9 (7,165)	13.7 (4,466)	64.4 (21,045)
Total	7.57	8.72	8.83	9.14	20.9 (7,926)	17.2 (6,529)	61.9 (23,439)

Team questions		Electronic Health Record		p-value
Team questions		Yes	No	p-value
When the user needs to schedule an appointment, what are the possibilities?	In person, at unit ¹	99.8 (14,428)	99.8 (22,838)	0.263
	By phone ¹	53.3 (7,706)	28.0 (6,419)	<0.001
	By social networks ¹	23.1 (3,342)	18.4 (4,216)	<0.001
	By specific website or application ¹	4.3 (621)	3.4 (774)	<0.001
Has the team carried out an assessment or study of spontaneous demand in the last 12 months? ¹		74.4 (10,757)	68.5 (15,682)	<0.001
Does the team attend to spontaneous demand in this unit? ¹		99.6 (14,390)	98.8 (22,622)	<0.001
Number of shifts (morning/afternoon/night) in which patient reception takes place ²		2.049±0.374	1.954±0.365	<0.001
Number of days of the week in which patient reception takes place ²		4.986±0.526	4.808±0.760	<0.001
Does the team provide patient reception during weekends? ¹		5.8 (831)	1.7 (379)	<0.001
Does the team provide patient reception on Saturdays? ¹		5.8 (830)	1.6 (373)	<0.001
Does the team provide patient reception on Sundays? ¹		0.8 (116)	0.6 (139)	0.033
What is(are) the main process(es) for spontaneous demand reception?	By queue/ticket number ¹	25.7 (3,702)	25.3 (5,731)	0.399
	By order of arrival ¹	71.1 (10,234)	76.4 (17,281)	<0.001
	By risk and vulnerability assessment ¹	96.0 (13,816)	94.4 (21,356)	<0.001
When responding to spontaneous demand, the team carries out:	Emergency care ¹	96.9 (13,937)	93.8 (21,216)	<0.001
	Prescription renewal ¹	93.3 (13,433)	95.0 (21,484)	<0.001
	Risk and vulnerability assessment ¹	98.5 (14.172)	97.4 (22,036)	<0.001
Does the team use protocols/criteria to guide the case management in patient reception? ¹		92.8 (13,357)	86.4 (19,535)	<0.001
Were the professionals on the patient reception team trained in the use of risk and vulnerability assessment protocols/criteria? ¹		90.3 (12,065)	86.6 (16,927)	<0.001
The team provides facilitated access to:	Retrieve and present test results ¹	98.3 (14,204)	97.5 (22,314)	<0.001
The team provides facilitated access to:	Address post-appointment questions or show how their situation has progressed ¹	98.5 (14,233)	98.3 (22,513)	0.333

Variable for analysis	Sig.	Adjusted Odds Ratio	95%CI
Variable for analysis	Sig.	Adjusted Odds Ratio	Bottom	Higher
When the user needs to schedule an appointment, scheduling by phone is a possibility	<0.001	3.179	3.030	3.335
When the user needs to schedule an appointment, scheduling via social media is a possibility	<0.001	0.780	0.736	0.827
The primary care team carried out an assessment or study of spontaneous demand in the last 12 months	<0.001	1.106	1.051	1.163
One of the main processes for spontaneous demand reception is through risk and vulnerability assessment	0.356	1.053	0.944	1.174
When responding to spontaneous demand, the team provides emergency care	<0.001	1.664	1.485	1.866
When responding to spontaneous demand, the team carries out a risk and vulnerability assessment	0.001	1.329	1.122	1.574
The team uses protocols/criteria to guide the case management in patient reception	<0.001	1.656	1.530	1.793
The team is located in a capital	<0.001	2.614	2.453	2.787

User questions		Electronic Health Record		p-value
User questions		Yes	No
Most of the time, the first service you tend to look for when you need health care is this primary healthcare unit ¹		89.4 (49,364)	87.8 (74,417)	<0.001
For which services do you usually seek this primary healthcare unit:	Scheduled consultations ¹	87.3 (48,220)	87.0 (73,826)	0.123
	Unscheduled consultations ¹	68.8 (37,989)	65.8 (55,791)	<0.001
	Emergency care ¹	45.4 (25,056)	39.8 (33,760)	<0.001
Most of the time, how are medical appointments scheduled at this Primary Healthcare Unit?	By phone ¹	4.6 (2,548)	1.6 (1,348)	<0.001
	Online ¹	0.2 (119)	0.2 (138)	0.025
	Goes to the unit and schedules the appointment ¹	83.9 (46,180)	80.1 (67,783)	<0.001
	The community health agent schedules the appointment ¹	8.7 (4,779)	14.6 (12,363)	<0.001
	This primary healthcare unit does not offer appointment scheduling ¹	1.8 (1,010)	2.9 (2,474)	<0.001
	Other unmentioned scheduling methods ¹	0.7 (379)	0.6 (491)	0.012
Is appointment scheduling available every day and at any time the Primary Healthcare Unit is open? ¹		66.4 (33,963)	60.9 (47,239)	<0.001
How do you evaluate this appointment scheduling method? ^2.3		2.20±0.91	2.20±0.88	0.001
When you manage to schedule an appointment, is it usually for the same day? ¹		39.7 (21,267)	43.0 (35,104)	<0.001
Most of the time, your appointments at this unit are:	On an individual, previously scheduled time slot ¹	26.6 (14,282)	13.6 (11,166)	<0.001
	On previously scheduled period/shift time slot, in a first-come, first-served basis ¹	61.0 (32,746)	74.9 (61,342)	<0.001
	On a first-come, first-served basis, without scheduling ¹	11.5 (6,195)	10.6 (8,644)	<0.001
	Other forms not mentioned in instrument ¹	0.9 (490)	0.9 (703)	0.312
On average, how many days do you wait between scheduling an appointment and seeing the doctor at this unit? ²		11.89±22.05	9.18±18.00	<0.001
On average, how many days do you wait between scheduling the appointment and seeing the nurse in this unit? ²		5.01±13.81	4.23±10.07	<0.001
Most of the time you come to the health unit without having an appointment to resolve any problem, are you able to be heard? ¹		87.1 (41,272)	86.1 (59,528)	<0.001
For your convenience, would you prefer appointments to be:	On an individual, previously scheduled time slot ¹	25.0 (13,644)	20.3 (17,030)	<0.001
	On previously scheduled period/shift time slot, in a first-come, first-served basis ¹	9.1 (4,941)	11.3 (9,481)	<0.001
	On a first-come, first-served basis, without scheduling ¹	7.5 (4,075)	8.1 (6,767)	<0.001
	I am satisfied, there is no need for changes in scheduling ¹	56.3 (30,683)	58.2 (48,838)	<0.001
	Other forms not mentioned in instrument ¹	2.2 (1,179)	2.2 (1,813)	0.985
The last time you had an urgent problem, did you seek out this Primary Healthcare Unit? ¹		65.7 (25,473)	61.2 (34,140)	<0.001
Why didn’t you seek this Primary Healthcare Unit?	Because you need to arrive early since the service is on a first-come, first-served basis ¹	5.1 (584)	3.7 (714)	<0.001
	Because it does not handle urgent cases ¹	52.2 (6,010)	59.7 (11,453)	<0.001
	Because there was no professional available at the unit ¹	6.3 (727)	7.1 (1,370)	0.005
	Because the unit was closed at the time ¹	36.5 (4,203)	29.4 (5,649)	<0.001
Did you manage to get assistance at this Primary Healthcare Unit? ¹		89.5 (22,756)	88.6 (30,198)	0.001
Why were you unable to get assistance at this Primary Healthcare Unit?	Because you need to arrive early since the service is on a first-come, first-served basis ¹	15.2 (360)	11.6 (403)	<0.001
	Because it does not handle urgent cases ¹	38.4 (909)	42.1 (1,465)	0.005
	Because there was no professional available at the unit ¹	29.1 (688)	27.7 (962)	0.237
	Because the unit was closed at the time ¹	17.3 (409)	18.7 (649)	0.189
How long did you wait to be seen? ²		28.83±39.62	23.37±33.80	<0.001
When you didn't have an appointment scheduled and needed to ask questions to professionals, were you able to? ¹		81.7 (34,201)	81.2 (50.234)	0.031
When you didn't have a scheduled appointment and needed to retrieve or show test results to professionals, were you able to? ¹		66.2 (27,929)	68.3 (42,946)	<0.001
What do you think about the way you are welcomed/received when seeking the service? ^2.3		1.82±0.72	1.87±0.71	<0.001
If you could, would you change teams or health units? ¹		10.3 (5,589)	11.3 (9,481)	<0.001
Why would you change teams/units?	Unit is far ¹	13.6 (760)	17.8 (1,684)	<0.001
	Service hours do not meet needs ¹	15.9 (887)	18.1 (1,720)	<0.001
	Cannot get service ¹	29.7 (1,662)	30.4 (2,880)	0.419
	Poor service ¹	32.1 (1,796)	29.5 (2,798)	0.001
	Professionals at another unit are better ¹	28.7 (1,604)	25.8 (2,450)	<0.001
	Other reasons not listed ¹	31.7 (1,773)	34.6 (3,279)	<0.001

Variable for analysis	Sig.	Adjusted Odds Ratio	95%CI
Variable for analysis	Sig.	Adjusted Odds Ratio	Bottom	Higher
Most of the time, the first service that the user tends to look for when they need health care is this Primary Healthcare Unit	<0.001	1.226	1.171	1.283
Appointments can be done every day and at any time during the unit operating hours	<0.001	1.188	1.153	1.224
Most of the time, consultations at this unit are by individual time slot appointment.	<0.001	1.438	1.364	1.515
Most of the time, appointments at this unit are on previously scheduled period/shift time slot, in a first-come, first-served basis.	<0.001	0.728	0.696	0.761
Most of the time when users come to the unit without having an appointment to resolve any problem, they are able to be heard	0.033	1.047	1.004	1.092
The last time the user had an urgent problem, they sought out this Primary Healthcare Unit	<0.001	1.198	1.161	1.236
The unit is located in a capital	<0.001	2.113	2.030	2.200

ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Chief editors:

Romeu Gomes, Antônio Augusto Moura da Silva