Supply/demand ratio for medical consultations, diagnostic tests and chronic kidney disease monitoring in the Brazilian National Health System: a descriptive study, state of São Paulo, Brazil, 2019

Samaan, Farid; Gutierrez, Marcelo; Kirsztajn, Gianna Mastroianni; Sesso, Ricardo Cintra

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Epidemiologia e Serviços de Saúde

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Sumário

Original article • Epidemiol. Serv. Saúde 31 (2) • 2022 • https://doi.org/10.1590/S2237-96222022000200014 copy

Supply/demand ratio for medical consultations, diagnostic tests and chronic kidney disease monitoring in the Brazilian National Health System: a descriptive study, state of São Paulo, Brazil, 2019

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To determine the supply/demand ratio for procedures related to diagnosis and treatment for chronic kidney disease in the Brazilian National Health System (SUS), in the state of São Paulo, Brazil, 2019.

Methods:

This was a descriptive study, using data from the SUS outpatient and hospital information systems. The numbers of medical consultations, diagnostic and chronic kidney disease monitoring tests, performed in the period, were compared with the demand estimation, obtained through ministerial guidelines.

Results:

Exclusive SUS users were 28,791,244, and individuals with arterial hypertension and/or diabetes mellitus, 5,176,188. The number of procedures performed and the ratio between this number and the needs of the population were 389,414 consultations with nephrologists (85%); 11,540,371 serum creatinine tests (223%); 705,709 proteinuria tests (14%); 438,123 kidney ultrasounds (190%); and 1,045 kidney biopsies (36%).

Conclusion:

In the chronic kidney disease care in the SUS it could be seen simultaneous existence of lack of supply, waste and inadequate screening of important procedures.

Keywords:
Renal Insufficiency, Chronic; Primary Health Care; Health Planning; Unified Health System; Epidemiology, Descriptive

Regional health department	Total population^a	20 years and older population^a	Adults with hypertension and/or diabetes^a,b	Percentage of supplementary health coverage^c
Metropolitan area of São Paulo	21,734,682	15,777,313	3,865,442	43.0
Araçatuba	791,256	602,709	147,664	23.5
Araraquara	1,025,982	767,356	188,002	35.5
Baixada Santista	1,865,397	1,359,370	333,046	36.8
Barretos	440,907	330,176	80,893	29.5
Bauru	1,800,757	1,332,249	326,401	23.3
Campinas	4,671,287	3,460,938	847,930	41.8
Franca	718,176	521,324	127,724	31.7
Marília	1,149,132	866,792	212,364	19.8
Piracicaba	1,586,546	1,174,604	287,778	40.9
Presidente Prudente	775,627	586,950	143,803	22.8
Registro	284,509	202,198	49,539	9.0
Ribeirão Preto	1,523,682	1,124,229	275,436	36.9
São João da Boa Vista	834,872	630,473	154,466	29.7
São José do Rio Preto	1,629,470	1,248,033	305,768	30.4
Sorocaba	2,534,157	1,844,086	451,801	27.7
Taubaté	2,552,610	1,867,047	457,427	29.4
State of São Paulo	45,919,049	33,695,847	8,255,483	37.3

Regional health departament	n (%)^a
Regional health departament	Consultation with nephrologists	Serum creatinine	Albuminuria	24-hour proteinuria	Kidney ultrasounds	Kidney biopsies
Metropolitan area of São Paulo	129,717 (65.4)	5,793,701 (262.7)	199,533 (9.0)	159,150 (7.2)	215,650 (217.4)	733 (59.1)
Araçatuba	4,726 (48.8)	79,183 (70.1)	2,386 (2.1)	1,663 (1.5)	6,014 (124.1)	1 (1.7)
Araraquara	4,725 (44.6)	177,792 (146.6)	4,012 (3.3)	3,814 (3.1)	8,870 (167.6)	0 (0.0)
Baixada Santista	20,764 (110.0)	432,517 (205.4)	16,292 (7.7)	7,860 (3.7)	18,530 (196.4)	3 (2.5)
Barretos	7,273 (146.2)	198,692 (348.4)	4,980 (8.7)	3,591 (6.3)	5,162 (207.6)	2 (6.4)
Bauru	20,851 (94.3)	429,834 (171.6)	10,831 (4.3)	21,188 (8.5)	12,976 (117.4)	26 (18.8)
Campinas	36,101 (83.0)	1,036,812 (210.1)	63,506 (12.9)	29,257 (5.9)	39,441 (181.3)	79 (29.1)
Franca	7,840 (99.8)	137,917 (158.0)	6,189 (7.1)	1,582 (1.8)	9,471 (241.2)	8 (16.3)
Marília	8,810 (59,7)	264,126 (155.0)	3,883 (2.3)	3,402 (2.0)	8,577 (116.3)	20 (21.7)
Piracicaba	5.522 (36.8)	360,660 (212.1)	7,824 (4.6)	4,940 (2.9)	9,896 (132.0)	4 (43)
Presidente Prudente	5,703 (59.5)	163,686 (147.4)	4,687 (4.2)	2,109 (1.9)	9,060 (189.1)	26 (43.4)
Registro	2,025 (48.9)	99,276 (220.2)	997 (2.2)	461 (1.0)	5,306 (256.1)	3 (11.6)
Ribeirão Preto	21,366 (138.9)	443,680 (255.2)	20,457 (11.8)	10,520 (6.1)	11,770 (153.0)	81 (84.2)
São João da Boa Vista	5,551 (59.1)	171,300 (157.8)	3,676 (3.4)	2,686 (2.5)	7,993 (170.3)	4 (6.8)
São José do Rio Preto	25,191 (138.9)	408,133 (191.8)	11,385 (5.4)	13,184 (6.2)	24,286 (267.8)	13 (11.5)
Sorocaba	23,883 (81.4)	577,184 (176.6)	19,633 (6.0)	10,124 (3.1)	20,402 (139.2)	12 (6.5)
Taubaté	59,366 (205.9)	765,878 (237.2)	32,501 (10.1)	17,406 (5.4)	24,719 (171.5)	30 (16.7)
State of São Paulo	389,414 (84.6)	11,540,371 (223.0)	412,772 (8.0)	292,937 (5.7)	438,123 (190.3)	1,045 (36.3)

Regional health departament	Illiteracy rate (%)	Degree of urbanization (%)	GDP^a per capita (BRL)	Per capita income (BRL)	Density of nephrologists^b	Density of endocrinologists^b	Density of general practitioner^b	Medical consultations in PHC^c/year/inhabitant	Density of ultrasound machinesd
Metropolitan area of São Paulo	3.5	98.9	55,053	1,175.0	2.7	1.8	52.9	1.1	7.3
Araçatuba	5.9	92.3	31,007	817.7	0.6	1.0	78.5	1.9	9.4
Araraquara	5.0	95.3	38,041	888.9	1.7	3.1	116.4	1.0	7.9
Baixada Santista	4.0	99.8	34,319	967.8	2.4	1.4	79.4	0.7	7.9
Barretos	5.6	94.8	41,710	803.9	3.2	3.2	127.0	2.3	11.6
Bauru	5.3	91.9	32,840	857.4	2.7	2.1	85.9	1.2	9.8
Campinas	3.9	95.6	65,048	1,073.4	2.2	1.6	70.8	0.8	6.5
Franca	5.0	95.2	33,115	816.1	1.7	1.7	85.5	1.5	9.7
Marília	6.0	91.4	31,020	791.1	1.3	3.0	107.3	1.5	9.2
Piracicaba	4.2	95.3	45,468	938.5	2.2	1.0	110.4	1.0	7.3
Presidente Prudente	6.8	89.3	29,387	795.2	1.8	1.3	121.7	1.5	8.5
Registro	8.5	71.2	30,831	524.2	0.7	0.4	52.0	1.1	15.1
Ribeirão Preto	4.6	97.0	41,833	1,014.7	3.2	2.0	84.6	1.6	12.4
São João da Boa Vista	5.2	90.7	34,215	819.5	1.6	1.8	76.8	1.5	7.8
São José do Rio Preto	5.8	91.7	33,611	887.8	2.0	2.1	108.3	2.9	10.5
Sorocaba	4.9	86.3	38,333	798.5	1.9	2.0	58.1	1.1	6.9
Taubaté	3.8	94.1	45,475	910.4	2.4	1.9	86.5	1.0	8.5
State of São Paulo	4.2	95.9	48,538	1,036.5	2.4	1.8	70.3	1.2	7.9

Supply/demand ratio	r^a (p-valor^b)^c
Supply/demand ratio	Population	Illiteracy rate	Degree of urbanization	GDP^a per capita	Per capita income	Density of nephrologists^b	Density of endocrinologists^b	Density of general practitioner^b	Medical consultations in PHC^c/year/inhabitant	Density of ultrasound machinesd
Consultations with nephrologists	0.26 (0.287)	-0.28 (0.266)	0.25 (0.324)	0.28 (0.257)	0.21 (0.404)	0.64 (0.004)	0.43 (0.077)	0.13 (0.610)	0.22 (0.389)	0.32 (0.200)
Serum creatinine	0.34 (0.163)	-0.51 (0.031)	0.44 (0.066)	0.67 (0.002)	0.45 (0.060)	0.75 (< 0.001)	0.10 (0.781)	-0.20 (0.414)	-0.18 (0.483)	0.08 (0.754)
Proteinuria	0.64 (0.004)	-0.71 (0.001)	0.63 (0.005)	0.79 (< 0.001)	0.72 (0.001)	0.85 (< 0.001)	0.32 (0.192)	-0.06 (0.817)	-0.17 (0.509)	-0.16 (0.531)
Kidney ultrasounds	-0.09 (0.705)	-0.04 (0.864)	0.18 (0.645)	0.07 (0.773)	0.08 (0.760)	0.15 (0.559)	-0.17 (0.508)	-0.15 (0.559)	0.04 (0.867)	0.20 (0.433)
Kidney biopsies	0.32 (0.191)	-0.16 (0.520)	0.12 (0.622)	0.20 (0.418)	0.24 (0.336)	0.33 (0.179)	0.02 (0.938)	-0.22 (0.372)	0.10 (0.680)	0.08 (0.742)

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
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[1] Correspondence
Farid Samaan fsamaan@saude.sp.gov.br