Characteristics of the health system and population at risk
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Utilization of health services and consumer satisfaction
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Expected outcomes after implementing the CNM role
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Free access to health provided by the Brazilian Unified Health System.(4040. Paim J, Travassos C, Almeida C, Bahia L, Macinko J. The Brazilian health system: history, advances, and challenges. Lancet. 2011;377(9779):1778–97.)
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High rates of intervention in labor and delivery.(4141. Cassiano MC, Carlucci EM, Gomes CF, Bennemann RM. Saúde materno infantil no Brasil: evolução e programas desenvolvidos pelo Ministério da Saúde. Rev Serv Público (Brasília). 2014;65(2):227–44.,4242. França GV, Restrepo-Méndez MC, Maia MF, Victora CG, Barros AJ. Coverage and equity in reproductive and maternal health interventions in Brazil: impressive progress following the implementation of the Unified Health System. Int J Equity Health. 2016;15(1):149.)
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Better or equivalent clinical outcomes and lower rates of interventions for care provided by CNMs compared to care provided by physicians.(1919. Newhouse RP, Stanik-Hutt J, White KM, Johantgen M, Bass EB, Zangaro G, et al. Advanced practice nurse outcomes 1990-2008: a systematic review. Nurs Econ. 2011;29(5):230–50.,4343. Schober MM. Factors influencing the development of advanced practice nursing in Singapore [Doctoral]. United Kingdom: Sheffield Hallam University; 2013. 243,4545. Altman MR, Murphy SM, Fitzgerald CE, Andersen HF, Daratha KB. The cost of nurse-midwifery care: use of interventions, resources, and associated costs in the hospital setting. womens health issues. 2017;27(4):434–40.)
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Health system covers most of the Brazilian population.(4040. Paim J, Travassos C, Almeida C, Bahia L, Macinko J. The Brazilian health system: history, advances, and challenges. Lancet. 2011;377(9779):1778–97.)
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Health system faces underfunding issues.(4040. Paim J, Travassos C, Almeida C, Bahia L, Macinko J. The Brazilian health system: history, advances, and challenges. Lancet. 2011;377(9779):1778–97.)
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High rates of C-section.(4141. Cassiano MC, Carlucci EM, Gomes CF, Bennemann RM. Saúde materno infantil no Brasil: evolução e programas desenvolvidos pelo Ministério da Saúde. Rev Serv Público (Brasília). 2014;65(2):227–44.,4242. França GV, Restrepo-Méndez MC, Maia MF, Victora CG, Barros AJ. Coverage and equity in reproductive and maternal health interventions in Brazil: impressive progress following the implementation of the Unified Health System. Int J Equity Health. 2016;15(1):149.)
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Patient satisfaction is proven to be higher with care provided by CNMs.(4343. Schober MM. Factors influencing the development of advanced practice nursing in Singapore [Doctoral]. United Kingdom: Sheffield Hallam University; 2013. 243)
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Family Health Program expanded primary health care to poorest areas but inequities remain.(4141. Cassiano MC, Carlucci EM, Gomes CF, Bennemann RM. Saúde materno infantil no Brasil: evolução e programas desenvolvidos pelo Ministério da Saúde. Rev Serv Público (Brasília). 2014;65(2):227–44.,4242. França GV, Restrepo-Méndez MC, Maia MF, Victora CG, Barros AJ. Coverage and equity in reproductive and maternal health interventions in Brazil: impressive progress following the implementation of the Unified Health System. Int J Equity Health. 2016;15(1):149.)
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Difficulties in access to health care in remote and rural areas.(4141. Cassiano MC, Carlucci EM, Gomes CF, Bennemann RM. Saúde materno infantil no Brasil: evolução e programas desenvolvidos pelo Ministério da Saúde. Rev Serv Público (Brasília). 2014;65(2):227–44.,4242. França GV, Restrepo-Méndez MC, Maia MF, Victora CG, Barros AJ. Coverage and equity in reproductive and maternal health interventions in Brazil: impressive progress following the implementation of the Unified Health System. Int J Equity Health. 2016;15(1):149.)
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Level of good obstetrical practices bellow expectation.(2828. Shekar M, Kakietek J, Dayton Eberwein J, Walters D. Reaching the global target for breastfeeding. In Shekar M, Kakietek OJ, Walters D, Dayton Eberwein J, editors. An investment framework for nutrition: Reaching the global targets for stunting, anemia, breastfeeding, and wasting. Directions in Development—Human Development. Washington (D.C.): World Bank Group; 2017.,4242. França GV, Restrepo-Méndez MC, Maia MF, Victora CG, Barros AJ. Coverage and equity in reproductive and maternal health interventions in Brazil: impressive progress following the implementation of the Unified Health System. Int J Equity Health. 2016;15(1):149.)
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Approach to care provided by CNMs is patient-centered.(4444. Atsalos C, Biggs K, Boensch S, Gavegan FL, Heath S, Payk M, et al. How clinical nurse and midwifery consultants optimise patient care in a tertiary referral hospital. J Clin Nurs. 2014;23(19-20):2874–85.)
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Rede Cegonha guarantees comprehensiveness care in maternal and infant care field.(4141. Cassiano MC, Carlucci EM, Gomes CF, Bennemann RM. Saúde materno infantil no Brasil: evolução e programas desenvolvidos pelo Ministério da Saúde. Rev Serv Público (Brasília). 2014;65(2):227–44.)
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Prenatal coverage and childbirth care almost universal.(88. Leal MD, Bittencourt SD, Torres RM, Niquini RP, Souza PR Jr. Determinants of infant mortality in the Jequitinhonha Valley and in the North and Northeast regions of Brazil. Rev Saude Publica. 2017;51(0):12.,4141. Cassiano MC, Carlucci EM, Gomes CF, Bennemann RM. Saúde materno infantil no Brasil: evolução e programas desenvolvidos pelo Ministério da Saúde. Rev Serv Público (Brasília). 2014;65(2):227–44.)
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Shortcomings in quality of care of pregnant women.(88. Leal MD, Bittencourt SD, Torres RM, Niquini RP, Souza PR Jr. Determinants of infant mortality in the Jequitinhonha Valley and in the North and Northeast regions of Brazil. Rev Saude Publica. 2017;51(0):12.)
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Neonatal outcomes of care provided by CNMs are comparable with care provided by physicians.(1919. Newhouse RP, Stanik-Hutt J, White KM, Johantgen M, Bass EB, Zangaro G, et al. Advanced practice nurse outcomes 1990-2008: a systematic review. Nurs Econ. 2011;29(5):230–50.,4545. Altman MR, Murphy SM, Fitzgerald CE, Andersen HF, Daratha KB. The cost of nurse-midwifery care: use of interventions, resources, and associated costs in the hospital setting. womens health issues. 2017;27(4):434–40.)
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Lack of organization in the health care network.(88. Leal MD, Bittencourt SD, Torres RM, Niquini RP, Souza PR Jr. Determinants of infant mortality in the Jequitinhonha Valley and in the North and Northeast regions of Brazil. Rev Saude Publica. 2017;51(0):12.)
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Lack of supplies and infrastructure of the health system.(2929. Almeida KJ, Roure FN, Bittencourt RJ, Santos RM, Bittencourt FV, Gottems LB, et al. Active health Ombudsman service: evaluation of the quality of delivery and birth care. Rev Saude Publica. 2018;52:76.,4242. França GV, Restrepo-Méndez MC, Maia MF, Victora CG, Barros AJ. Coverage and equity in reproductive and maternal health interventions in Brazil: impressive progress following the implementation of the Unified Health System. Int J Equity Health. 2016;15(1):149.)
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High maternal mortality ratio.(88. Leal MD, Bittencourt SD, Torres RM, Niquini RP, Souza PR Jr. Determinants of infant mortality in the Jequitinhonha Valley and in the North and Northeast regions of Brazil. Rev Saude Publica. 2017;51(0):12.,4141. Cassiano MC, Carlucci EM, Gomes CF, Bennemann RM. Saúde materno infantil no Brasil: evolução e programas desenvolvidos pelo Ministério da Saúde. Rev Serv Público (Brasília). 2014;65(2):227–44.)
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Higher breastfeeding rates.(1919. Newhouse RP, Stanik-Hutt J, White KM, Johantgen M, Bass EB, Zangaro G, et al. Advanced practice nurse outcomes 1990-2008: a systematic review. Nurs Econ. 2011;29(5):230–50.)
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Poor distribution of health professionals throughout the country.(4040. Paim J, Travassos C, Almeida C, Bahia L, Macinko J. The Brazilian health system: history, advances, and challenges. Lancet. 2011;377(9779):1778–97.,4141. Cassiano MC, Carlucci EM, Gomes CF, Bennemann RM. Saúde materno infantil no Brasil: evolução e programas desenvolvidos pelo Ministério da Saúde. Rev Serv Público (Brasília). 2014;65(2):227–44.)
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Socioeconomic inequalities.(4242. França GV, Restrepo-Méndez MC, Maia MF, Victora CG, Barros AJ. Coverage and equity in reproductive and maternal health interventions in Brazil: impressive progress following the implementation of the Unified Health System. Int J Equity Health. 2016;15(1):149.)
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Infant mortality ratio above the ideal level.(88. Leal MD, Bittencourt SD, Torres RM, Niquini RP, Souza PR Jr. Determinants of infant mortality in the Jequitinhonha Valley and in the North and Northeast regions of Brazil. Rev Saude Publica. 2017;51(0):12.,4141. Cassiano MC, Carlucci EM, Gomes CF, Bennemann RM. Saúde materno infantil no Brasil: evolução e programas desenvolvidos pelo Ministério da Saúde. Rev Serv Público (Brasília). 2014;65(2):227–44.)
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Lower or equivalent health care costs when compared to assistance provided by physicians.(2121. Casey M, O'Connor L, Cashin A, Smith R, O'Brien D, Nicholson E, et al. An overview of the outcomes and impact of specialist and advanced nursing and midwifery practice, on quality of care, cost and access to services: A narrative review. Nurse Educ Today. 2017; 56:35–40.,4545. Altman MR, Murphy SM, Fitzgerald CE, Andersen HF, Daratha KB. The cost of nurse-midwifery care: use of interventions, resources, and associated costs in the hospital setting. womens health issues. 2017;27(4):434–40.)
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