Factors associated with the evaluation of quality of primary health care by older adults living in the Metropolitan Region of Belo Horizonte, Minas Gerais, Brazil, 2010

Augusto, Daniel Knupp; Lima-Costa, Maria Fernanda; Macinko, James; Peixoto, Sérgio Viana

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Epidemiologia e Serviços de Saúde

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 28 (1) • 2019 • https://doi.org/10.5123/S1679-49742019000100017 copy

Factors associated with the evaluation of quality of primary health care by older adults living in the Metropolitan Region of Belo Horizonte, Minas Gerais, Brazil, 2010^* * Article based on the Master’s Degree dissertation by Daniel Knupp Augusto, entitled ‘Factors associated with the evaluation of Primary Health Care attributes by elderly people who do not have private health insurance, living in the Metropolitan Region of Belo Horizonte, in 2010’, submitted to the Postgraduate Public Health Program, Instituto René Rachou, Fundação Oswaldo Cruz (Fiocruz)/Minas Gerais, in March 2016. The Belo Horizonte Metropolitan Region Health Survey was funded by the Department of Primary Health Care / Health Care Secretariat / Brazilian Ministry of Health. Maria Fernanda Lima-Costa and Sérgio Viana Peixoto are productivity fellows of the National Council for Scientific and Technological Development (CNPq)/Ministry of Science, Technology, Innovations and Communications (MCTIC).

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to analyze factors associated with the perception of quality of primary health care (PHC) services by older adults.

Methods:

this was a cross-sectional survey with 893 older adults aged 60 years and over living in the Metropolitan Region of Belo Horizonte, MG, Brazil; the study’s outcomes were the indicators of the essential attributes of PHC, while explanatory variables included sociodemographic conditions, use of health services and health conditions; Poisson regression with robust variance was used.

Results:

older adults aged 80 years and over, women and those with higher education levels gave better evaluations for access and longitudinality, while evaluation was worst among those who reported greater use of health services and chronic health conditions, especially for the PHC attributes of coordination of care and family and community orientation.

Conclusion:

poorer health conditions and higher use of services are associated with a more negative perception of PHC attributes among the elderly.

Keywords:
Primary Health Care; Health of the Elderly; Epidemiologic Factors; Quality of Health Care; Cross-Sectional Studies, Health evaluation

Variables	Percentage (95%CI^a)
Age range (in years)
60-69	58.3 (54.6;62.0)
70-79	31.0 (27.8;34.5)
≥80	10.6 (8.6;13.1)
Female sex	62.0 (58.6;65.3)
Non-white skin color	58.9 (54.7;63.0)
Schooling (in years of study)
<4	39.8 (36.0;43.6)
4-7	45.6 (41.8;49.4)
≥8	14.7 (12.0;17.8)
Residing in the municipality of Belo Horizonte	53.7 (50.2;57.2)
Medical appointment in the last 12 months	77.6 (73.9;80.8)
Hospitalization in the last 12 months	8.8 (7.0;11.0)
Blood pressure measured in the last 2 years	98.3 (97.2;98.9)
Cholesterol measured in the last 5 years	98.5 (97.4;99.1)
Blood sugar measured in the last 2 years	93.3 (91.3;94.8)
Self-reported diseases
Arterial hypertension	60.5 (57.0;63.9)
Diabetes	17.6 (15.0;20.6)
Angina or heart attack	6.1 (4.6;8.1)
Stroke	5.2 (3.8;7.1)
Arthritis	18.5 (15.7;21.7)
Depression	8.5 (6.7;10.7)
Number of self-reported diseases
0	27.7 (24.5;31.2)
1	39.7 (36.1;43.5)
≥2	32.6 (29.2;36.0)
Good perception of attributes
First-contact access	73.9 (70.1;77.5)
Continuity	63.2 (59.3;66.9)
Comprehensiveness	69.0 (65.3;72.5)
Care coordination	76.9 (73.5;80.1)
Family orientation	67.1 (63.5;70.5)
Community orientation	40.6 (36.8;44.5)

Variables	First-contact access	Continuity	Comprehensiveness	Care coordination	Family orientation	Community orientation
Variables	PR (95%CI)^a	PR (95%CI)^a	PR (95%CI)^a	PR (95%CI)^a	PR (95%CI)^a	PR (95%CI)^a
Age range, in years (reference age range: 60-69 years)
70-79	1.04 (0.95;1.15)	1.09 (0.95;1.25)	1.00 (0.89;1.13)	0.98 (0.89;1.08)	0.95 (0.84;1.08)	1.03 (0.84;1.27)
≥80	1.13 (1.00;1.27)^b	1.32 (1.16;1.52)^b	1.08 (0.93;1.27)	0.98 (0.85;1.13)	0.94 (0.78;1.14)	0.97 (0.71;1.33)
Female sex (reference: male)	1.09 (1.00;1.19)^b	1.05 (0.94;1.17)	1.04 (0.94;1.15)	0.98 (0.91;1.06)	0.93 (0.84;1.03)	0.96 (0.81;1.14)
Non-White skin color (reference: White)	1.07 (0.96;1.19)	1.15 (1.02;1.30)^b	1.11 (0.99;1.23)	1.07 (0.98;1.17)	1.02 (0.92;1.14)	0.91 (0.75;1.11)
Schooling, in years of study (reference: <4 years)
4-7	1.06 (0.96;1.17)	1.06 (0.93;1.20)	1.09 (0.97;1.23)	1.08 (0.98;1.19)	1.08 (0.95;1.21)	1.17 (0.95;1.44)
≥8	1.18 (1.04;1.33)^b	1.24 (1.05;1.46)^b	1.12 (0.96;1.32)	1.12 (0.99;1.27)	1.03 (0.86;1.22)	1.04 (0.75;1.44)
Resident in Belo Horizonte (reference: other Metropolitan Region municipalities)	0.89 (0.80;0.98)^b	1.05 (0.93;1.19)	1.02 (0.92;1.14)	0.97 (0.89;1.06)	1.05 (0.94;1.17)	1.17 (0.95;1.45)

Variáveis	First-contact access	Continuity	Comprehensiveness	Care coordination	Family orientation	Community orientation
Variáveis	PR (95%CI)^a	PR (95%CI)^a	PR (95%CI)^a	PR (95%CI)^a	PR (95%CI)^a	PR (95%CI)^a
Medical appointment in the last 12 months (reference: no appointment)	0.86 (0.78;0.94)^b	0.84 (0.75;0.95)^b	0.99 (0.88;1.12)	0.95 (0.87;1.04)	0.95 (0.84;1.08)	0.80 (0.64;0.99)^b
Hospitalization in the last 12 months (reference: not hospitalized)	0.98 (0.84;1.15)	0.99 (0.81;1.20)	1.05 (0.90;1.24)	1.05 (0.92;1.20)	1.04 (0.87;1.24)	0.96 (0.70;1.30)
Blood pressure measured in the last 2 years (reference: not measured)	1.02 (0.76;1.36)	0.95 (0.68;1.34)	1.34 (0.85;2.11)	0.90 (0.74;1.09)	0.76 (0.63;0.92)^b	0.66 (0.43;1.03)
Cholesterol measured in the last 5 years (reference: not measured)	0.92 (0.71;1.19)	0.93 (0.64;1.37)	1.06 (0.71;1.57)	1.05 (0.78;1.41)	0.93 (0.68;1.27)	0.86 (0.48;1.56)
Blood sugar measured in the last 2 years (reference: not measured)	0.93 (0.80;1.08)	0.90 (0.74;1.09)	1.02 (0.85;1.24)	1.00 (0.86;1.17)	0.79 (0.70;0.90)^b	0.84 (0.62;1.16)
Arterial hypertension (reference: not measured)	0.97 (0.89;1.05)	1.04 (0.93;1.17)	0.94 (0.85;1.04)	0.91 (0.84;0.99)^b	0.91 (0.82;1.01)	0.86 (0.73;1.02)
Diabetes (reference: not measured)	0.93 (0.82;1.05)	1.10 (0.95;1.26)	0.97 (0.85;1.12)	0.95 (0.84;1.07)	0.87 (0.74;1.02)	0.85 (0.66;1.10)
Angina or heart attack (reference: not reported)	0.96 (0.80;1.15)	1.05 (0.86;1.28)	0.92 (0.74;1.14)	0.89 (0.73;1.10)	1.08 (0.89;1.31)	1.42 (1.07;1.90)^b
Stroke (reference: not reported)	0.89 (0.70;1.13)	0.90 (0.67;1.20)	1.07 (0.87;1.32)	1.04 (0.87;1.23)	0.79 (0.58;1.06)	0.93 (0.61;1.44)
Arthritis (reference: not reported)	0.89 (0.78;1.02)	1.05 (0.91;1.21)	1.05 (0.93;1.19)	0.95 (0.85;1.06)	0.80 (0.67;0.95)^b	0.75 (0.57;0.97)^b
Depression (reference: not reported)	0.95 (0.80;1.14)	1.10 (0.92;1.31)	0.96 (0.80;1.16)	0.89 (0.76;1.05)	1.14 (0.98;1.33)	1.26 (0.97;1.64)
Number of self-reported diseases (reference: none)
1	1.00 (0.91;1.11)	0.98 (0.85;1.13)	0.91 (0.80;1.02)	0.91 (0.84;1.00)^b	0.85 (0.76;0.96)^b	0.80 (0.64;0.99)^b
≥2	0.90 (0.80;1.02)	1.12 (0.97;1.29)	0.95 (0.84;1.08)	0.88 (0.79;0.98)^b	0.84 (0.74;0.95)^b	0.86 (0.69;1.07)

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[1] Correspondence: Sérgio Viana Peixoto - Fundação Oswaldo Cruz, Instituto René Rachou, Av. Augusto de Lima, No. 1715, Belo Horizonte, MG, Brazil. Postcode: 30190-009. E-mail: sergio@minas.fiocruz.br