Factors associated with service user embracement by Primary Health Care teams in Brazil, 2012: a cross-sectional study

Giordani, Jessye Melgarejo do Amaral; Amaral Júnior, Orlando Luiz do; Hugo, Fernando Neves; Hilgert, Juliana Balbinot

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Epidemiologia e Serviços de Saúde

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Original Article • Epidemiol. Serv. Saúde 29 (5) • 2020 • https://doi.org/10.1590/S1679-49742020000500017 copy

Factors associated with service user embracement by Primary Health Care teams in Brazil, 2012: a cross-sectional study^* * This study is derived from the Ph.D. thesis by Jessye Melgarejo do Amaral Giordani, entitled ‘User embracement in primary health care: policies, meanings and evidence’, defended at the Federal University of Rio Grande do Sul Postgraduate Epidemiology Program in 2015. The study received support from the National Council for Scientific and Technological Development (CNPq)/Ministry of Science, Technology, Innovation and Communication (MCTIC), in the form of a doctorate scholarship: Process No. 141889/2015-2.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To evaluate prevalence and factors associated with service user embracement by Primary Health Care teams in Brazil.

Methods:

This is a cross-sectional study that included teams that took part in the 2012 National Program for Primary Health Care Access and Quality Improvement (PMAQ-AB) (Cycle I). The outcome used was ‘user embracement by the health team’. The independent variables were macro-region, municipal profile, Gini index and Family Health Strategy population coverage, team meetings, study of spontaneous demand, consideration of user opinions and existence of continuing education. Multilevel Poisson regression analysis was performed.

Results:

The sample consisted of 13,751 teams. User embracement prevalence was 78.3% (95%CI 77.6;79.1). In the hierarchical analysis, the highest prevalence of user embracement was found among Southern region teams (PR=1.37 – 95%CI 1.27;1.48) taking the Northeast region as a reference.

Conclusion:

There is an uneven distribution of Primary Care teams practicing user embracement in Brazil, possibly associated with regional inequalities.

Keywords:
User Embracement; Primary Health Care; Multilevel Analysis; Cross-Sectional Studies; Social Inequity

Variables		n (%)	Service user embracement prevalence	Crude PR^b b) PR: prevalence ratio.	Model 1 Adjusted PR^b b) PR: prevalence ratio.	p-value^c c) Refers to adjusted prevalence ratios.
Variables		n (%)	(95%CI)^a a) 95%CI: 95% confidence interval.	(95%CI)^a a) 95%CI: 95% confidence interval.	(95%CI)^a a) 95%CI: 95% confidence interval.	p-value^c c) Refers to adjusted prevalence ratios.
Macro-region
	Northeast	3,918 (28.5)	62.1 (60.6;63.6)	1.00	1.00
	North	655 (4.8)	71.3 (67.7;74.6)	1.13 (1.03;1.25)	1.15 (1.03;1.27)	<0.01
	Midwest	739 (5.4)	84.2 (81.3;86.6)	1.34 (1.23;1.47)	1.31 (1.18;1.44)	<0.01
	Southeast	6,049 (43.9)	84.1 (83.1;84.9)	1.33 (1.26;1.41)	1.29 (1.21;1.38)	<0.01
	South	2,390 (17.4)	90.6 (89.4;91.7)	1.44 (1.35;1.53)	1.37 (1.27;1.48)	<0.01
Municipal profile
	20% poverty	2,343 (17.0)	64.5 (62.5;66.4)	1.00	1.00
	G100^d d) G100: the 100 municipalities with more than 80,000 inhabitants and with the lowest levels of public revenue per capita and high social vulnerability social.	770 (5.6)	70.5 (67.2;73.6)	1.08 (0.98;1.21)	0.98 (0.88;1.09)	0.82
	Capital/metropolitan region	4,969 (36.1)	82.7 (81.6;83.8)	1.29 (1.22;1.38)	1.07 (0.99;1.15)	0.07
	Other locations	5,669 (41.3)	81.2 (80.2;82.2)	1.25 (1.19;1.33)	1.04 (0.97;1.12)	0.21
FHS population coverage ^e e) FHS: Family Health Strategy.
	More than 4,000 people	2,919 (22.5)	78.4 (76.9;79.9)	1.00	1.00
	Up to 4,000 people	10,085 (77.5)	78.4 (77.6;79.2)	0.98 (0.94;1.03)	0.99 (0.94;1.03)	0.69
	Gini Index^f f) Average (standard deviation).	0.52 (0.06)	0.51 (0.06)	0.38 (0.27;0.52)	0.77 (0.53;1.12)	0.19

Variables		n (%)	Service user embracement prevalence	Crude PR^b b) PR: prevalence ratio.	Model 2 Adjusted PR^b b) PR: prevalence ratio.	p-value^c c) Refers to adjusted prevalence ratios.
Variables		n (%)	(95%CI)^a a) 95%CI: 95% confidence interval.	(95%CI)^a a) 95%CI: 95% confidence interval.	(95%CI)^a a) 95%CI: 95% confidence interval.	p-value^c c) Refers to adjusted prevalence ratios.
Holds team meetings
	No	142 (1.1)	76.1 (68.4;82.3)	1.00	1.00
	Yes	13,603 (98.9)	78.3 (77.6;79.1)	1.08 (0.67;1.71)	1.06 (0.83;1.37)	0.61
Carried out demand study
	No	8,048 (58.5)	75.8 (74.9;76.8)	1.00	1.00
	Yes	5,703 (41.5)	81.8 (80.8;82.8)	1.29 (1.16;1.43)	1.05 (0.97;1.14)	0.16
Considers service user opinions
	No	1,301 (9.4)	72.9 (70.4;75.2)	1.00	1.00
	Yes	12,449 (90.6)	78.9 (78.2;79.6)	1.31 (1.11;1.52)	1.03 (0.99;1.08)	0.10
Carries out continuing education actions
	No	2,500 (21.7)	75.6 (73.9;77.3)	1.00	1.00
	Yes	9,029 (78.3)	80.8 (80.1;81.6)	1.05 (0.99; 1.10)	1.03 (0.98;1.09)	0.18

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[1] Correspondence: Jessye Melgarejo do Amaral Giordani – Universidade Federal de Santa Maria, Cidade Universitária, Av. Roraima, No. 1000, Prédio 26F, Odontologia, Bairro Camobi, Santa Maria, RS, Brazil. Postcode: 97105-900. E-mail: jessyesm@hotmail.com