Abstract
BackgroundA usual source of care (USC) has been conceptualized as having a health provider or place available for patients to consult when sick or in need of medical care. Having a USC is a means to achieve longitudinality of care with Primary Health Care (PHC) providers. Brazil has made enormous progress in PHC and thus provides an important opportunity to investigate USC in a middle-income country context.MethodsThis study uses data from a nationally representative household survey, the 2013 National Health Survey (n = 62,986), to describe the prevalence of having a USC in Brazil and to investigate to what extent the Family Health Strategy (FHS) has contributed to USC prevalence. Analyses include descriptive, bivariate and multivariable Poisson regression.ResultsShow very high rates of people reporting any type of USC (74.4 %) and more than one third reporting PHC as their USC. Household enrolment in the FHS was positively associated with having any USC (PR:1.09; 95 % CI: 1.07–1.12) and a stronger association with having PHC as the regular source of care (PR:1.63;95 % CI:1.54–1.73). FHS enrolment was negatively associated with reporting emergency/urgent care facilities as one’s USC (PR: 0.67; 95 % CI: 0.59–0.76). The association between the more consolidated FHS with having a USC was strongest in the poorest regions of the country (North, Northeast and Central-West). Having PHC as one’s USC showed a positive dose-response relationship with the FHS in all regions, especially in the Central-West.ConclusionsOur results have important implications for the health care model in Brazil and in other countries, especially those seeking to base their national health systems more strongly on primary health care. The study suggests expanding primary health care can increase the establishment of a USC which can help assure better monitoring of chronic conditions and attention to patient needs.
Highlights
A usual source of care (USC) has been conceptualized as having a health provider or place available for patients to consult when sick or in need of medical care
The Brazilian National Health Survey (Pesquisa Nacional de Saúde-PNS) is nationally-representative household survey developed by the Brazilian Institute of Geography and Statistics (IBGE) and Ministry of Health and conducted in 2013
We present results of multivariable Poisson regression models for each USC outcome as the prevalence is over 10 % and adjusted prevalence ratios and 95 % confidence intervals (CI) for the association of enrollment in the Family Health Strategy (FHS) and USC and were estimated
Summary
A usual source of care (USC) has been conceptualized as having a health provider or place available for patients to consult when sick or in need of medical care. A usual source of care (USC) has been conceptualized as having a specific health provider or place for patients to consult when sick or in need of medical care [1]. It is directly related with longitudinality, one of the core dimensions of primary health care [2], defined by patient follow-up over time by a general practitioner or PHC staff, characterizing an implicit therapeutic relationship based on professional responsibility and mutual confidence [3]. A recent exploratory study in England shows that more than
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