The scope of practice of primary health care physicians in rural and urban areas in Brazil.

Ana Cristina Van Stralen,Mariangela Leal Cherchiglia,Cristiana Leite Carvalho,Sábado Nicolau Girardi,Ilka Afonso Reis,Celia Regina Pierantoni

doi:10.1590/0102-311x00211520

Abstract

This study aimed to identify differences in the scope of practice of primary care physicians and find the main factors associated with expanded practice in rural and urban areas of Brazil. Data from an online survey with 2,277 primary care physicians, conducted between January and March 2016, were used. Differences regarding activities and procedures performed by physicians per area were verified using Kruskal-Wallis/Dunn's post hoc and chi-square tests. Multivariate linear regression analyses were done using a bootstrap technique to identify the main factors associated with an expanded scope of practice. Regardless of the location, the results showed that the practices of the primary care physicians are below their competences. Rural physicians performed a higher number of procedures and activities compared with their peers from intermediate and urban municipalities. Within the overall sample, the variables related to a broader scope of practice included: male gender, work in rural municipalities, participation in training and continuing education programs and consultation of clinical protocols, articles and books. This study contributes with evidence that the medical scope of practice varies according to location. Recognizing and understanding the differences and associated factors for an expanded scope of practice is necessary to determine the skills and resources required for practice in rural and urban areas, collaborating in proposals of strategies to improve quality and access of health care services.

Highlights

Primary healthcare (PHC) in Brazil is crucial to the Unified National Health System (SUS) 1
The sample was reached through convenience from a list of physicians enrolled in the Family Health Specialization Program and other short-term courses focused on PHC offered by the Open University System of SUS (UNA-SUS, Portuguese)
4,218 physicians consented to participate, of which 2,277 responses were considered for the present analysis

Summary

Introduction

Primary healthcare (PHC) in Brazil is crucial to the Unified National Health System (SUS) 1. The consolidation of PHC over the past decades is one of the major advances made by SUS as a public policy and universal system. Different policies and programs contributed to the expansion of PHC. The adoption of the Family Health Program in 1994 can be highlighted as responsible for changing and reorganizing the model of care. In 2006, it became known as the Family Health Strategy (FHS) after the publication of the National Policy on Primary Care (PNAP, in Portuguese). Under strong recent threats (some reported in the discussion), FHS is considered the main PHC model in Brazil. Physicians play an important role in this team, attracting and retaining them in PHC to rural, remote and unsafe areas of urban centers is a continuous challenge 4

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Discussion

Conclusion