Brazilian Health Care Research Articles

Federal governance in building the policy to combat the COVID-19 pandemic in Brazilian primary health care

Resumo Este artigo objetiva descrever e analisar o processo de pactuação federal da política de enfrentamento à pandemia de COVID-19 no âmbito da atenção primária à saúde (APS). Trata-se de um estudo de análise de políticas para o qual se realizou pesquisa documental exploratória buscando identificar os registros dos debates e publicações oficiais do Ministério da Saúde acerca das políticas/orientações relacionadas à gestão e ao trabalho na APS ao longo da pandemia. À luz do referencial de governança em políticas públicas, procedeu-se à análise de conteúdo dos achados. O debate sobre o tema foi identificado em 23 reuniões/encontros oficiais, em sua maioria no âmbito da gestão, sendo menores os espaços científicos e de participação popular. No que se refere ao conteúdo das 34 publicações ministeriais, apenas 15 haviam sido discutidas previamente com outras representações institucionais. Não apenas pela pouca propensão aos debates, mas pelas contradições e ausências percebidas ao se concatenar o conteúdo das discussões e das publicações oficiais, percebeu-se evidente descoordenação central, rompimento do pacto federativo e hierarquização do modelo histórico de governança em redes no Sistema Único de Saúde, induzidos pela agenda autoritária e negacionista da Presidência da República.

Community therapy as a strategy for promoting the mental health of professors in the COVID-19 pandemic.

To understand the perception of university professors about Integrative Community Therapy as a mental health promotion strategy. Qualitative, phenomenological and interventional research, conducted with professors of the Nursing course at the Universidade Estadual do Sudoeste da Bahia, Jequié, Bahia, Brazil. The experiential descriptions were produced through phenomenological interviews, whose resulting material was analyzed based on the Ambiguity Analytical technique. The professors expressed a lack of interaction between them, a fact that has become a reality in everyday academic life and that has worsened in the emergence of the COVID-19 pandemic. In this context, the Community Therapy circles in a virtual environment proved to be effective in sharing psychosocial and physical demands, as well as in the collective discussion of problem situations and the search for joint solutions. The study highlights the potential of Community Therapy as an integrative and complementary practice to the Brazilian public health care model.

Brazilian Primary Health Care strategies during the COVID-19 pandemic: A scoping review

Resumo A Atenção Primária à Saúde é a porta de entrada dos usuários ao sistema de saúde brasileiro e foi, especialmente, impactada pelas demandas com a COVID-19. Essa revisão identificou e mapeou sistematicamente evidências sobre as estratégias novas ou adaptadas desenvolvidas na Atenção Primária à Saúde durante a pandemia de COVID-19 no Brasil. Foi realizada uma revisão de escopo, conforme metodologia proposta pelo JBI. Os resultados apresentados em uma síntese narrativa, foram analisados e discutidos à luz da Teoria do Processo de Trabalho em Saúde que agrupou as publicações em dois grandes domínios de estratégias, gerenciais e assistenciais, sendo elas novas, adaptadas ou mantidas. A partir de 49 estudos, mapeou-se 226 intervenções (130 gerenciais; 96 assistenciais). Em ambos os domínios, as novas estratégias apareceram em maior número e as mantidas, em menor. A diversidade de intervenções explicitou distintos modelos de atenção, que ora se aproximaram de um enfoque biologicista, ora da integralidade e da longitudinalidade baseada no cuidado centrado na pessoa, na família e na comunidade. Evidenciou-se, assim, que perduram os mesmos desafios anteriores ao período pandêmico.

Precarization of nurses’ work: an analysis in the Brazilian Primary Health Care

Resumo Este artigo teve como objetivo analisar os tipos de vínculos de trabalho das enfermeiras da Atenção Primária à Saúde no Brasil. Tratou-se de um estudo transversal de abordagem quantitativa e descritiva. Utilizaram-se os microdados secundários referentes ao desdobramento da pesquisa de avaliação externa do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica. Quanto ao tipo de vínculo, com exceção da Região Norte (33,70%), todas as outras regiões apresentaram como principal respondente servidoras públicas estatutárias: Sul (66,20%), Centro-Oeste (56,50%), Nordeste (40,33%), Sudeste (36,69%). Enfermeiras com contrato temporário pela administração pública e contrato temporário por prestação de serviço tiveram participação importante no Nordeste (29,51% e 19,33%) e Centro-Oeste (16,03% e 17,86%). Contrato e empregado via Consolidação das Leis do Trabalho tiveram mais expressão no Sudeste (23,54% e 8,27%) e no Sul (5,93% e 19,31%). No Sudeste, foi expressiva a participação de trabalhadoras contratadas por organizações sociais de saúde. Notou-se a presença crescente de vínculos precários de trabalho em detrimento dos vínculos estáveis. As novas formas de organização flexível das relações de trabalho trazem impacto significativo ao processo de trabalho, sobrecarregam as enfermeiras, em condições de trabalho inadequadas, e comprometem a qualidade da assistência, reduzindo a resolutividade da Atenção Primária.

Análise temporal de indicadores da Estratégia Saúde da Família sob o olhar da Política Nacional da Atenção Básica

Throughout the three editions of the Brazilian National Primary Health Care Policy (PNAB), changes were made in relation to the structure of the Family Health Strategy (FHS), with emphasis on modifications concerning the priority nature of the FHS as an organization and care strategy in primary health care. The objective was to analyze temporal trends in indicators related to the FHS from the perspective of the three PNAB editions: 2006, 2011, and 2017. This is a descriptive study of the temporal trend of indicators selected from a logical model constructed by components related to the FHS in the three editions of the PNAB. The logical model was developed based on the components Territory/Enrollment, Teams, Work Process, Territory Planning and Management, and Care for Priority Groups by Family Health Teams, each one being represented by selected indicators. The construction of the national and regional time series between 2007 and 2020 was carried out using the Joinpoint software. Most of the indicators showed an upward trend in the first time segments identified by the models, followed by segments of stability or decrease, especially after the year 2017. The indicator Number of community health workers stands out, which decreased after 2017 in most geographical regions and in Brazil. The 2017 PNAB may have discouraged the continuation and expansion of the FHS as the priority model of primary health care, by allowing and financing new teamwork arrangements and processes.

Medicina personalizada: panorama e comparação de desafios e oportunidades para sua implantação no SUS

The objective of this work is, through a literature review, to promote the debate on personalized medicine and acquire a broad view of the subject and its tools from the perspective of oncology, disseminate the topic, support, and encourage initiatives to implement its technologies in the Brazilian public healthcare system, collaborating for a sustainable ecosystem in the incorporation of technologies, and above all, with the health and quality of life of patients. The implementation of personalized medicine technologies in SUS is feasible and effective. The scenario is optimistic considering the latest updates from the Ministry of Health with the establishment of the Brazilian Genomes Program. With wise management of resources and actions focused on creating an infrastructure that supports it, the entire public healthcare system will be benefited and can take advantage of the improvements. Personalized medicine is the future of healthcare.

The New Coronavirus Pandemic and the Trend of Breast Cancer Diagnosis according to Age-Group: Total and Interrupted Time Series Study

Objective: There is a lack of studies evaluating the COVID-19 pandemic effect on breast cancer detection according to age-group. This study aimed to assess the pandemic impact on the trend of mammograms, breast biopsies, and breast cancer stage at diagnosis according to age-group. Methods: This was an ecological time series study by inflection point regression model. We used data from women aged between 30 and 49, 50 and 69, and 70 years or more available in an open-access dataset of the Brazilian public healthcare system (2017–2021). We analyzed the trend of the variables in the pre-pandemic and the pandemic effect on the total time series. Results: The decreasing or stationary trend of mammograms in the pre-pandemic has changed to a decreasing trend in the total time series in all age-groups. Before the pandemic, the increasing trend of breast biopsies has changed to stationary in the total time series in all age-groups. The increasing trend of tumors at stages 0 to II in the pre-pandemic has changed to decreasing or stationary in the total time series. Finally, the increasing trend of tumors at stage III or IV remained increasing in the total time series in all age-groups. Conclusion: The pandemic has changed the stationary or increasing trend to a decreasing or stationary trend of mammograms, breast biopsies, and tumors at stages 0 to II but has not influenced the increasing trend of tumors at stages III and IV in all age-groups.

Psychiatric outcomes and overall functionality in students from health care programs during the pandemic: a cross-sectional study at the first COVID-19 wave in Brazil.

There are evidences that Coronavirus Disease 2019 (COVID-19) pandemic impacted students from health care programs, including associations between anxiety or depression, inadequate coping mechanisms or unhealthy habit. However, little is known about possible predictors of mental health or psychiatric symptoms in Brazilian health care students during this period. : To evaluate possible associated factors of anxiety and depressive symptoms, as a measure of psychiatric outcomes, and quality of life, as a parameter of overall functionality in Brazilian students from health care programs during the COVID-19 pandemic. Cross-sectional study conducted with Brazilian students from health care programs from May to December 2020. Participants were recruited through social media and answered a 71-item open online questionnaire exploring demographic characteristics and personal behaviors during the pandemic, anxiety, depression and quality of life. We searched for potential associated variables of psychiatric symptoms and mental health in these individuals using Poisson regression models. Multivariate models showed depression and anxiety were associated to poor quality of life, and medication abuse was associated with higher anxiety and poor quality of life. Psychotherapy was an effective coping strategy for anxiety, and meditation or mindfulness practice and physical activity improved the quality of life of the students. Our study provides important information about the factors and coping strategies associated with psychological impacts of the COVID-19 pandemic that should be helpful to reflect and to design appropriate interventions.

Access to reconstructive plastic surgery for patients undergoing bariatric surgery in the Unified Health System (SUS).

obesity is one of the most common diseases worldwide, and the most effective treatment to it is the bariatric surgery. One of the negative impacts of this procedure is the body dysmorphia caused by overhanging skin. In Brazil, the national health system - Sistema Único de Sáude (SUS) - provide body contouring surgery to treat post-bariatric patients, since 2007. This article aims to describe the Brazilian public health approach to post bariatric patients and perform an analyze in the Brazilian health care database. in Brazilian Health System database, a search for the post-bariatric procedures performed between 2007 to 2021 was done. The variables analyzed were geographic location, year, mean days of hospitalization, death, and mortality rate. Also, we evaluated the number of bariatric procedures done in the same period. Statistical analysis was performed using the Student-t and the chi-square tests and p-value <0.5 was considered significant. a total of 12,717 plastic surgery procedures in post bariatric patients were done, with a national prevalence of 13.8%. Dermolipectomy was the most performed procedure, with 6,719. The years of 2020 and 2021 suffered a decreased of 64.3% and 70.9% in the number of surgeries (p<0,001). Bariatric Procedures had a high rate and a higher percentage of growth comparing to post bariatric surgery (p<0,001), totalizing 93,589 surgeries. Brazil had a significant number of body contouring surgery, however with a low prevalence. Dermoliepctomy was the most common procedure performed. We could notice a significant impact of COVID pandemic in those procedures .

Repensando a competência cultural nas práticas de saúde no Brasil: por um cuidado culturalmente sensível

Abstract Planning and implementing health policies and practices in countries with Primary Health Care-oriented systems must recognize and manage social inequality issues in health, which hinder comprehensive and equitable care. A widely advocated strategy for detecting and dealing with such challenges is the notion of cultural competence (CC). In this article, we will present the notion of CC, its criticisms, and theoretical-practical alternatives and, then, a narrative review of Brazilian publications related to healthcare in the Family Health Strategy. Recognizing sociocultural diversity in planning health interventions in Brazil is essential, given that it is an extremely diverse country, whose health system is organized on the premises of the Health Reform but that presents important inequities still. We argue that the inclusion and the negotiation of sociocultural differences in health practices would benefit from the observation of the social-historical context and the reflection on the Brazilian health care experiences and the everyday care practices within the communities.

Estratégias dos serviços de Atenção Primária durante a pandemia da COVID-19 no Brasil: uma revisão de escopo

Abstract Primary Health Care is the gateway for users to access the Brazilian healthcare system and has been particularly affected by the COVID-19 pandemic demands. This review systematically identified and mapped evidence regarding novel or adapted strategies developed within PHC during the COVID-19 pandemic in Brazil. Our results are presented as a narrative synthesis following the JBI methodology. They were analyzed and discussed through the lens of the Health Work Process Theory, which allowed us to categorize the publications into two principal domains of strategies, managerial and clinical, encompassing strategies that were new, adapted, or maintained in healthcare services. Two hundred twenty-six interventions were identified (130 managerial and 96 clinical) from 49 studies. The new strategies appeared more frequently in both domains, while the maintained ones were less prevalent. The array of interventions highlights different care models, sometimes aligned with a biomedical approach. In contrast, others focus on comprehensiveness and longitudinality based on a person-centered care, in the family, and the community. Thus, this review identified that the same pre-pandemic challenges persist.

Malignant neoplasm of breast in Brazilian women: A cross-sectional study from 2008 to 2019

ObjectiveBreast cancer is the most lethal malignancy for women worldwide. Developed countries, such as Portugal, Spain, and the United States, have declining mortality rates due to breast cancer; however, in developing countries, the epidemiological reports are scarce. In this context, the aims of this study are to describe and discuss the female breast cancer profile of hospitalization and mortality according to age and geographic region in Brazil from 2008 to 2019. MethodsData were obtained from the National Health System Department of Informatics (DATASUS), maintained by the Brazilian Ministry of Health, which includes the registers of hospitalization and mortality by malignant neoplasm of breast (code C50, ICD-10). Proportional rates of hospitalization and deaths were estimated per 100,000 inhabitants according to respective subjects’ age, region, and year of the occurrence. ResultsFrom 2008 to 2019, 643,822 hospital admissions due to malignant neoplasm of breast were reported in Brazil, of which the South and Southeast regions were the most prevalent. Higher hospitalization rates were seen in subjects aged 50–79-years-old. Regarding mortality, 53,480 deaths by breast cancer were reported; similarly to hospitalization, the Southeast and South were the most affected regions. Mortality rates have increased over time in different magnitudes depending on subjects’ age. ConclusionWe have shown an increase in morbidity and mortality over time, which is dependent on patients’ age and region. The results presented here may contribute to the ongoing discussion about the role and future perspectives of the Brazilian health care system, especially regarding to the strategies for the prevention, control, and treatment of breast cancer.

Does Legal Change Induce Behavioral Change in Domestic Violence Against Women?

In this paper, we study the effectiveness of the Brazilian "Maria da Penha" Law-a law that imposed criminal sanctions on and promoted rehabilitation programs for known perpetrators of acts of domestic violence exclusively against women, issued restraining orders against perpetrators, required perpetrators to surrender firearms, and established police units uniquely trained to address violence against women. Using difference-in-difference analyses estimated with data on Brazilian monthly assault-related hospitalizations and with gender as treatment variable, we find that the law contributed to a 22% reduction in assault-related hospitalizations among women as compared with men. Our data is collected from the Brazilian public healthcare system named Sistema Único de Saúde, which provides public information on detailed records of hospitalizations in Brazil. We provide robustness checks of our analyses and examine heterogeneous effects of the law. With respect to the latter, we deduce that the effectiveness of the law in reducing assault-related hospitalizations among women was especially pronounced in municipalities where women are most vulnerable to domestic violence. We conclude with a discussion of our results, with an eye to policy implications and areas for future research.

Professional Factors Associated with Case Resolution without Referrals of Orofacial Pain Cases to Secondary Dental Care by Telehealth in Brazil: A Cross-Sectional Study in 2019 and 2020.

This study aimed to identify professional factors associated with case resolution without a referral of orofacial pain to secondary health care by Brazilian Primary Health Care (PHC) practitioners who demanded asynchronous teleconsulting, stratified by year, in 2019 and 2020 (the COVID-19 Pandemic burst). A cross-sectional study employed secondary databases from asynchronous teleconsulting Telehealth Brazil Networks from January 2019 to December 2020. The outcome was the dichotomous variable "If referral to secondary care was avoided." As covariates: sex, healthcare professions, and category of orofacial pain doubts. A negative binomial regression model estimated each covariate's unadjusted and adjusted PR (95%CI) and p values, stratified for 2019 and 2020. There was a difference in descriptive factors associated with case resolution without a referral from 2019 to 2020. Females prevailed in both years, and the total demand decreased to a third from 2019 to 2020. The rate of resoluteness decreased by 19.1%. In 2019, nurses (PR = 0.69 CI 95% 0.57-0.83) and other professionals (PR = 0.84 CI 95% 0.73-0.97) showed less frequency of case resolution without a referral than did general dentists. In 2020, oral-cavity-related doubts (PR = 1.18 CI 95% 1.06-1.32) and temporomandibular disorders (PR = 1.33 95% 1.15-1.54) surpassed other causes of orofacial pain in case resolution without a referral, and female professionals avoided referrals more frequently than men (PR = 1.24 CI 95% 1.21-1.38). In conclusion, in 2019, oral cavity doubts and the PHC profession influenced the case resolution. Female professionals and oral cavity doubts scored the higher case resolution without a referral for the service in 2020.

ANÁLISE DA DISTRIBUIÇÃO ESPACIAL DAS URGÊNCIAS ODONTOLÓGICAS E SUA RELAÇÃO COM O SISTEMA ÚNICO DE SAÚDE

The study aims to analyze the profile of emergency service patients in dentistry (SUO-FOB) and the spatial analysis of their households concerning the network of Primary Health Care and emergencyin dentistryof the Brazilian Health System (SUS), in aprospective cohortstudy. The data were collected from February2017 to August2018 in theSUO-FOBand e-SUS, municipality of Bauru, São Paulo, Brazil. Among4,121 patients, 78.60% were between 20 and 64 years old, 81% presented pain as themain complaint, and the location of their households showed a spatial pattern of higher intensity of concentration in the outskirts of the city. This study evidencedthat the SUO-FOB contributes to oralhealth care in the municipality, especially in areas where it requiresimprovement. The university emergency services can help support the Brazilian health care network when demanded.

EE9 Cost-Effectiveness Analysis of Dupilumab, Mepolizumab and Benralizumab for Severe Eosinophilic Asthma With Blood Eosinophil Count ≥300 Cells/Mcl in the Brazilian Private Healthcare Perspective

To compare the cost-effectiveness of dupilumab, mepolizumab and benralizumab for the treatment of patients with severe eosinophilic asthma using ICS-LABA with baseline blood eosinophil count ≥ 300 cells/mcl and three or more episodes of asthma exacerbation, or corticosteroid-maintenance, in the previous year, in the Brazilian private healthcare perspective.

Analysis of epidemiological and economic data of hemophilia A patients in Brazil

Objective: To describe the annual medical direct costs per hemophilia A (HA) patient in the Brazilian public healthcare system (SUS) and to understand and describe the patients’ hospital journey, demographical characteristics, and the procedures in the. Methods: This retrospective analysis of DataSUS databases. Data from individuals with registries of HA treatment were gathered between January 1st, 2018, and June 30th, 2021. Besides the D66 ICD-10th code (HA), were also considered the occurrence of some procedures like factor VIII dosage and by-pass therapy dispensation or administration as inclusion criteria. Exclusion criteria were occurrence of factor IX dispensation and female patients were excluded, among others. A record linkage using sociodemographic characteristics was conducted to identify unique patients. Results: Were identified 2,298 individuals underwent ambulatory and 1,018 underwent hospital treatments. The results show that most patients are from the Southeast region of the country, white and middle-aged individuals. The median cost of HA treatment per patient-year was BRL 90.36 for ambulatory care and BRL 1,015.31 for hospital care procedures. The costs were significantly higher for more severe patients and for those between 12 and 18 years old (BRL 1,974.75 and BRL 1,049.09, respectively). Conclusion: The evidence demonstrated encourages the implementation of policies aiming to improve the quality of care provided to patients with HA. Providing referral centers for hemophiliac patients is primordial for the success of the treatment and can result in efficiency.

Profile of COVID-19 in Brazil—risk factors and socioeconomic vulnerability associated with disease outcome: retrospective analysis of population-based registers

ObjectivesTo classify the most up-to-date factors associated with COVID-19 disease outcomes in Brazil.DesignRetrospective study.SettingNationwide Brazilian COVID-19 healthcare registers.ParticipantsWe used healthcare data of individuals diagnosed with mild/moderate (n=70 056 602) or...

EE574 Cemiplimab and Pembrolizumab for Advanced Non-Small Cell Lung Cancer With PD-L1 ≥ 50%: Number Needed to Treat and Cost of Preventing an Event in the Brazilian Private Healthcare System Perspective

To analyze the number needed to treat (NNT) and cost of preventing an event (COPE) for cemiplimab and pembrolizumab as first-line treatments for advanced non-small-cell lung cancer with PD-L1 ≥ 50%, under the Brazilian private healthcare perspective.

PD61 What Are The Drivers Of Transitioning From Fee-For-Service To Value-Based Payment Models In The Brazilian Private Healthcare System?

IntroductionThe Brazilian National Agency for private healthcare system (ANS) makes the regulation for private healthcare system in Brazil. ANS, since 2019, is running the pilot value-based new payment models project. In total, 13 projects were selected by ANS. This research aims to identify the key drivers for moving from fee for service (FFS) to value-based payment models in the Brazilian healthcare private system.MethodsWe interviewed managers of private healthcare plans (13 in total) participating in the Value-Based Payment Models run by ANS. Data were collected through semi-structured interviews during 2021. Twelve managers were invited to the interview and eight accepted the invitation. The key questions were: “Why are healthcare providers transitioning from the fee for service model to value-based models?” and “What are your motivations to participate in the ANS project?” For data analysis, Bardin’s content analysis was chosen. Data validation was performed using the debriefing technique.ResultsThe main reasons for transitioning from FFS to value-based models were related to weaknesses of FFS (58%), strengths of the value-based payment model (14%) and sector needs (14%). Fee-for-service weaknesses are related to financial impacts – including waste and unsustainability (55%), and lack of transparency – including lack of trust and conflict of interest (28%). Strengths of the value-based payment model were related to financial benefits (100%), in other words, greater return on investment. The key unmet needs of the sector are related to improvement of the financial status - including lower costs and less waste (71%), and improvement of care delivery quality (29%). Continuity was reported as a benefit of FFS, according to 43 percent of respondents.ConclusionsOur results suggest that financial motivations are the main reason to transition from fee-for-service to value-based models.