Brazilian Family Health Program Research Articles

The Effect of Brazil's Family Health Program on Cognitive Skills

The Effect of Brazil's Family Health Program on Cognitive Skills

Equity and economic evaluation of system-level health interventions: A case study of Brazil's Family Health Program.

Distributional economic evaluation estimates the value for money of health interventions in terms of population health and health equity impacts. When applied to interventions delivered at the population and health system-level interventions (PSIs) instead of clinical interventions, additional practical and methodological challenges arise. Using the example of the Programme Saúde da Familia (PSF) in Brazil, a community-level primary care system intervention, we seek to illustrate these challenges and provide potential solutions. We use a distributional cost-effectiveness analysis (DCEA) approach to evaluate the impact of the PSF on population health and between-state health inequalities in Brazil. Data on baseline health status, disease prevalence and PSF effectiveness are extracted from the literature and incorporated into a Markov model to estimate the long-term impacts in terms of disability-adjusted life years. The inequality and average health impacts are analysed simultaneously using health-related social welfare functions. Uncertainty is computed using Monte Carlo simulation. The DCEA encountered several challenges in the context of PSIs. Non-randomized, quasi-experimental methods may not be powered to identify treatment effect heterogeneity estimates to inform a decision model. PSIs are more likely to be funded from multiple public sector budgets, complicating the calculation of health opportunity costs. We estimate a cost-per-disability-adjusted life years of funding the PSF of $2640. Net benefits were positive across the likely range of intervention cost. Social welfare analysis indicates that, compared to gains in average health, changes in health inequalities accounted for a small proportion of the total welfare improvement, even at high levels of social inequality aversion. Evidence on the population health and health equity impacts of PSIs can be incorporated into economic evaluation methods, although with additional complexity and assumptions. The case study results indicate that the PSF is likely to be cost-effective but that the inequality impacts are small and highly uncertain.

Knowledge and perceptions about generic drugs by users of PSF in triple borders

Abstract Background The Brazilian Ministry of Health, by the National Policy on Medication, Ordinance 3916 from October 30th 1998, reinforces the Law of Generics of February 1999 (Law No. 9787 from February 10th, 1999, aiming, among other things, to reduce the prices and make access to medications easier for population). Objective The main objective was to identify the level of knowledge of the population regarding generic drugs. Method Descriptive, quantitative study, with 520 users interviewed in four health care units that implemented the Brazilian Family Health Program. Such units represent four health districts in Foz do Iguaçu, PR, Brazil. Results Most of the interviewed know and/or have heard about generic drugs. For many people, the generic drug represents only a more affordable type of medication. Conclusion The need for health education to clarify the population’s questions was found, so they could identify and acquire their medication safely and with confidence.

Racial inequalities in public dental service utilization: Exploring individual and contextual determinants among middle-aged Brazilian adults.

To investigate differences between Pardos (mixed) and Blacks with their White counterparts in the use of public dental service among a sample of Brazilian adults taking into consideration the role of individual and contextual characteristics. A total of 6196 adults aged 35-44years were sampled from the 2010 Brazilian National Oral Health Survey and nested in one of 27 Brazilian State Capitals. Binary multilevel logistic analyses were conducted. Use of public dental service in the last visit was the outcome, and self-reported colour/race (Pardo, Black, White) was the explanatory variable. Individual covariates were sex, level of education, family income, self-reported need for treatment, dental pain in the last 6months, presence of decayed, filled and missing teeth. The State Capital covariates were proportion of Pardos/Blacks, Human Development Index, Gini coefficient, Integration of dental teams into Brazil Family Health Program and dentist per population rate. Pardos and Blacks were 1.25 (95% CI 1.10-1.42) and 1.73 (95% CI 1.41-2.11) times, respectively, more likely to visit the public dental service than Whites. Adjustments for level of education and income were more relevant in affecting the estimates between groups than any other covariate, but differences persisted. Colour/race was independently associated with the type of service used in the last dental visit after fully adjusted for individual and State Capital characteristics. Racial differences in dental service utilization were evident for middle-aged adults in Brazil. The results found highlight the importance of investments in public dental service as Pardos and Blacks relied more on this type of service than Whites.

PROGRAMA DE SAÚDE DA FAMÍLIA NO BRASIL: REFLEXÕES CRÍTICAS À LUZ DA PROMOÇÃO DE SAÚDE

O Programa de Saúde da Família (PSF) foi instituído há 20 anos no Brasil e exige reflexões atualizadas para seu aperfeiçoamento. Tendo se inspirado no modelo canadense, o PSF brasileiro se propõe a ser uma estratégia de enfrentamento dos riscos de agravos e condições de saúde contemporâneas baseada no modelo de abordagem biopsicossocial. Entretanto, a compreensão dos conceitos sobre comunidade, família, gênero e etnicidade precisam ser aprofundados para melhores resultados das estratégias utilizadas pelas equipes de saúde e pelos agentes comunitários.O objetivo desta análise documental foi comparar o SUS com o sistema de saúde canadense, discutindo possíveis causas dos determinantes sociais de saúde que persistem no Brasil dentro dos PSFs.Para isso, se confrontou os achados de programas nacionais e de programas canadenses, com a literatura científica no tema. Os resultados demonstram que o PSF brasileiro precisa de reestruturação para que haja uma verdadeira promoção da saúde. Dentre as principais necessidades, destacam-se um novo papel para os agentes comunitários de saúde, melhores condições e ampliação das equipes profissionais de saúde e reorganização do sistema quanto ao papel das mulheres e dos homens e dos diferentes grupos étnicos.

The impact of health workers' training on breastfeeding and complementary feeding practices

This study aimed to evaluate the impact on feeding practices for infants (<1 year of age) resulting from update training for health workers in the Ten Steps to Healthy Feeding of Children Under Two. Health Care Centers (HCC) in Porto Alegre, Rio Grande do Sul State, Brazil, were randomized into a control group (n=11) and an intervention group (n=9). Health centers organized according to Brazil's Family Health Program (FHP) were included as an intervention cluster (n=12). Infant feeding practices were evaluated at the health centers at 6 months (n=918) and again at 12 months of age (n=799). The results showed that mean duration of exclusive breastfeeding was significantly longer in the two groups that received the intervention (2.56±1.91 months in the FHP intervention and 2.32±1.63 months in the HCC intervention) compared to the HCC control group (1.91±1.60 months). There was a positive impact on the quality of complementary feeding of infants treated at the health centers that participated in the intervention, especially those with the FHP.

The Brazilian Family Health Program and secondary stroke and myocardial infarction prevention: a 6-year cohort study.

We compared the incidence of recurrent or fatal cardiovascular disease in patients using Brazil's government-run Family Health Program (FHP) with those using non-FHP models of care. From 2005 to 2010, we followed outpatients discharged from city public hospitals after a first ever stroke for stroke recurrence and myocardial infarction, using data from all city hospitals, death certificates, and outpatient monitoring in state-run and private units. In the follow-up period, 103 patients in the FHP units and 138 in the non-FHP units had exclusively state-run care. Stroke or myocardial infarction occurred in 30.1% of patients in the FHP group and 36.2% of patients in non-FHP care (rate ratio [RR] = 0.85; 95% confidence interval [CI] = 0.61, 1.18; P = .39); 37.9% of patients in FHP care and 54.3% in non-FHP care (RR = 0.68; 95% CI = 0.50, 0.92; P = .01) died. FHP use was associated with lower hazard of death from all causes (hazard ratio [HR] = 0.58; P = .005) after adjusting for age and stroke severity. The absolute risk reduction for death by all causes was 16.4%. FHP care is more effective than is non-FHP care at preventing death from secondary stroke and myocardial infarction.

International Participatory Research Framework: triangulating procedures to build health research capacity in Brazil.

This study advances Community-based Participatory Research (CBPR) by presenting a set of triangulated procedures (steps and actions) that can facilitate participatory research in myriad international settings. By using procedural triangulation-the combination of specific steps and actions as the basis for the International Participatory Research Framework (IPRF)-our approach can improve the abilities of researchers and practitioners worldwide to systematize the development of research partnerships. The IPRF comprises four recursive steps: (i) contextualizing the host country; (ii) identifying collaborators in the host country; (iii) seeking advice and endorsement from gatekeepers and (iv) matching partners' expertise, needs and interests. IPRF includes the following sets of recursive participatory actions: (A(1)) becoming familiar with local languages and culture; (A(2)) sharing power, ideas, influence and resources; (A(3)) gathering oral and written information about partners; (A(4)) establishing realistic expectations and (A(5)) resolving personal and professional differences. We show how these steps and actions were used recursively to build a partnership to study the roles of community health workers (CHWs) in Brazil's Family Health Program (PSF). The research conducted using IPRF focused on HIV prevention, and it included nearly 200 CHWs. By using the IPRF, our partnership achieved several participatory outcomes: community-defined research aims, capacity for future research and creation of new policies and programs. We engaged CHWs who requested that we study their training needs, and we engaged CHWs' supervisors who used the data collected to modify CHW training. Data collected from CHWs will form the basis for a grant to test CHW training curricula. Researchers and community partners can now use the IPRF to build partnerships in different international contexts. By triangulating steps and actions, the IPRF advances knowledge about the use of CBPR methods/procedures for international health research.

Study of patient population treated at a chiropractic clinic at a Brazilian Family Health Program

Study of patient population treated at a chiropractic clinic at a Brazilian Family Health Program

Aerobic conditioning, blood pressure (BP) and body mass index (BMI) of older participants of the Brazilian Family Health Program (FHP) after 16 weeks of guided physical activity

Because physical exercise is an efficient means to improve maximum consumption of oxygen (VO 2max) and reduce body fat, the objective of this work was to evaluate the effect of 4 months of a guided physical activity program on BMI, BP and estimated VO 2max of older participants of the FHP. The sample was composed of 70 older participants who were divided into two groups: the experimental group (EG) (26 women and 9 men) and the control group (CG) (20 women and 15 men). The program of physical activity included walking, hydrogymnastics, weight-training exercises and stretching exercises. The intensity of the aerobics exercises was set such that participants would achieve 55–65% of the estimated maximum heart rate, with the corresponding effort to be subjectively rated by the participant as 12–13 points on a 6–20 point scale. After 4 months of guided physical activity, there was a significant 19.26% improvement in the VO 2max in the EG ( p ≤ 0.001), and the diastolic pressure in the EG was significantly lower than that in the CG ( p ≤ 0.001). In conclusion, the 16-week program of physical activity significantly improved the cardiorespiratory capacity of older individuals.

Prevalência de transtornos mentais comuns e fatores associados em uma população assistida por equipes do Programa Saúde da Família

OBJETIVO: Avaliar a prevalência de casos suspeitos de transtornos mentais comuns em uma população assistida por uma equipe do Programa Saúde da Família e investigar os fatores associados à ocorrência dessa morbidade. MÉTODOS: Pesquisa de levantamento, de corte transversal. A amostra, composta por 277 sujeitos, foi obtida por meio do método de amostragem aleatória do tipo sistemática. Para a coleta de dados, foram aplicados o Self Report Questionnaire (SRQ-20) e um questionário sociodemográfico. RESULTADOS: A prevalência global de casos suspeitos de transtornos mentais comuns na população alvo foi de 43,70%. O sexo feminino apresentou uma taxa de prevalência significativamente mais elevada (48,37%), quando comparado ao sexo masculino (34,41%). A variável "renda familiar" apresentou uma relação inversa com a prevalência de transtornos mentais comuns. A análise de regressão logística indicou que apenas as variáveis "uso de medicamento" e "renda familiar" estavam associadas significativamente à suspeita de casos de transtornos mentais comuns. CONCLUSÕES: Os resultados apontaram uma elevada prevalência de transtornos mentais comuns nessa população alvo, comparativamente aos dados de outros estudos semelhantes, indicando a necessidade de um cuidado especial por parte da Atenção Primária à Saúde, em particular para as famílias caracterizadas pelos fatores associados ao transtornos mentais comuns apontados nesta investigação.

Conceptual and methodological aspects in the study of hospitalizations for ambulatory care sensitive conditions

Hospitalization rates for Ambulatory Care Sensitive Conditions have been used to assess effectiveness of the first level of health care. From a critical analysis of related concepts, we discuss principles for selecting a list of codes and, taking the example of the Brazilian Family Health Program, propose a methodological pathway for identifying variables in order to inform statistical models of analysis. We argue that for the indicator to be comparable between regions, disease codes should be selected based on sensitivity and specificity principles, not on observed disease frequency. Rates of hospitalization will be determined, at a distal level, by the socio-economic environment and their effect on the social and demographic structure. Timely and effective care depends on the organization of health services, their availability and access barriers, which depend on the ways health and related technology are conceptualised and on their adherence to the biomedical model or to the Primary Health Care (PHC) principles; performance indicators of the health system will be the proximal determinants. This indicator is potentially useful for primary care evaluation. The historical reconstruction of PHC improves the analysis of the indicator variability.

Avaliação da referência e contrarreferência no Programa Saúde da Família na Região Metropolitana do Rio de Janeiro (RJ, Brasil)

This article presents the results of research on the functioning of the reference and counter-reference system in support of activities carried out by the Brazilian Family Health Program in the cities of Duque de Caxias (RJ) and Rio de Janeiro. The research had as premise that the resolution capacity of the Brazilian Family Health Program depends on the support of specialist's medical appointments and diagnosis test offered by health care unities of the secondary level, and depends upon reference and counter-reference information. The research's results may be summarized as: (1) limited offer of specialized services in the secondary level of the health care system; (2) nonexistence or failure of counter-reference information; (3) deficient organization of regulation activities; (4) insufficient utilization of clinical guidelines for patient referrals; (5) precariousness of information and communication systems; (6) high level of political influence in the management of health care services; and (7) different denominations and great diversity of types of service offered by secondary health care unities.

Evaluating the impact of community‐based health interventions: evidence from Brazil's Family Health Program

This paper analyzes the direct and indirect impacts of Brazil's Family Health Program, using municipality level mortality data from the Brazilian Ministry of Health, and individual level data from the Brazilian household survey. We estimate the effects of the program on mortality and on household behavior related to child labor and schooling, employment of adults, and fertility. We find consistent effects of the program on reductions in mortality throughout the age distribution, but mainly at earlier ages. Municipalities in the poorest regions of the country benefit particularly from the program. For these regions, implementation of the program is also robustly associated with increased labor supply of adults, reduced fertility, and increased school enrollment. Evidence suggests that the Family Health Program is a highly cost-effective tool for improving health in poor areas.

The physiotherapy at Brazilian family health program: user’s perspectives

Introduction: The Health Family Program (HFP) was raised in the 90´s, following the Brazilian Health System, aiming to increase the population health. This qualitative study was developed in Maracanau city in the Health Family Basic Units (HFBU) with a group of patients with different diseases and different ages. Objective: The objective was to describe the perception of the users about Physical Therapy performance at the health family team. Materials and Methods: Descriptive qualitative study performed at Maracanau city in the metropolitan region of Fortaleza - Ceara, with families assisted by the Health Family Program. 15 subjects were interviewed, 07 caregivers and 08 patients in the period from March to May 2008. Data were collected through unstructured interviews and analyzed through the technique of content analysis. Results: As results the analyzes of the interviews showed three thematic categories: Physical Therapy´s benefits, The access to Physical Therapy, and The interventions frequency. Conclusion: It’s possible to conclude that in spite of the difficulties as the low number of professionals and work conditions, the users had showed satisfied, reinforcing the importance of this professional at the HFP.

Saúde mental no Programa Saúde da Família: caminhos e impasses de uma trajetória necessária

The focus of this study is mental health care in the Brazilian Family Health Program (FHP), with the complexity of such care as the main premise. The objectives were to analyze the actual conditions of mental health care in FHP services in Cuiabá, Mato Grosso State, describing the dynamics of such care and identifying situations and instruments used by different health professionals in dealing with problems of mental distress in the community. By means of a descriptive exploratory methodology, the discourses of eight health teams were studied, using content analysis. The study concluded that the demand for care for individuals with mental distress was not recorded on the patient charts, nor was it part of a proposal for individual or family interventions; some measures were taken according to a lay concept of 'mental illness' and treatment, while referral to the specialized mental health care network was frequently used, despite its precariousness, thus reflecting the need for continuing training in mental health.

Ser médico no PSF: formação acadêmica, perspectivas e trabalho cotidiano

Este trabalho investiga a formação acadêmica e a motivação de médicos do Programa de Saúde da Família (PSF) para atuarem na área e as vivências adquiridas. Trata-se de estudo exploratório, descritivo e qualitativo. As categorias de análise foram: carência de formação em atenção básica na escola médica e início da carreira; trabalho cotidiano do médico; visita domiciliar; relação multiprofissional na equipe; trabalho médico - realização profissional, rotatividade e falta de perspectivas; compreensão da população acerca do PSF. Os profissionais optaram pelo PSF por motivações pessoais, havendo pouco destaque e preparação para a atividade na graduação. Foi mencionada a importância dos agentes comunitários, do trabalho em grupos e das visitas domiciliares, apesar de alguns referirem impossibilidade de efetuar os dois últimos itens. Há insatisfação profissional devido a sobrecarga de trabalho, dificuldades no relacionamento multiprofissional, falta de retorno financeiro e de reconhecimento de outros profissionais e da população. Foram apontados falta de apoio e vontade política necessários ao êxito do programa. A pesquisa permitiu identificar falta de articulação entre escola médica e gestão municipal na formação de profissionais para atuação no PSF.

Resiliência: nova perspectiva na promoção da saúde da família?

This descriptive study deals with some concepts of resilience seeking to understand the concept from the viewpoint of health promotion, one of the basic principles of the Brazilian Family Health Program (FHP). Resilience appeared as a new subject in human sciences and in the health area. In human sciences, resilience means the positive capacity of an individual to construct itself coping with adversities, a dimension more attentive to social conditions. Although there is no consensus with regard to this subject, there seem to be some aspects related with Health Promotion. We emphasize the modern understanding of Health Promotion in order to illustrate some aspects associated with resilience such as the greater capacity of Man to decide about the determinants of his health condition. Given that Health Promotion is one of the attributions of the Family Health Program, we contextualized the program emphasizing the action of the health professionals in this area in relation to the subject, seeking to promote health working with resilience. The multi-professional teams of the Family Health Program represent at the same time a network of support and protection for the families, identifying possible risk factors. The emphasis given to the promotion of resilience however should not substitute the public policies for fighting the social inequality and precarious life conditions of part of the population.

Perspectivas de médicos do Programa Saúde da Família acerca das linhas de cuidado propostas pela Agenda de Compromissos para a Saúde Integral da Criança e Redução da Mortalidade Infantil

The aim of this study was to understand how physicians from a team in the Brazilian Family Health Program perceive their work in child health, as compared to the program's principles outlined in the Agenda for Commitment to Comprehensive Child Health and Reduction of Infant Mortality, under the Ministry of Health. The backdrop was the strategy for implementation of primary care under the Unified National Health System (SUS). Semi-structured interviews were held, and the material was submitted to content analysis. According to the findings, in general the Agenda is being met. However, there are difficulties with referral and counter-referral; the measures proposed by the Family Health Program require medical and sociological competence and face problems inherent to biomedical training; the infrastructure and inputs are precarious; and the training provided does not prepare physicians sufficiently for a more comprehensive approach. In conclusion, the primary care model in Brazil requires adjustments to the country's reality, and partnerships that transcend the system are necessary.

Evaluating the Impact of Community-Based Health Interventions: Evidence from Brazil's Family Health Program

This paper analyzes the direct and indirect impacts of Brazil's Family Health Program. We estimate the effects of the program on mortality and on household behavior related to child labor and schooling, employment of adults, and fertility. We find consistent effects of the program on reductions in mortality throughout the age distribution, but mainly at earlier ages. Municipalities in the poorest regions of the country benefit particularly from the program. For these regions, implementation of the program is also robustly associated with increased labor supply of adults, reduced fertility, and increased schooling. Evidence suggests that the Family Health Program is a highly cost-effective tool for improving health in poor areas.