scholarly journals Use of rehabilitation services by persons with disabilities in Brazil: A multivariate analysis from Andersen’s behavioral model

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250615
Author(s):  
Arthur de Almeida Medeiros ◽  
Maria Helena Rodrigues Galvão ◽  
Isabelle Ribeiro Barbosa ◽  
Angelo Giuseppe Roncalli da Costa Oliveira
Keyword(s):  
Health Care ◽  
Multivariate Analysis ◽  
Primary Health Care ◽  
Behavioral Model ◽  
Individual Characteristics ◽  
Rehabilitation Services ◽  
Socioeconomic Conditions ◽  
Persons With Disabilities ◽  
Andersen’S Behavioral Model ◽  
Primary Health

Background For many years, discussions about health care for people with disabilities (PwD) in Brazil have not been treated as a priority; however, based on the advances made at the beginning of this century, new policies have been developed with the aim of improving access of these people to health services. Therefore, the aim of this study was to analyze how individual characteristics and contextual indicators are associated with access to rehabilitation services for PwD in Brazil. Methods A multivariate analysis was performed based on data from the National Health Survey 2013, considering access to rehabilitation services by PwD as the primary outcome and individual and contextual factors selected from Andersen’s behavioral model as independent variables. The contextual variables were reduced to two composite indicators (1-primary health care coverage and unfavorable socioeconomic conditions, and 2-economic inequality) from the analysis of the principal components. Poisson regression analysis with robust variance was performed to estimate the prevalence ratio (PR) and the respective 95% confidence interval (95%CI). Results Access to rehabilitation services by PwD was more prevalent in people aged 0 to 17 years (PR = 3.28; 95%CI 2.85–3.78), who are illiterate (PR = 1.24; 95%CI 1.09–1.40), whose socioeconomic level is A or B (PR = 1.60; 95%CI 1.35–1.88), who have health insurance (PR = 1.31; 95%CI 1.15–1.49), who have severe limitations (PR = 3.09; 95%CI 2.64–3.62), who live in states with a good offer of Specialized Rehabilitation Centers, both type II (PR = 1.20; CI95% 1.08; 1.33) and type IV (PR = 1.29; CI95% 1.15; 1.44), and who have greater coverage of primary health care, but unfavorable socioeconomic conditions (PR = 1.15; CI95% 1.03–1.28). Conclusion The results clarify the social inequities that exist regarding access to rehabilitation services for PwD in Brazil and highlight the need to formulate and implement public policies that guarantee the realization of the rights of these people.

scholarly journals Satisfaction of clients with disabilities with services offered at primary health care centres in Ndola, Zambia

2012 ◽  
Vol 68 (2) ◽  
Author(s):  
N. Mlenzana ◽  
R. Mwansa
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Services ◽  
Health Professionals ◽  
Health Care Services ◽  
Waiting Times ◽  
Care Providers ◽  
Persons With Disabilities ◽  
Care Services ◽  
Primary Health

To establish satisfaction level of persons with disabilitiesregarding health services at primary health care centres in Ndola, Zambia.Key stakeholders views on satisfaction of services is an important componentof service rendering thus obtaining information is important in assistingwith the evaluation of health care service delivery. This will assist in improvingeffectiveness and availability of health care services to persons with physicaldisabilities.All persons with disabilities attending both rehabilitation centres andprimary health care centres in Ndola, Zambia, were targeted for this study. Willing participants were convenientlyselected to take part in the study.A cross sectional, descriptive study design using quantitative methods of data collection was used. The GeneralPractice Assessment Questionnaire was adjusted, piloted for Ndola population and used in this study to establishsatisfaction of participants. The study was ethically cleared at the University of the Western Cape and Zambia.Information and consent forms were signed by participants.Quantitative data was analysed descriptively and was reported in percentages.In the current study there were 191 participants of whom 56% were male and 44% were female with age rangefrom 18-65 years. Fifty-two percent of the participants presented with learning disabilities and 38% of persons withphysical disabilities. Majority of clients (54%) were dissatisfied with availability of services and health care servicesat the health care centres. Areas that clients were dissatisfied with were accessibility, consultation with health professionals,waiting times and opening hours of the health care centres.Clients with disabilities who accessed health care services from selected health centres in Ndola were dissatisfiedwith aspects of health services. Accessibility, consultation with health professionals, waiting times and opening hoursof the health care centres were the origin of client dissatisfaction. Other clients were satisfied with thoroughness ofhealth care providers regarding symptoms, feelings, reception and treatment received at the primary health care centre.Understanding the views of the clients is essential in improving health delivery services and could impact on thecompliance of people attending primary health care services.

scholarly journals Maternal mode of living and child health

2002 ◽  
Vol 55 (2) ◽  
pp. 151-156 ◽  
Author(s):  
Jane L.G. Dytz ◽  
Semíramis M. M. Rocha
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Low Income ◽  
Reproductive Behavior ◽  
Federal District ◽  
Health Policies ◽  
Socioeconomic Conditions ◽  
Primary Health ◽  
Mothers And Children ◽  
And Child Health

ln this article, maternal mode of living is investigated, examining both socioeconomic conditions and lifestyle factors, in order to identify to what extent health policies are tangibly meeting the needs of low income Brazilian mothers and children. Data are derived from unstructured interviews with 17 mothers with children underage 6, residing in the Federal District, Brazil. Their stories reveal a life marked by economic difficulties and inadequate living conditions, aggravated by early reproductive behavior, confinement to the home and no leisure. Although they have access to primary health care, the quality is inadequate. Increased awareness to the mother's situation is necessary in order to improve the health of young children.

Access to Primary Health Care Among Persons With Disabilities in Rural Areas: A Summary of the Literature

1996 ◽  
Vol 12 (1) ◽  
pp. 45-53 ◽  
Author(s):  
Denise M. Lishner ◽  
Mary Richardson PhD ◽  
Phyllis Levine ◽  
Donald Patrick
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Rural Areas ◽  
Persons With Disabilities ◽  
Primary Health

scholarly journals Prevalence of Older Adult Disability and Primary Health Care Responsiveness in Low-Income Communities

Life ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 133
Author(s):  
Giovana Montoro Pazzini Watfe ◽  
Lais Fajersztajn ◽  
Euler Ribeiro ◽  
Paulo Rossi Menezes ◽  
Marcia Scazufca
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Family Physician ◽  
Low Income ◽  
Sao Paulo ◽  
Individual Characteristics ◽  
World Health ◽  
São Paulo ◽  
Middle Income ◽  
Primary Health

In Brazil and in most low- and middle-income countries (LMICs), information about how prepared the health care system is for the rapid aging of the population is scarce. We investigated the prevalence of disability and areas of life affected by disability among elders of the public primary health care in São Paulo and Manaus, Brazil. We investigated whether people with disability visited a primary care professional more frequently, the individual characteristics associated with disability, and differences by city. We randomly selected participants aged ≥60 years (n = 1375). The main outcome was disability, evaluated with the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0). Exposure variables were consultation with a family physician, sociodemographic characteristics, health status, social support, and lifestyle. The prevalence of global disability was higher in Manaus (66.2% vs. 56.4% in São Paulo). In both cities, participation and mobility were the areas of life most affected by disability. The number of consultations with a family physician was not associated with disability. The high prevalence of disability and associated risk factors indicates that public primary health care is not meeting the needs of elders in both cities. It is warning because most elders in LMICs live in more underserved communities compared to Brazil.

scholarly journals Lessons from Disability Counting in Ecuador, with a Contribution from Primary Health Care

2021 ◽  
Vol 18 (10) ◽  
pp. 5103
Author(s):  
Debrouwere Inge ◽  
Álvarez Vera Pedro Celestino ◽  
Pavón Benítez Ximena del Carmen ◽  
Rosero Arboleda Celia Katherine ◽  
Prinzie Peter ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
A Priori ◽  
Service Planning ◽  
Counting Method ◽  
Cross Sectional ◽  
Persons With Disabilities ◽  
Primary Health ◽  
Disability Prevalence ◽  
Cross Sectional Studies

Disability data are essential for policy. Yet, the predominant use of disability prevalence for service planning reflects dichotomous counting, increasingly less compatible with current disability thinking. Difficulties relate to variations in rates, the lack of matching with needs, and the use of prevalence to compare disability situations. From the perspective of Primary Health Care (PHC), we explore methods for disability counting regarding the usefulness of prevalences in identifying persons with disabilities and meeting their needs with local service implementation. First, we analyze the methods and results of six national cross-sectional studies in Ecuador. Then, we present a case about an exploratory needs-driven method for disability counting in a local PHC setting. The analysis of variations in rates focuses the attention on reasons for and risks of a priori exclusion of persons with disabilities from services. Longitudinal disability counting as a collateral result of meeting needs in the PHC setting yields local disability data worthy of further exploration. Thinking about disability counting from a PHC scope in a developing country prompted reflection on the comparison of prevalences to evaluate disability situations. Findings invite further exploration of the needs-driven counting method, its contributions to planning local services, and complementarity with cross-sectional disability counting.

Health Care–Seeking Behavior in a Scheduled Tribe Community in India: A Mixed-Methods Research Using the Framework of Andersen’s Behavioral Model

2021 ◽  
pp. 101053952199369
Author(s):  
Debayan Podder ◽  
Aparajita Dasgupta ◽  
Madhumita Dobe ◽  
Bobby Paul ◽  
Lina Bandyopadhyay ◽  
...  
Keyword(s):  
Health Care ◽  
Qualitative Interviews ◽  
Behavioral Model ◽  
Care Seeking ◽  
Primary Health Center ◽  
Andersen’S Behavioral Model ◽  
Primary Health ◽  
Care Seeking Behavior ◽  
Seeking Behavior ◽  
Health Care Seeking Behavior

India’s scheduled tribe population very often bears the brunt of inequity in accessing health care. The mixed-method research assessed the health care–seeking behavior (HSB) of a tribal community residing in the eastern fringes of Kolkata metropolis. An adult, preferably the head, in 209 households was interviewed followed by qualitative interviews with relevant stakeholders. Conceptual framework of Andersen’s behavioral model helped in identifying the potential predisposing, enabling, and need factors that influenced HSB. A total of 25.4% respondents reportedly sought informal care during last illness episode. Multivariable hierarchical-regression model (Nagelkerke R2 = 0.381) showed that respondents’ education level (adjusted odds ratio [AOR]; 95% confidence interval [CI]: 2.52 [1.22-5.21]), household size (AOR [95% CI]: 3.14 [1.41-6.95]), nonenrollment to health insurance (AOR [95% CI]: 2.47 [1.08-5.59]), decision making by household head (AOR [95% CI]: 2.40 [1.23-4.71]), distance from the nearest urban primary health center (AOR [95% CI]: 3.18 [1.44-7.03]), and poor perception to illness severity [AOR [95% CI]: 2.24 [1.07-4.72]) were significantly associated to inappropriate HSB. Predominant health system barriers that emerged from qualitative interviews were irregular logistics, unfavorable outpatient timing, absence of female doctors, and nonretention of doctors at local urban primary health center. Community level barriers were poor awareness, self-medication practices, poor health insurance coverage, and poor public transportation. Recognition of these determinants may help in developing health promotion interventions tailored to their needs.

scholarly journals Vulnerability of adolescents to sexually transmissible diseases in primary care

2018 ◽  
Vol 12 (3) ◽  
pp. 753 ◽  
Author(s):  
Patricia Santos de Oliveira ◽  
Ana Cristina Freire Abud ◽  
Ana Dorcas De Melo Inagaki ◽  
José Antônio Barreto Alves ◽  
Kaellyne Figueiredo Matos
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Sexually Transmitted Diseases ◽  
Health Care Services ◽  
Socioeconomic Conditions ◽  
Sexually Transmitted ◽  
Care Services ◽  
Primary Health ◽  
Primary Health Care Services ◽  
Uso Del Preservativo

ABSTRACT Objective: to identify the vulnerability situations adolescents are in relation to Sexually Transmitted Diseases in Primary Health Care. Method: this is a bibliographical, descriptive, integrative review type search of articles in the MEDLINE, BDENF and LILACS databases, in the period from January 2011 to December 2015. For this purpose, the following descriptors were used: adolescent, sexually transmitted diseases and primary health care, all with associations applying the “AND” in Portuguese, English and Spanish languages. The instrument adapted from the Ursi 2006 study was used to select the articles, which allowed outlining the main information. Results: there were 12 articles analyzed after applying the criteria. The results identified the following themes: socioeconomic conditions, early onset of sexual activity, lack of condom use, gender differences and difficulty of communication and access to Primary Health Care services. Conclusion: it was observed that adolescents need to be sensitized on the circumstances that lead to Sexually Transmitted Diseases, through partnerships with health services and social spaces in the community. Descriptors: Adolescent; Sexually Transmitted Diseases; Primary Health Care; Sexuality; Condoms; Gender Identity. RESUMO Objetivo: identificar as situações de vulnerabilidade em que os adolescentes se encontram em relação às Doenças Sexualmente Transmissíveis na Atenção Primária à Saúde. Método: estudo bibliográfico, descritivo, tipo revisão integrativa com busca de artigos nas bases de dados MEDLINE, BDENF e LILACS, no período de janeiro de 2011 a dezembro de 2015. Para tanto, utilizou-se os descritores: adolescente, doenças sexualmente transmissíveis e atenção primária à saúde, todos com associações aplicando-se o “AND” nos idiomas português, inglês e espanhol, além disso, para a seleção dos artigos, foi utilizado o instrumento adaptado do estudo de Ursi 2006, o qual permitiu esquematizar as principais informações. Resultados: foram analisados 12 artigos após aplicação dos critérios. Os resultados identificaram as seguintes temáticas: condições socioeconômicas; início precoce da atividade sexual; falta do uso do preservativo; diferença de gêneros; e dificuldade de comunicação e acesso aos serviços de Atenção Primária à Saúde. Conclusão: observou-se que os adolescentes necessitam ser sensibilizados sobre as circunstâncias que acarretam às Doenças Sexualmente Transmissíveis por meio de parcerias com os serviços de saúde e espaços sociais na comunidade. Descritores: Adolescente; Doenças Sexualmente Transmissíveis; Atenção Primária à Saúde; Sexualidade; Preservativos; Identidade de Gênero. RESUMEN Objetivo: identificar las situaciones de vulnerabilidad en que los adolescentes se encuentran en relación a las Enfermedades Sexualmente Transmisibles en la Atención Primaria a la Salud. Método: estudio bibliográfico, descriptivo, tipo revisión integradora con búsqueda de artículos en las bases de datos MEDLINE, BDENF y LILACS, en el período de enero de 2011 a diciembre de 2015. Para eso, se utilizaron los descriptores: adolescente, enfermedades sexualmente transmisibles y atención primaria a la salud, todos con asociaciones aplicándose “AND” en los idiomas portugués, inglés y español, además de eso, para la selección de los artículos fue utilizado el instrumento adaptado del estudio de Ursi 2006, el cual permitió esquematizar las principales informaciones. Resultados: fueron analizados 12 artículos después de la aplicación de los criterios. Los resultados identificaron las siguientes temáticas: condiciones socioeconómicas, inicio precoz de la actividad sexual, falta del uso del preservativo, diferencia de géneros y dificultad de comunicación y acceso a los servicios de Atención Primaria a la Salud. Conclusión: se observó que los adolescentes necesitan ser sensibilizados sobre las circunstancias que acarretan las Enfermedades Sexualmente Transmisibles, por medio de la asociación con los servicios de salud y espacios sociales en la comunidad. Descriptores: Adolescente; Enfermedades de Transmisión Sexual; Atención Primaria de Salud; Sexualidad; Condones; Identidad de Género. 

scholarly journals Analisis Utilisasi Resep Antibiotik Pasien Rawat Jalan Tingkat Pertama (RJTP) di Puskesmas Tebet Jakarta Selatan, Tahun 2005

2007 ◽  
Vol 1 (6) ◽  
pp. 266
Author(s):  
Nurlaili Isnaini
Keyword(s):  
Infectious Disease ◽  
Health Care ◽  
Multivariate Analysis ◽  
Primary Health Care ◽  
Bacterial Resistance ◽  
Drug Expenditure ◽  
Average Price ◽  
Primary Health ◽  
Antibiotics Use ◽  
Price Analysis

Kecenderungan peningkatan penggunaan antibiotika di Pelayanan Kesehatan Dasar merupakan penggunaaan obat yang tidak rasional dan akan menghambat penurunan angka morbiditas dan mortalitas penyakit. Pemberian antibiotika yang berlebihan akan meningkatkan resistensi bakteri dan meningkatkan pembiayaan obat. Tujuan penelitian ini adalah mengetahui gambaran utilisasi obat antibiotika Hasil penelitian menemukan bahwa persentase resep obat pasien RJTP yang berisi antibiotika 37,74 %. Proporsi terbesar pemanfaatan obat antibiotika pada pasien RJTP di Puskesmas Tebet tahun 2005 ditemukan pada kelompok usia dewasa (12-65 tahun) yaitu sebesar 56,5 %, pasien yang bayar sendiri yaitu sebesar 89,8 %, penyakit infeksi lain selain ISPA yaitu sebesar 61,6 % dan rata-rata lama hari pemberian obat antibiotika adalah 4 hari dimana nilai ini tidak sesuai dengan pedoman pengobatan antibiotika yang belaku. Rata-rata harga obat per-lembar resep adalah Rp. 6.226,01,- sedangkan rata-rata jumlah R/ nya adalah 3 R/. Hasil analisis multivariat menunjukkan bahwa usia, status pembayaran, jenis penyakit (ISPA) dan lama hari pemberian obat secara signifikan mempengaruhi rata-rata harga obat dan rata-rata jumlah R/ per-lembar resepnya. Disarankan perlu dilakukan upaya peresepan pengobatan sesuai dengan standar pengobatan yang berlaku terutama lama hari pemberian obat, analisa lebih lanjut mengenai rata-rata harga obat per-lembar resep yang lebih spesifik yaitu dengan hanya menganalisa rata-rata harga obat antibiotika.Kata kunci : Utilisasi, obat antibiotika, pasien RJTPThe tendencies of overusing of antibiotics in primary health care indicates the irrational drug use and inhibits the decrease of morbidity and mortality through increasing bacterial resistance and elevate drug expenditure. The objective of this study was to know the description of antibiotics drug utilization. Results of this study were the percentage of prescription containing antibiotics was 37,74 %. The biggest proportion of antibiotics utilization found in adult patients (12 -65 year old) i.e. 56.5%, individual payment patients was 89.8 % and non-ARI infectious disease was 61,6 %. The average number of days antibiotics use was 4 days, that was not in accordance to the antibiotics medication guideline. The average price of single prescription was Rp. 6.226,01 where the average R/ per prescription was 3 items. The result of multivariate analysis indicated age (except elderly), payment status, diagnosis of ARI and duration of antibiotics use significantly able to predict drug price per prescription and the average R/ per prescription. It was suggested to conduct standard prescription particu- larly regarding to duration of medication, more specific price analysis focused on antibiotics price is also suggested.Key words: Utilization, antibiotics drugs, RJTP patients

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