Determinants of outpatient expenditure within primary care in the Brazilian National Health System

ABSTRACT CONTEXT AND OBJECTIVE: One of the big challenges facing governments worldwide is the financing of healthcare systems. Thus, it is necessary to understand the factors and key components associated with healthcare expenditure. The aim here was to identify demographic, socioeconomic, lifestyle and clinical factors associated with direct healthcare expenditure within primary care, among adults attended through the Brazilian National Health System in the city of Bauru. DESIGN AND SETTING: Cross-sectional study conducted in five primary care units in Bauru (SP), Brazil. METHODS: Healthcare expenditure over the last 12 months was assessed through medical records of adults aged 50 years or more. Annual healthcare expenditure was assessed in terms of medication, laboratory tests, medical consultations and the total. Body mass index, waist circumference, hypertension, age, sex, physical activity and smoking were assessed through face-to-face interviews. RESULTS: The total healthcare expenditure for 963 participants of this survey was US$ 112,849.74 (46.9% consultations, 35.2% medication and 17.9% laboratory tests). Expenditure on medication was associated with overweight (odds ratio, OR = 1.80; 95% confidence interval, CI: 1.07-3.01), hypertension (OR = 3.04; 95% CI: 1.91-4.82) and moderate physical activity (OR = 0.56; 95% CI: 0.38-0.81). Expenditure on consultations was associated with hypertension (OR = 1.67; 95% CI: 1.12-2.47) and female sex (OR = 1.70; 95% CI: 1.14-2.55). CONCLUSIONS: Our results showed that overweight, lower levels of physical activity and hypertension were independent risk factors associated with higher healthcare expenditure within primary care.

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Time trends in physical activity of adult users of the Brazilian National Health System: 2010-2014. Longitudinal study

Sao Paulo Medical Journal ◽

10.1590/1516-3180.2017.0025190317 ◽

2017 ◽

Vol 135 (4) ◽

pp. 369-375 ◽

Cited By ~ 2

Author(s):

Bruna Camilo Turi ◽

Jamile Sanches Codogno ◽

Rômulo Araújo Fernandes ◽

Kyle Robinson Lynch ◽

Eduardo Kokubun ◽

...

Keyword(s):

Physical Activity ◽

Longitudinal Study ◽

Health System ◽

National Health ◽

Time Trends ◽

Economic Status ◽

National Health System ◽

Sports Participation ◽

Male Sex

ABSTRACT CONTEXT AND OBJECTIVE: In this longitudinal study, we aimed to describe time trends of physical activity (PA) in different domains from 2010 to 2014 among users of the Brazilian National Health System, taking into account the effects of sex, age and economic status (ES). DESIGN AND SETTING: Longitudinal study conducted in five primary care units in Bauru (SP), Brazil. METHODS: The sample was composed of 620 men and women who were interviewed in 2010, 2012 and 2014. The same group of researchers conducted the interviews, using the questionnaire developed by Baecke et al. Scores for occupational, exercise/sport, leisure-time/transportation and overall PA were considered in this longitudinal survey. Time trends of PA over the four years of follow-up were assessed according to sex, age and ES. RESULTS: We found that after four years of follow-up, the reduction in overall PA (-13.6%; 95% confidence interval, CI = -11.9 to -15.3) was statistically significant. Additionally, declines in the occupational domain and exercise/sports participation were affected by age, while the reduction in overall PA was affected by sex, age and ES. CONCLUSIONS: Overall PA decreased significantly from 2010 to 2014 among these outpatients of the Brazilian National Health System, and age and male sex were important determinants of PA in its different domains.

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Errata: Factors associated with the diffusion rate of innovations: a pilot study from the perspective of the Brazilian Unified National Health System

Cadernos de Saúde Pública ◽

10.1590/0102-311xer011116 ◽

2016 ◽

Vol 32 (11) ◽

Keyword(s):

Pilot Study ◽

Health System ◽

National Health ◽

Diffusion Rate ◽

National Health System ◽

Factors Associated

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Contextual and individual factors associated with dissatisfaction with the Brazilian Unified National Health System, 2011-2012

Cadernos de Saúde Pública ◽

10.1590/0102-311x00065015 ◽

2016 ◽

Vol 32 (10) ◽

Cited By ~ 4

Author(s):

Lúcia Gimenes Passero ◽

Jessye Melgarejo do Amaral Giordani ◽

Fernando Neves Hugo ◽

Vanessa Bielefeldt Leotti Torman ◽

Suzi Alves Camey ◽

...

Keyword(s):

Health System ◽

National Health ◽

User Satisfaction ◽

Strong Association ◽

National Health System ◽

Quality Of Healthcare ◽

Outcome Variable ◽

Individual Factors ◽

Cross Sectional ◽

Factors Associated

Abstract: User satisfaction is known to be related to quality of healthcare. The aim of this study was to evaluate the influence of contextual and individual factors associated with user dissatisfaction with the Brazilian Unified National Health System (SUS). This was a cross-sectional multilevel study. Data were collected via telephone by the ombudsman's office of the SUS. Telephone numbers were randomly selected from a telephone company database. Health services, socioeconomic, and individual demographic variables were evaluated, in addition to information on the municipalities. The outcome variable was dissatisfaction with the SUS. Hierarchical multilevel logistic regression was used, and 18,673 individuals were contacted. Prevalence of dissatisfaction was 63.4% (95%CI: 62.7-64.1). Unmet demand (OR = 3.66), waiting time > 4 hours (OR = 2.82), and number of Primary Healthcare Units (OR = 0.89) were associated statistically with dissatisfaction. Characteristics of the health teams' work process showed a strong association with dissatisfaction.

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Feasibility evaluation of a mindfulness-based stress reduction program for primary care professionals in Brazilian national health system

Complementary Therapies in Clinical Practice ◽

10.1016/j.ctcp.2019.01.005 ◽

2019 ◽

Vol 35 ◽

pp. 8-17 ◽

Cited By ~ 3

Author(s):

Pedro Henrique Ribeiro Santiago ◽

Leonardo Rodrigues Valle Serra e Meira ◽

Cláudia Flemming Colussi

Keyword(s):

Primary Care ◽

Health System ◽

National Health ◽

Stress Reduction ◽

National Health System ◽

Reduction Program ◽

Feasibility Evaluation ◽

Mindfulness Based Stress Reduction ◽

Primary Care Professionals

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Primary care utilisation patterns among an urban immigrant population in the Spanish National Health System

BMC Public Health ◽

10.1186/1471-2458-11-432 ◽

2011 ◽

Vol 11 (1) ◽

Cited By ~ 27

Author(s):

Amaia Calderón-Larrañaga ◽

Luis A Gimeno-Feliu ◽

Rosa Macipe-Costa ◽

Beatriz Poblador-Plou ◽

Daniel Bordonaba-Bosque ◽

...

Keyword(s):

Primary Care ◽

Health System ◽

National Health ◽

National Health System ◽

Immigrant Population ◽

Spanish National Health System ◽

Care Utilisation

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Association between obesity and knee osteoarthritis in users of brazilian unified national health system

Bioscience Journal ◽

10.14393/bj-v36n3a2020-48178 ◽

2020 ◽

Vol 36 (3) ◽

Author(s):

Eduardo Paul Chacur ◽

Thiago Montes Fidale ◽

Jean Ezequiel Limongi ◽

Fernando Leonardo Diniz ◽

Dalton Muller Pessoa Filho ◽

...

Keyword(s):

Physical Activity ◽

Physical Examination ◽

Health System ◽

National Health ◽

Strong Association ◽

National Health System ◽

Radiological Examination ◽

Continuous Variables ◽

Functional Classification ◽

Knee Oa

Verify possible associations between obesity and knee OA in users of Brazilian Unified National Health System (Sistema Único de Saúde - SUS) of primary care network in Catalão-GO, Brazil. This is an observational study conducted in 2014 and 2015. A total of 81 volunteers from the Basic Attention Network in the city of Catalão, with body mass index (BMI) over 30 kg/m2 in both sexes, age between 40 and 60 years, and OA on radiological examination of the knee. Obesity was classified according to BMI. The diagnosis of osteoarthritis (OA) was made clinically and by radiography according to Kellgren radiological classification. The level of physical activity was assessed using the Baecke questionnaire and the Gordon Functional Classification. The volunteers underwent an anthropometric evaluation and physical examination with inspection and palpation of the joint and subsequent radiological examination of the knee. The volunteers answered a questionnaire on the level of physical activity and functional classification. Data analysis was performed using Fisher’s exact test or chi-square test was used for comparisons of two proportions. In comparisons of continuous variables, Student’s t-test or the nonparametric Wilcoxon-Mann-Whitney test was used. The level of significance was set to 5%. Practice of regular physical exercise decreases functional impairment in obese individuals with knee OA. The weight variable demonstrated a strong association with the severity of OA and degree of functionality of patients. Obesity and OA durations and lack of patient guidance are variables that may contribute to the progression of knee OA. Although the incidence among men is lower, they are more severely affected and anthropometric evaluation and physical examination are an efficacy implementations for Brazilian users of SUS.

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Surveillance of cancer survivors: Results from a survey of primary care physicians working in the Spanish National Health System.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.15_suppl.e21562 ◽

2016 ◽

Vol 34 (15_suppl) ◽

pp. e21562-e21562

Author(s):

Begoña Graña ◽

Ana Martinez ◽

Manuel Lado ◽

Maria Forjan ◽

Rosario Garcia Campelo ◽

...

Keyword(s):

Primary Care ◽

Cancer Survivors ◽

Health System ◽

National Health ◽

Primary Care Physicians ◽

National Health System ◽

Spanish National Health System

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Associated factors to the perception of clinical coordination in the Catalan national health system

European Journal of Public Health ◽

10.1093/eurpub/ckz186.349 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

L Esteve Matalí ◽

I Vargas ◽

E Sánchez ◽

F Cots ◽

P Plaja ◽

...

Keyword(s):

Health System ◽

National Health ◽

Care Coordination ◽

Associated Factors ◽

National Health System ◽

Organizational Factors ◽

The Other ◽

Level Of Care ◽

Factors Associated ◽

Levels Of Care

Abstract Background Clinical coordination across levels of care is a priority for health systems. The aim is to analyse the factors associated to a high perception of clinical coordination of primary (PC) and secondary care (SC) doctors of the Catalan national health system (NHS). Methods Cross-sectional study based on the self-administered online questionnaire COORDENA-CAT. Data collection: October-December 2017. Study population: PC and SC (acute and long term) doctors of the public Catalan NHS that had been working for at least one year in the organization, had direct contact with patients and related with doctors of the other level of care. The participation rate was 20.5%, with a sample of 3308 doctors. Outcome variable: perception of clinical coordination across levels of care. Explanatory variables: socio-demographic, employment characteristics, attitude towards work, type of area (according to type of hospital and managing entity), interactional factors, organizational factors and knowledge of existing coordination mechanisms. Stratification variable: level of care. Descriptive and multivariate analysis by logistic regression. Results Only 32.13% of PC doctors and 35.72% of SC doctors found that patient care was coordinated across care levels within their area. In both levels of care, knowing the doctor of the other level; finding that their practice influences the other care level; finding that the organization’s management facilitates coordination; working in an area where the same entity manages SC and majority of PC and to hold joint clinical case conferences are factors positively associated to a high perception of clinical coordination. Besides, there are other positively associated factors exclusive for each level of care. Conclusions Several common interactional and organizational factors are positively associated to a high perception of care coordination. Introducing policies to enhance such factors can foster care coordination in the Catalan NHS. Key messages This study found out factors associated to clinical coordination across care levels in each level. It helps to develop specific coordination policies by level of care to address those factors.

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