The impact of the Brazilian family health on selected primary care sensitive conditions: A systematic review
The impact of the Brazilian family health on selected primary care sensitive conditions: A systematic review
Data
2017
Autores
Bastos, Mayara Lisboa
Menzies, Dick
Hone, Thomas
Dehghani, Kianoush
Trajman, Anete
Journal Title
Journal ISSN
Volume Title
Publisher
PLOS ONE
Resumo
Background
Brazil has the largest public health-system in the world, with 120 million people covered by
its free primary care services. The Family Health Strategy (FHS) is the main primary care
model, but there is no consensus on its impact on health outcomes. We systematically
reviewed published evidence regarding the impact of the Brazilian FHS on selective primary
care sensitive conditions (PCSC).
Methods
We searched Medline, Web of Science and Lilacs in May 2016 using key words in Portu-
guese and English, without language restriction. We included studies if intervention was the
FHS; comparison was either different levels of FHS coverage or other primary health care
service models; outcomes were the selected PCSC; and results were adjusted for relevant
sanitary and socioeconomic variables, including the national conditional cash transfer pro-
gram (Bolsa Familia). Due to differences in methods and outcomes reported, pooling of
results was not possible.
Results
Of 1831 records found, 31 met our inclusion criteria. Of these, 25 were ecological studies.
Twenty-one employed longitudinal quasi-experimental methods, 27 compared different lev-
els the FHS coverage, whilst four compared the FHS versus other models of primary care.
Fourteen studies found an association between higher FHS coverage and lower post-neo-
natal and child mortality. When the effect of Bolsa Familia was accounted for, the effect of
the FHS on child mortality was greater. In 13 studies about hospitalizations due to PCSC, no
clear pattern of association was found. In four studies, there was no effect on child and
elderly vaccination or low-birth weight. No included studies addressed breast-feeding, den-
gue, HIV/AIDS and other neglected infectious diseases.
Conclusions
Among these ecological studies with limited quality evidence, increasing coverage by the
FHS was consistently associated with improvements in child mortality. Scarce evidence on
other health outcomes, hospitalization and synergies with cash transfer was found.
Description
Palavras-chave
Brazil, Family Health / statistics & numerical data*, Humans, Primary Health Care / statistics & numerical data*.
Citação
Bastos ML, Menzies D, Hone T, Dehghani K, Trajman A (2017) The impact of the Brazilian family health on selected primary care sensitive conditions: A systematic review. PLoS ONE 12(8):e0182336. doi: 10.1371/journal.pone.0182336.