Expansion of primary healthcare and emergency hospital admissions among the urban poor in Rio de Janeiro Brazil: A cohort analysis.
Expansion of primary healthcare and emergency hospital admissions among the urban poor in Rio de Janeiro Brazil: A cohort analysis.
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DOI：
10.1016/j.lana.2022.100363
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发表时间：
2022-11
期刊：
影响因子：
--
通讯作者：
Millett, Christopher
中科院分区：
文献类型：
--
作者：
Hone, Thomas;Macinko, James;Trajman, Anete;Palladino, Raffaele;Coeli, Claudia Medina;Saraceni, Valeria;Rasella, Davide;Durovni, Betina;Millett, Christopher
低收入和中等收入国家缺乏关于初级保健与急诊入院之间关系的有力证据。本研究评估了如何分阶段推出的家庭健康战略（FHS），以城市穷人在巴西里约热内卢影响急诊入院和再入院的门诊护理敏感条件（ACSC）。研究人员对里约热内卢市的120万成年人进行了为期五年的随访（2012年1月至2016年12月）。使用多水平Poisson回归模型，结合社会经济和家庭特征的逆概率治疗加权和回归调整（IPTW-RA），评估FHS使用与急诊入院和30天再入院可能性之间的关联。协会中的不平等现象在不同的原因和主要的社会经济群体中进行了审查。分析了2，551，934次初级保健咨询和15，627次入院的记录。在IPTW-RA分析中，每增加一次FHS咨询，ACSC入院率降低3%（RR：0.97; 95%CI：0.95，0.98），30天内因任何非出生原因再入院率降低63%（RR：0.37; 95%CI：0.30，0.46），ACSC 30天再入院率降低57%（RR：0.43; 95%CI：0.33，0.55）。年龄较大、受教育程度最低、失业和收入较高的个人，与FHS使用相关的ACSC入学率下降幅度较大。对初级保健的投资对于减少中低收入国家的急诊入院率及其相关费用十分重要。DFID/MRC/Wellcome Trust/ESRC。
Robust evidence on the relationship between primary care and emergency admissions is lacking in low- and middle-income countries. This study evaluates how the phased roll out of the family health strategy (FHS) to the urban poor in Rio de Janeiro Brazil affected emergency hospital admissions and readmissions from ambulatory-care sensitives conditions (ACSCs). A cohort of 1.2 million adults in Rio de Janeiro city were followed for five years (Jan 2012 to Dec 2016). The association between FHS use and the likelihood of emergency hospital admissions and 30-day readmissions were evaluated using multi-level Poisson regression models with inverse probability treatment weighting and regression adjustment (IPTW-RA) for socioeconomic and household characteristics. Inequalities in associations were examined across groups of causes and by key socioeconomic groups. Records from 2,551,934 primary care consultations and 15,627 admissions were analysed. In IPTW-RA analyses, each additional FHS consultation was associated with a 3% lower rate of ACSC admission (RR: 0.97; 95%CI: 0.95, 0.98), a 63% lower rate of 30-day readmissions from any non-birth cause (RR: 0.37; 95%CI: 0.30, 0.46), and an 57% lower rate of 30-day readmissions from ACSCs (RR: 0.43; 95%CI: 0.33, 0.55). Individuals who were older, had the lowest educational attainment, were unemployed, and had higher incomes had larger reductions in ACSC admissions associated with FHS use. Investment in primary care is important for reducing emergency hospital admissions and their associated costs in LMICs. DFID/MRC/Wellcome Trust/ESRC.
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影响因子：
8.1
作者：
da Silva EN;Powell-Jackson T
通讯作者：
Powell-Jackson T
影响因子：
15.8
作者：
Hone T;Saraceni V;Medina Coeli C;Trajman A;Rasella D;Millett C;Durovni B
通讯作者：
Durovni B
影响因子：
2.9
作者：
Flojstrup, Marianne;Bogh, Soren Bie;Brabrand, Mikkel
通讯作者：
Brabrand, Mikkel
DOI：
10.1016/s2214-109x(18)30386-3
发表时间：
2018-11
期刊：
The Lancet. Global health
影响因子：
--
作者：
Kruk ME;Gage AD;Arsenault C;Jordan K;Leslie HH;Roder-DeWan S;Adeyi O;Barker P;Daelmans B;Doubova SV;English M;García-Elorrio E;Guanais F;Gureje O;Hirschhorn LR;Jiang L;Kelley E;Lemango ET;Liljestrand J;Malata A;Marchant T;Matsoso MP;Meara JG;Mohanan M;Ndiaye Y;Norheim OF;Reddy KS;Rowe AK;Salomon JA;Thapa G;Twum-Danso NAY;Pate M
通讯作者：
Pate M
影响因子：
4.8
作者：
de Azevedo Barros, Marilisa Berti;Lima, Margareth Guimaraes;Malta, Deborah Carvalho
通讯作者：
Malta, Deborah Carvalho