Impact of Rapid Expansion of the Estrategia de Saude da Familia in Rio de Janeiro: Mixed Methods Evaluation

里约热内卢 Estrategia de Saude da Familia 快速扩张的影响：混合方法评估

• 批准号: MR/P014593/1
• 负责人: Christopher Joseph Millett
• 金额: $ 61.14万
• 依托单位: Imperial College London
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2017
• 资助国家: 英国
• 起止时间: 2017 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FP014593%2F1
• 关键词: Impact; Rapid; Expansion; Estrategia; de

The United Nations has recently set a target for countries to provide comprehensive healthcare at low cost to all citizens. While this is a welcome development, there are concerns that strengthening Primary Health Care (PHC) is not prioritised enough within national and international plans to achieve this. These concerns are grounded in knowledge that health systems with stronger PHC tend to have greater population reach, can respond better to local health needs, and provide a comprehensive set of benefits at lower cost. One potential reason for the lack of priority given to PHC is that most previous research in this area has been conducted in North America and Europe.Brazil has invested in PHC over the last 20 years through the Estrategia Saude da Familia (ESF). The focus of the ESF is to re-orientate the Brazilian health system to PHC through the delivery of community based health care by multidisciplinary teams. The ESF is much less developed in large cities than rural areas, with poor populations living in favelas (urban slums) being especially underserved. ESF coverage was low (7% in 2008) in Rio de Janeiro until recently, but this has increased substantially since 2011(to 50% in June 2016) reflectings political ambition to achieve universal coverage in the city. The impact of ESF expansion in Rio de Janeiro on health outcomes and costs has important implications for how health systems in large cities in Brazil and internationally should be developed.Our project will be conducted by a multi-disciplinary team of researchers and policy makers from Brazil, UK and USA, including doctors, health planners, mathematical modellers, and social scientists. It involves quantitative analyses of a unique database that has linked information from patients' medical records (both primary care and hospitalisation records), data on eligibility for state welfare benefits, and deaths in the city. This component of the project will examine whether public investment in ESF in Rio de Janeiro has produced better health outcomes, including a lower likelihood of being admitted to hospital for chronic conditions and a lower risk of death during infancy. It will examine whether individuals dually enrolled in the ESF and a major conditional cash transfer programme derive health benefits above those obtained from each programme in isolation. The project will also explore whether certain groups of patients, including from different race/ethnic groups, benefit more from the ESF than others. We will observe practices in health clinics and undertake interviews with health managers, clinicians, and patients to understand success in the implementation process and barriers to programme expansion. We will undertake mathematical modelling to estimate the potential benefits from further expansion of the programme in the city and whether comparable benefits may accrue if the ESF is expanded in other major Brazilian cities.Our project aims to influence the development of PHC in Rio de Janeiro, other large cities in Brazil, and internationally by generating and actively disseminating timely evidence to policy-makers especially in a period of economical crisis. We will achieve this by including policy-makers and programme implementers from Rio de Janeiro in our research team. We will jointly host dissemination events with the Pan American Health Association in Rio de Janeiro and Brasilia with policy-makers from cities across Brazil to share the findings in order to inform policy development in the country and internationally. Our evaluation will provide important information to other countries seeking to achieve UHC in major urban areas and large cities, such as Colombia and India. By fostering links between academics and policy makers from Brazil, UK, and USA with extensive experience in analysing linked datasets, microsimulation modelling and qualitative research, we will build research skills and research translation capacity among all team members.

联合国最近为各国制定了一项目标，以低成本向所有公民提供全面的医疗保健。虽然这是一个值得欢迎的发展，但令人关切的是，在国家和国际计划中，加强初级卫生保健（PHC）没有得到足够的重视，无法实现这一目标。这些关切基于这样一种认识，即具有较强初级保健的卫生系统往往覆盖更多的人口，能够更好地响应当地卫生需求，并以较低的成本提供全面的效益。初级保健没有得到重视的一个潜在原因是，这一领域以前的大多数研究都是在北美和欧洲进行的。在过去的20年里，巴西通过沙特家庭战略（ESF）对初级保健进行了投资。ESF的重点是通过多学科小组提供以社区为基础的卫生保健，将巴西卫生系统重新定位为初级保健。大城市的ESF远不如农村地区发达，居住在favelas（城市贫民窟）的贫困人口尤其得不到服务。直到最近，巴西里约热内卢的ESF覆盖率很低（2008年为7%），但自2011年以来大幅增加（2016年6月达到50%），反映了在该市实现全民覆盖的政治雄心。可持续发展基金在里约热内卢扩大对卫生结果和成本的影响，对巴西和国际大城市的卫生系统应如何发展具有重要意义。我们的项目将由来自巴西、英国和美国的多学科研究人员和政策制定者组成的团队进行，包括医生、卫生规划人员、数学建模人员和社会科学家。它涉及对一个独特数据库的定量分析，该数据库将患者的医疗记录（包括初级保健和住院记录）、国家福利资格数据和该市死亡人数的信息联系起来。该项目的这一组成部分将审查在巴西里约热内卢对社会健康基金的公共投资是否产生了更好的健康结果，包括因慢性病住院的可能性较低和婴儿期死亡的风险较低。它将审查同时参加社会稳定基金和主要有条件现金转移支付方案的个人获得的健康福利是否高于单独从每个方案获得的福利。该项目还将探讨某些患者群体，包括来自不同种族/民族的患者，是否比其他患者更能从ESF中受益。我们将观察卫生诊所的做法，并与卫生管理人员、临床医生和患者进行面谈，以了解实施过程的成功和扩大方案的障碍。我们将进行数学建模，以估计在该市进一步扩大该计划的潜在效益，以及如果在巴西其他主要城市扩大ESF，是否会产生类似的效益。我们的项目旨在通过产生并积极向决策者及时传播证据，特别是在经济危机时期，影响里约热内卢、巴西其他大城市以及国际上初级卫生保健的发展。为了实现这一目标，我们将把来自巴西里约热内卢的政策制定者和项目执行者纳入我们的研究团队。我们将与泛美卫生协会在里约热内卢和巴西利亚与巴西各城市的决策者共同举办宣传活动，分享调查结果，以便为该国和国际上的政策制定提供信息。我们的评估将为哥伦比亚和印度等寻求在主要城市地区和大城市实现全民健康覆盖的其他国家提供重要信息。通过促进来自巴西、英国和美国的学者和政策制定者之间的联系，他们在分析关联数据集、微观模拟建模和定性研究方面拥有丰富的经验，我们将在所有团队成员中建立研究技能和研究翻译能力。

项目成果

Expansion of primary healthcare and emergency hospital admissions among the urban poor in Rio de Janeiro Brazil: A cohort analysis.

• DOI: 10.1016/j.lana.2022.100363
• 发表时间: 2022-11
• 期刊: LANCET REGIONAL HEALTH-AMERICAS
• 作者: Hone, Thomas;Macinko, James;Trajman, Anete;Palladino, Raffaele;Coeli, Claudia Medina;Saraceni, Valeria;Rasella, Davide;Durovni, Betina;Millett, Christopher
• 通讯作者: Millett, Christopher

Contribution of primary care expansion to Sustainable Development Goal 3 for health: a microsimulation of the 15 largest cities in Brazil.

• DOI: 10.1136/bmjopen-2021-049251
• 发表时间: 2022-01-11
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Basu S;Hone T;Villela D;Saraceni V;Trajman A;Durovni B;Millett C;Rasella D
• 通讯作者: Rasella D

Additional file 8 of Racial and socioeconomic disparities in multimorbidity and associated healthcare utilisation and outcomes in Brazil: a cross-sectional analysis of three million individuals

附加文件 8：巴西多种疾病的种族和社会经济差异以及相关医疗保健利用和结果：对 300 万人的横断面分析

• DOI: 10.6084/m9.figshare.14897398
• 发表时间: 2021
• 作者: Hone T

Record linkage under suboptimal conditions for data-intensive evaluation of primary care in Rio de Janeiro, Brazil.

• DOI: 10.1186/s12911-021-01550-6
• 发表时间: 2021-06-15
• 期刊: BMC medical informatics and decision making
• 影响因子: 3.5
• 作者: Coeli CM;Saraceni V;Medeiros PM Jr;da Silva Santos HP;Guillen LCT;Alves LGSB;Hone T;Millett C;Trajman A;Durovni B
• 通讯作者: Durovni B

Additional file 4 of Racial and socioeconomic disparities in multimorbidity and associated healthcare utilisation and outcomes in Brazil: a cross-sectional analysis of three million individuals

附加文件 4：巴西多种疾病的种族和社会经济差异以及相关医疗保健利用和结果：对 300 万人的横断面分析

• DOI: 10.6084/m9.figshare.14897386
• 发表时间: 2021
• 作者: Hone T