Primary Care Assessment Tool: regional differences based on the National Health Survey from Instituto Brasileiro de Geografia e Estatística

Pinto, Luiz Felipe; Quesada, Leonardo Arêas; D’Avila, Otavio Pereira; Hauser, Lisiane; Gonçalves, Marcelo Rodrigues; Harzheim, Erno

doi:10.1590/1413-81232021269.10112021

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ARTICLE • Ciênc. saúde coletiva 26 (09) • Sept 2021 • https://doi.org/10.1590/1413-81232021269.10112021 copy

Primary Care Assessment Tool: regional differences based on the National Health Survey from Instituto Brasileiro de Geografia e Estatística

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

In 2019, unprecedentedly among the official statistical institutes worldwide, the IBGE included a particular module on evaluating primary health care in its central population-based population survey, the National Health Survey (PNS-2019). The survey considered the reduced version of the Primary Care Assessment Tool (PCAT), developed and disseminated by Starfield and Shi, to assess the existence and extent of the structure and process characteristics of PHC services. It is the most significant probabilistic sample using this instrument ever conducted in a single country in the world that interviewed users aged 18 or over (n=9,677). The results of the Brazilian overall PCAT scores (5.9 [5.8; 5.9]) point to significant regional and intraregional contrasts, with the South of the country standing out with the best evaluations of primary care services (overall score = 6.3 [6.2; 6.5]) and the North with the worse (overall score = 5,5 [5,3; 5,7]). There were also statistically significant and more favorable differences between residents of households registered by family health teams, among older adults, and those using health services the most (adults with reported morbidities).

Key words:
Primary health care; Health assessment; Household surveys; PCAT; Brazil

Federation Units (UF) and Great Regions	UF Total		Capitals
Federation Units (UF) and Great Regions	Sample realized (*)	Expanded population	Sample realized (*)	Expanded population
Rondônia	164	94,819	78	28,620
Acre	196	51,674	91	21,350
Amazonas	339	274,781	152	139,724
Roraima	194	29,542	104	19,289
Pará	322	506,264	75	90,898
Amapá	93	36,249	51	20,306
Tocantins	278	178,894	50	20,347
North Region	1,586	1,172,221	601	340,534
Maranhão	392	373,547	50	46,895
Piauí	372	356,681	115	81,762
Ceará	515	722,079	54	103,695
Rio Grande do Norte	409	367,094	89	56,235
Paraíba	388	350,981	142	72,573
Pernambuco	424	700,061	115	142,982
Alagoas	427	338,587	139	82,328
Sergipe	296	196,994	87	43,084
Bahia	420	1,463,675	71	121,724
Northeast Region	3,643	4,869,701	862	751,278
Minas Gerais	638	2,036,536	189	237,559
Espírito Santo	364	308,008	129	38,183
Rio de Janeiro	331	818,908	79	196,022
São Paulo	727	3,933,558	309	1,097,418
Southeast Region	2,060	7,097,010	706	1,569,182
Paraná	535	1,116,811	112	166,419
Santa Catarina	513	815,700	69	33,995
Rio Grande do Sul	460	1,128,737	78	88,217
South Region	1,508	3,061,248	259	288,631
Mato Grosso do Sul	272	214,242	100	51,786
Mato Grosso	231	290,933	61	25,816
Goiás	222	408,039	58	65,458
Distrito Federal	155	147,161	155	147,161
Midwest Region	880	1,060,375	374	290,221
Brazil	9,677	17,260,556	2,802	3,239,846

Characteristics	Total (PCAT sample)	% column	(%) Lower Limit CI	(%) Upper Limit CI	General PCAT Score	CI
Geographical region*
North	1,172,221	6.8%	[6.5%;	7.1%]	5.5	[5.3; 5.7]
Northeast	4,869,701	28.2%	[27.7%;	28.7%]	5.8	[5.6; 5.9]
Southeast	7,097,010	41.1%	[39.6%;	42.5%]	5.8	[5.7; 6.0]
South	3,061,248	17.7%	[17.0%;	18.4%]	6.3	[6.2; 6.5]
Midwest	1,060,375	6.1%	[5.7%;	6.5%]	5.8	[5.6; 6.0]
Gender
Male	5,203,907	30.1%	[29.3%;	30.9%]	5.9	[5.8; 6.0]
Female	12,056,650	69.9%	[69.5%;	70.1%]	5.8	[5.8; 5.9]
Age group*
18-39 years	5,627,197	32.6%	[31.7%;	33.5%]	5.6	[5.5; 5.8]
40-59 years	6,176,806	35.8%	[35.0%;	36.5%]	5.9	[5.7; 6.0]
60 years or over	5,456,554	31.6%	[30.8%;	32.4%]	6.1	[6.0; 6.2]
Ethnicity/skin color
White	6,554,888	38.0%	[36.9%;	38.9%]	5.9	[5.7; 6.0]
Black/brown	10,514,155	60.9%	[60.4%;	61.4%]	5.9	[5.8; 6.0]
Marital status
With spouse	11,221,591	65.0%	[64.6%;	65.4%]	5.9	[5.8; 6.0]
Without spouse	6,038,966	35.0%	[34.1%;	35.8%]	5.9	[5.8; 6.0]
Has health plan?
Yes	968,387	5.6%	[4.8%;	6.4%]	5.9	[5.5; 6.2]
No	16,292,169	94.4%	[94.3%;	94.5%]	5.9	[5.8; 5.9]
Occupation
Employed	7,969,308	46.2%	[45.5%;	46.8%]	5.8	[5.7; 5.9]
Unemployed	9,291,248	53.8%	[53.1%;	54.5%]	5.9	[5.8; 6.0]
Per capita household income ranges*
Up to one minimum wage	11,172,146	64.7%	[64.2%;	65.3%]	5.8	[5.7; 5.9]
More than one and less than three minimum wages	5,578,185	32.3%	[31.3%;	33.2%]	6.0	[5.9; 6.2]
More than three minimum wages	510,225	3.0%	[2.5%	3.4%]	5.8	[5.4; 6.2]
Reported morbidity
Systemic arterial hypertension *
Yes	6,765,463	39.2%	[38.4%;	40.0%]	6.2	[6.1; 6.3]
No	10,495,093	60.8%	[60.2%;	61.4%]	5.7	[5.6; 5.8]
Diabetes mellitus*
Yes	2,742,081	15.9%	[15.0%;	16.7%]	6.3	[6.1; 6.4]
No	14,518,475	84.1%	[83.9%;	84.3%]	5.8	[5.7; 5.9]
Depression*
Yes	2,647,281	15.3%	[14.3%;	16.3%]	6.1	[5.9; 6.2]
No	14,613,276	84.7%	[84.4%;	84.9%]	5.8	[5.8; 5.9]
Heart disease*
Yes	1,359,166	7.9%	[7.2%;	8.5%]	6.4	[6.1; 6.6]
No	15,901,390	92.1%	[92.1%;	92.2%]	5.8	[5.7; 5.9
Asthma
Yes	1,010,602	5.9%	[5.0%;	6.6%]	6.0	[5.7; 6.3]
No	16,249,954	94.1%	[94.0%;	94.3%]	5.9	[5.8; 5.9]

Sociodemographic characteristics and morbidity	Description	Brazil		North		Northeast		Southeast		Sul		Midwest
		(%)	Score	(%)	Score	(%)	Score	(%)	Score	(%)	Score	(%)	Score
		(%)	PCAT (CI)	(%)	PCAT (CI)	(%)	PCAT (CI)	(%)	PCAT (CI)	(%)	PCAT (CI)	(%)	PCAT (CI)
Gender	Male	30.15	5.92 [5.80-6.04]	29.61	5.58 [5.33-5.83]	27.48	5.91 [5.70-6.11]	30.41	5.80 [5.57-6.02]	33.91	6.36 [6.14-6.59]	30.42	5.73 [5.39-6.07]
Gender	Female	69.85	5.84 [5.76-5.93]	70.39	5.45 [5.24-5.66]	72.52	5.7 [5.58-5.82]	69.59	5.84 [5.67-6.01]	66.09	6.28 [6.10-6.46]	69.58	5.84 [5.61-6.07]
Age group	Up to 39 years	32.60	5.62 [5.50-5.75]	46.53	5.24 [4.99-5.50]	37.83	5.49 [5.32-5.67]	28.69	5.71 [5.44-5.97]	26.93	5.97 [5.68-6.27]	35.77	5.61 [5.31-5.91]
	40-59 years	35.79	5.86 [5.73-5.99]	31.60	5.50 [5.26-5.73]	35.77	5.80 [5.64-5.96]	35.87	5.77 [5.49-6.04]	37.15	6.27 [6.06-6.48]	35.95	5.97 [5.62-6.32]
	60 years or over	31.61	6.12 [6.01-6.23]	21.87	5.99 [5.75-6.23]	26.40	6.07 [5.87-6.27]	35.44	5.99 [5.78-6.19]	35.92	6.6 [6.41-6.78]	28.28	5.85 [5.53-6.17]
Ethnicity/skin color	White	37.98	5.87 [5.75-5.99]	12.82	5.31 [4.76-5.86]	19.05	5.94 [5.69-6.18]	42.66	5.57 [5.36-5.77]	69.31	6.32 [6.14-6.51]	30.86	5.78 [5.43-6.14]
Ethnicity/skin color	Black/brown	60.91	5.86 [5.77-5.95]	85.88	5.51 [5.34-5.68]	79.66	5.7 [5.59-5.82]	56.33	6.01 [5.82-6.21]	29.72	6.25 [6.03-6.47]	67.93	5.82 [5.59-6.06]
Marital status	with spouse	65.01	5.86 [5.77-5.96]	68.09	5.42 [5.23-5.61]	65.68	5.73 [5.60-5.85]	62.21	5.86 [5.67-6.05]	70.70	6.26 [6.08-6.44]	60.95	5.83 [5.58-6.08]
Occupation	unemployed (*)	53.83	5.91 [5.81-6.00]	53.26	5.46 [5.23-5.69]	58.84	5.74 [5.60-5.87]	51.73	5.89 [5.7-6.08]	52.94	6.38 [6.19-6.57]	48.08	5.97 [5.71-6.23]
Per capita household income range	Up to one MW (**)	64.73	5.8 [5.71-5.88]	81.72	5.45 [5.26-5.63]	86.36	5.73 [5.61-5.85]	54.53	5.81 [5.62-6.00]	49.02	6.18 [5.98-6.39]	60.28	5.73 [5.49-5.97]
With health plan	No	94.39	5.86 [5.79-5.94]	97.14	5.49 [5.32-5.66]	97.73	5.73 [5.62-5.84]	92.85	5.85 [5.7-6.00]	91.01	6.3 [6.16-6.45]	96.08	5.81 [5.60-6.01]
Arterial Hypertension	Yes	39.20	6.19 [6.08-6.29]	27.88	5.99 [5.76-6.22]	36.47	6.17 [6.00-6.34]	43.15	6.02 [5.84-6.21]	38.61	6.66 [6.45-6.88]	39.41	6.24 [5.90-6.57]
Diabetes	Yes	15.89	6.25 [6.08-6.43]	12.51	5.97 [5.62-6.33]	14.18	6.22 [5.91-6.52]	17.84	6.21 [5.91-6.52]	15.61	6.62 [6.31-6.93]	15.23	5.9 [5.42-6.38]
Heart disease	Yes	7.87	6.35 [6.11-6.60]	4.64	5.75 [5.21-6.28]	4.95	6.37 [5.74-7.00]	9.28	6.33 [5.94-6.73]	10.59	6.55 [6.16-6.94]	7.62	6.09 [5.57-6.60]
Asthma	Yes	5.85	5.99 [5.72-6.26]	5.20	5.55 [4.99-6.11]	3.57	5.78 [5.33-6.23]	6.75	6.03 [5.57-6.49]	7.77	6.25 [5.71-6.80]	5.56	5.62 [5.06-6.18]
Depression	Yes	15.34	6.05 [5.86-6.24]	7.15	5.76 [5.32-6.2]	9.87	5.79 [5.47-6.12]	17.25	5.89 [5.55-6.23]	22.67	6.59 [6.34-6.84]	15.53	5.82 [5.31-6.34]

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[1] Collaborations

LF Pinto prepared the structure and the initial text of the paper and approved the final version. All other authors contributed to the writing and review of the paper.