Prevalence of not receiving a home visit by Community Health Agents in Brazil and associated factors

Kessler, Marciane; Thumé, Elaine; Facchini, Luiz Augusto; Tomasi, Elaine

doi:10.1590/1413-812320222711.17072021EN

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FREE THEMES • Ciênc. saúde coletiva 27 (11) • Nov 2022 • https://doi.org/10.1590/1413-812320222711.17072021EN copy

Prevalence of not receiving a home visit by Community Health Agents in Brazil and associated factors

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This article aimed to identify the prevalence of not receiving a home visit by a community health agent (CHA) and the factors associated with it. This was a cross-sectional study, conducted with 38,865 health teams and 140,444 users in the entire country, who participated in the external evaluation of the Program of Access and Quality Improvement in Primary Health (PMAQ-AB, in Portuguese) in 2017/2018. The association between not receiving a home visit by a CHA and the characteristics of the towns, teams, and individuals were estimated by the prevalence ratio (PR) with 95% confidence intervals. The prevalence of not receiving a home visit by a CHA was 18.6% and the main causes were: CHA did not visit the home, lack of knowledge of the existence of CHAs in the neighborhood or unit, and no one present at the home when the CHA visited. The probability of receiving a home visit was higher in poorer regions like the Northeast Region of the country; in towns with a smaller population; among older age users with a lower income, users with chronic health conditions, or users who have someone with a physical disability at home. The results showed that there is a need to increase the coverage of CHA visits in the country, considering that their home visits improve equity in health care.

Key words:
Primary Health Care; Strategic Family Health; Community Health Agents; Healthcare Equity; Access to Health Services

Variable		Total of sample
Variable		n=139,362	100.0%
Characteristics of the municipality
Region
	South	19,971	14.3
	Southeast	46,609	33.4
	Midwest	11,723	8.4
	Northeast	51,956	37.3
	North	9,103	6.5
Size of municipality (inhabitants)
	Up to 10,000	18,198	13.1
	10,001-30,000	37,795	27.1
	30,001-100,000	33,102	23.8
	100,001-300,000	18,783	13.5
	More than 300,000	31,484	22.6
HDI-M
	0,000-0,499	443	0.32
	0,500-0,599	25,876	18.6
	0,600-0,699	43,857	31.5
	0,700-0,799	56,537	40.6
	0,800-1,000	12,621	9.1
Family healthcare coverage (%)
	Up to 50	20,535	14.7
	50,1-75,0	26,734	19.2
	75,1-99,9	29,256	21.0
	100,0	62,837	45.1
Characteristics of the team
Is there a population not covered by the FHS
	Yes	55,478	39.8
	No	83,884	60.2
Individual characteristics
Sex
	Female	109,294	78.4
	Male	30,068	21.6
Age (years)
	18-39	60,697	43.6
	40-59	47,758	34.3
	60 or over	30,907	22.2
Skin color
	White	43,937	31.9
	Mixed/Brown/ Black/Other	93,645	68.1
Per capita income (Reais)
	Quintile 1 (+poor)	28,168	20.2
	2	29,409	21.1
	3	26,741	19.2
	4	29,348	21.1
	Quintile 5 (+rich)	25,608	18.4
Chronic condition
	None	86,779	62.6
	SAH or DM	39,276	28.3
	SAH and DM	12,613	9.1
Someone with a physical disability at home
	Yes	10,878	7.8
	No	128,342	92.2
Pregnancy in the last 2 years
	Yes	20,953	19.2
	No	88,358	80.8
Has a child of up to 2 years of age
	Yes	15,621	11.2
	No	123,521	88.8

Variable		Prevalence	Non-adjusted PR*		Adjusted PR*
Variable		%	PR	CI95%	PR	CI95%
Level 1		18.6
Region				<0.001	-	-
	Northeast	15.7	1.00		-	-
	North	22.5	1.43	1.37-1.49	-	-
	Midwest	23.3	1.48	1.42-1.54	-	-
	Southeast	18.2	1.16	1.12-1.19	-	-
	South	22.5	1.43	1.38-1.48	-	-
Level 2
Size of municipality (Inhabitants)				<0.001		<0.001
	Up to 10,000	11.1	1.00	-	1.00	-
	10,001-30,000	13.3	1.20	1.15-1.26	1.16	1.10-1.22
	30,001-100,000	17.9	1.61	1.54-1.69	1.34	1.27-1.41
	100,001-300,000	23.8	2.15	2.04-2.25	1.60	1.51-1.69
	More than 300,000	26.9	2.43	2.32-2.54	1.80	1.70-1.91
HDI-M				<0.001		0.219
	0.000-0.499	13.8	1.00	-	1.0	-
	0.500-0.599	12.7	0.92	0.73-1.16	1.07	0.85-1.35
	0.600-0.699	15.5	1.12	0.89-1.42	1.13	0.90-1.42
	0.700-0.799	22.4	1.62	1.29-2.05	1.18	0.93-1.49
	0.800-1.000	24.3	1.76	1.39-2.23	1.07	0.84-1.36
Family healthcare coverage (%)				<0.001		<0.001
	100,0	12.3	1.00		1.0
	75.1-99.9	20.9	1.70	1.65-1.75	1.41	1.36-1.46
	50.1-75.0	25.9	2.11	2.05-2.18	1.60	1.53-1.66
	Up to 50	25.1	2.04	1.98-2.11	1.45	1.38-1.51
Level 3
Is there a population not covered by the FHS				<0.001		<0.001
	No	13.2	1.00		1.0
	Yes	26.8	2.03	1.98-2.07	1.74	1.70-1.78
Level 4
Sex				<0.001		<0.001
	Male	16.1	1.00		1.0
	Female	19.2	1.19	1.16-1.23	1.17	1.13-1.20
Age (years)				<0.001		<0.001
	60 or over	16.7	1.00		1.0
	40-59	18.1	1.08	1.05-1.12	1.13	1.10-1.17
	18-39	19.9	1.19	1.15-1.22	1.28	1.24-1.32
Skin color/Ethnicity				0.237		-
	White	18.8	1.00		-
	Mixed/Brown/ Black/Other	18.5	0.98	0.96-1.01	-	-
Per capita income (Reais)				<0.001		<0.001
	Quintile 1 (+poor)	16.6	1.00		1.0
	2	18.3	1.11	1.07-1.15	1.03	0.99-1.07
	3	18.7	1.13	1.09-1.17	1.05	1.01-1.09
	4	19.2	1.16	1.12-1.20	1.07	1.03-1.11
	Quintile 5 (+rich)	20.2	1.22	1.18-1.27	1.14	1.10-1.19
Level 5
Chronic Condition				<0.001		0.001
	SAH and DM	17.2	1.00		1.0
	SAH or DM	17.5	1.02	0.97-1.06	1.03	0.99-1.08
	None	19.2	1.11	1.07-1.16	1.08	1.03-1.13
Someone with a physical disability at home				<0.001		<0.001
	Yes	16.1	1.00		1.0
	No	18.8	1.16	1.11-1.22	1.17	1.12-1.22
Pregnancy in the last 2 years				0.282		-
	Yes	19.5	1.00		-
	No	19.2	0.98	0.95-1.01	-	-
Has a child of up to 2 years of age				0.604		-
	Yes	18.7	1.00		-
	No	18.5	0.99	0.96-1.02	-	-

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[1] Collaborations

M Kessler, E Thumé, LA Facchini and E Tomasi participated in the conception, design, analysis, writing of the article and critical review. All authors approved the version to be published.