Health Academy Program: correlation between noncommunicable chronic disease hospitalizations and program adherence in Brazilian municipalities, 2011-2017

Tusset, Dalila; Santos, Leandro dos; Merchan-Hamann, Edgar; Calmon, Paulo Carlos Du Pin

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Epidemiologia e Serviços de Saúde

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Original Article • Epidemiol. Serv. Saúde 29 (5) • 2020 • https://doi.org/10.1590/S1679-49742020000500013 copy

Health Academy Program: correlation between noncommunicable chronic disease hospitalizations and program adherence in Brazilian municipalities, 2011-2017^* * Article derived from the academic thesis entitled ‘Study of Health Fitness Center Program implementation in Brazil from 2011 to 2017 from a process perspective’, defended by Dalila Tusset at the University of Brasília Health Sciences Faculty Health Sciences Postgraduate Program in December 2019.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To analyze the correlation between municipalities adhering to the Health Fitness Center Program, noncommunicable chronic disease (NCD) hospitalizations and socioeconomic levels from 2011 to 2017.

Methods:

This was an ecological study; HFCP adherence indicators for 2,837 municipalities were calculated, as were NCD hospitalization indicators, according to funding categories and the Firjan Socioeconomic Development Index.

Results:

The HFCP adherence indicator was higher for municipalities that received Congress funding (1.18), had moderate to high Firjan Socioeconomic Development Indices (0.94) and high NCD hospitalization indicators (1.03) (p<0.001). There were positive correlations (p<0.05) between the two indicators in municipalities receiving Ministry of Health funding (r=0.14) and those receiving both Congress and Ministry of Health funding (r=0.12); whereas correlation was negative in municipalities with moderate to low Firjan Socioeconomic Development Indices (r=-0.09; p=0.013).

Conclusion:

The main form of adherence to the HFCP, according to population size, was through Congress funding. Municipalities with poorer socioeconomic and NCD indicators had lower adherence to the HFCP.

Keywords:
Primary Health Care; Health Programs and Plans; Health Equity; Chronic Disease; Ecological Study

Macro-region	Municipalities n	Adhering municipalities n (%)	Adherence n	Mean adherence indicator (standard deviation)
Northeast	1,794	979 (55)	1,338	1.07 (0.9)
North	450	261 (58)	383	1.33 (1.3)
Midwest	467	255 (55)	343	1.36 (1.2)
Southeast	1,668	736 (44)	1,102	1.18 (1.3)
South	1,191	606 (51)	775	1.36 (1.2)

Variables		Municipalities
Variables		n	%
Funding
	Congress	927	33
	Program (Ministry of Health budget resources)	1,605	57
	Both	305	11
Firjan Socioeconomic Development Indicator
	Low to regular	802	28
	Moderate to high	2,035	72
Chronic noncommunicable disease indicator
	Low	951	34
	Moderate	942	33
	High	944	33

Variables		Adherence indicator
Variables		Median (Quartile 1 and Quartile 3)	p-value^a a) The Wilcoxon-Mann-Whitney test was used for the Firjan Socioeconomic Development Indicator categories and for the NCD hospitalization indicator categories, while the Kruskal-Wallis test was used for funding categories.
Funding
	Congress	1.18 (0.60;2.05)	<0,001
	Program (Ministry of Health budget resources)	0.81 (0.34;1.70)^b b) Difference for Congress (p-value<0.001).
	Both	0.82 (0.38;1.43)^b b) Difference for Congress (p-value<0.001).
Índice Firjan de Desenvolvimento Socioeconômico – IFDM
	Baixo a regular	0.87 (0.60;2.05)	<0.001
	Moderado a alto	0.94 (0.38;1.95)	<0.001
Indicador de doenças crônicas não transmissíveis – IND-DCNT
	Baixo	0.90 (0.36;1.72)^c c) Difference for the NCD hospitalization indicator in the ‘high’ category (p-value<0.001).	<0.001
	Moderado	0.87 (0.36;1.75)^c c) Difference for the NCD hospitalization indicator in the ‘high’ category (p-value<0.001).
	Alto	1.03 (0.52;1.94)

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
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[1] Correspondence: Dalila Tusset – Rua Joaquim Esperidião, No. 730, Anápolis, GO, Brazil. Postcode: 75113-420 E-mail: dalilatusset@gmail.com