Lack of access and continuity of adult health care: a national population-based survey

Dilélio, Alitéia Santiago; Tomasi, Elaine; Thumé, Elaine; Silveira, Denise Silva da; Siqueira, Fernando Carlos Vinholes; Piccini, Roberto Xavier; Silva, Suele Manjourany; Nunes, Bruno Pereira; Facchini, Luiz Augusto

doi:10.1590/S0034-8910.2015049005503

Alitéia Santiago Dilélio

Departamento de Ciências da Saúde. Universidade Federal de Santa Maria. Palmeira das Missões, RS, Brasil

Elaine Tomasi

Programa de Pós-Graduação em Epidemiologia. Universidade Federal de Pelotas. Pelotas, RS, Brasil

Elaine Thumé

Programa de Pós-Graduação em Enfermagem. Universidade Federal de Pelotas. Pelotas, RS, Brasil

Denise Silva da Silveira

Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil

Fernando Carlos Vinholes Siqueira

Programa de Pós-Graduação em Educação Física. Universidade Federal de Pelotas. Pelotas, RS, Brasil

Roberto Xavier Piccini

Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil

Suele Manjourany Silva

Programa de Pós-Graduação em Epidemiologia. Universidade Federal de Pelotas. Pelotas, RS, Brasil

Bruno Pereira Nunes

Programa de Pós-Graduação em Epidemiologia. Universidade Federal de Pelotas. Pelotas, RS, Brasil

Luiz Augusto Facchini

Programa de Pós-Graduação em Epidemiologia. Universidade Federal de Pelotas. Pelotas, RS, Brasil

Correspondence: Alitéia Santiago Dilélio. Departamento de Medicina Social – UFPEL. Av. Duque de Caxias, 250 3º andar Fragata. 96030-001 Pelotas, RS, Brasil. E-mail: aliteia@gmail.com

Basead on the doctoral thesis of Alitéia Santiago Dilélio, titled: “Acesso e Utilização da Assistência Médica Ambulatorial ao Adulto na Rede de Serviços de Saúde do Brasil”, presented to the Graduate Program in Epidemiology of Universidade Federal de Pelotas, in 2014.

The authors declare no conflict of interest.

Variable (n)	Sample			Projection for the urban population (20 to 59 years)^b 92,168,985

	n^a	%	95%CI	n	95%CI
Hospitalized (n = 12,365)	961	7.8	7.3; 8.3	7,189,181	6,728,335;7,757,856
Despite not being hospitalized, a doctor had indicated hospitalization (n = 11,404)	30	0.3
Barriers to access
Lack of access to hospitalization (n = 991)^c	30	3.0	2.0;4.3	223,324	148,882;320,097
Reason for needing to be hospitalized (n = 30)
Emergency surgery/Operation	9	300	14.7;49.4	76,482	37,476;125,940
Non-emergency surgery/Operation	2	6.7	8.2;22.1	17,081	20,905;56,342
Clinical treatment	7	23.3	9.9;42.3	59,401	25,239;107,839
To have tests/Examinations	6	20.0	7.7;38.6	50,988	19,630;98,407
Other	6	20.0	7.7;38.6	50,988	19,630;98,407
Reason for not being hospitalized (n = 30)
Thought they did not need it	12	40.0	22.7;59.4	101,976	57,871;151,434
No hospital bed available	6	20.0	7.7;38.6	50,988	19,630;98,407
Family or work commitments	5	16.7	5.6;34.7	42,575	14,277;88,464
Afraid	4	13.3	3.7;30.7	33,907	9,433;78,266
Unable to pay	3	10.0	2.1;26.5	25,494	5,354;67,559
No transport available	1	3.3	0.08;17.2	8,413	204;43,850
Other	6	20.0	7.7;38.6	50,988	9,630;98,407
Health problem outcome after not being hospitalized (n = 30)
Got worse	6	20.0	7.7;38.6	50,988	19,630;98,407
Just the same as before	12	40.0	22.7;59.4	101,976	57,871;151,434
Improved a little	–	–	–
Improved considerably	4	13.3	3.7;30.7	33,907	9,433;78,266
Cured/Problem solved	8	26.7	12.3;45.9	68,069	31,358;117,017
Barriers to continuity of care
Did not receive explanation as to the reason for being hospitalized (n = 915)	799	87.3	85.0;89.4	6,276,155	6,110,804;6,427,128
Discharged from hospital without being referred to a follow-up appointment (n = 935)	401	42.9	39.7;46.1	3,084,159	2,854,105;3,314,212
Did not have the follow-up appointment (n = 534)	110	20.6	17.2;24.3	845,635	706,064;997,520
Reason why did not have follow-up appointment (n = 108)
Date of the appointment not reached yet	59	54.6	44.7;64.2	461,716	377,999;542,897
Did not attempt to make an appointment	33	30.6	22.1;40.2	258,764	186,885;339,945
Unable to go and make the appointment	3	2.8	0.6;7.9	23,678	5,074;66,805
Attempted to make an appointment. but none available	2	1.9	0.2;6.5	16,067	1,691;54,966
No doctor available on SUS and unable to pay for a private doctor	2	1.9	0.2;6.5	16,067	1,691;54,966
Attempted to make an appointment, but no doctor available at that service	1	0.9	0.02;5.0	7,611	169;42,282
Other	8	7.4	3.3;14.1	62,577	27,906;119,234
Opinion about care received (n = 923)
Very bad	43	4.7	3.4;6.2	337,891	244,432;445,729
Poor	12	1.3	0.7;2.3	93,459	5,032;165,351
Regular	79	8.6	6.8;10.6	618,270	488,864;762,053
Good	448	48.5	45.3;51.8	3,486,753	3,256,699;3,723,996
Very good	341	36.9	33.8;40.2	2,652,808	2,429,943;2,890,051
What happened to the problem after being hospitalized (n = 885)
Got worse	18	2.0	1.2;3.2	143,784	86,270;230,054
Just the same as before	59	6.7	5.1;8.5	481,675	366,648;611,080
Improved a little	140	15.8	13.5;18.4	1,135,891	970,539;1,322,809
Improved considerably	258	29.2	26.2;32.3	2,099,241	1,883,565;2,322,105
Cured/Problem solved	410	46.3	43.0;49.7	3,328,591	3,091,348;3,573,0.23

Variable (n)	Sample			Projection for the urban population (20 to 59 years)^b 92,168,985

	n^a	%	95%CI	n	95%CI
Accident and Emergency Care (n = 12,302)	2,243	18.2	17.6;18.9	16,774,755	16,221,741;17,419,938
Needed care, despite not receiving it (n = 10,059)	49	0.5
Barriers to access
Lack of access to accident and emergency care (n = 2,292)^c	49	2.1	1.6;2.8	360,186	274,428;480,248
Reason why care was not provided (n = 49)
Waiting time too long, gave up	24	49.0	34.4;63.7	184716	129,678;240,131
Too many people waiting	18	36.7	23.4;51.7	138,348	88,211;194,894
Specialist not available	12	24.5	13.3;38.9	92,358	50,137;146,642
Service refused to provide care	8	16.3	7.3;29.7	61,446	27,519;111,960
No transport available	2	4.1	0.5;14.0	15,456	188;52,776
Other	10	20.0	10.2;34.3	75,394	38,451;129,301
Problem outcome after not receiving care (n = 49)
Got worse	8	16.3	7.3;29.7	61,446	27,519;111,960
Just the same as before	15	30.6	18.3;45.4	115,353	68,986;171,145
Improved a little	14	28.6	16.6;43.3	107,814	62,577;163,229
Improved considerably	7	14.3	5.9;27.2	53,907	22,241;102,536
Cured/Problem solved	5	10.2	3.4;22.2	38,451	12,817;83,688
Barriers to continuity of care
Did not receive an explanation as to the reason for seeking care (n = 2,126)	1.415	66.6	64.5;68.6	11,171,987	10,819,717;11,507,482
Discharged from the accident and emergency unit without being referred to a follow-up appointment (n = 2,178)	1.854	85.1	83.6;86.6	14,275,317	14,023,695;14,526,938
Did not have the follow-up appointment (n = 324)	92	28.4	23.6;33.6	709,841	589,867;839,811
Reason why did not have the follow-up appointment (n = 91)
Did not attempt to make an appointment	33	36.3	26.4;47.0	257,672	187,398;333,625
Date of the appointment not reached yet	29	31.9	22.5;42.5	226,439	159,714;301,682
Attempted to make an appointment, but no doctor available at that service	5	5.5	1.8;12.4	39,041	12,777;88,020
Unable to go and make the appointment	3	3.3	0.7;9.3	23,425	4,969;66,015
No doctor available on SUS and unable to pay for a private doctor	2	2.2	0.3;7.7	15,616	2,130;54,658
Attempted to make an appointment, but none available	1	1.1	0.03;6.0	7,808	213;42,590
Other	18	19.8	12.2;29.5	140,548	86,601;209,403
Opinion about care received (n = 2,083)
Very bad	183	8.8	7.6;10.1	1,476,178	1,274,881;1,694,250
Poor	99	4.8	3.9;5.8	805,188	654,215;972,936
Regular	352	16.9	15.3;18.6	2,834,934	2,566,538;3,120,104
Good	1.105	53.0	50.9;55.2	8,890,620	8,538,350;9,259,665
Very good	344	16.5	14.9;18.2	2,767,835	2,415,656;3,053,005
Problem outcome after care was provided (n = 2,158)
Got worse	48	2.2	1.6;2.9	369,045	268,396;486,468
Just the same as before	341	15.8	14.3;17.4	2,650,411	2,398,790;2,918,807
Improved a little	584	27.1	25.2;29.0	4,545,959	4,227,238;4,864,679
Improved considerably	669	31.0	29.1;33.0	5,200,174	4,881,454;5,535,669
Cured/Problem solved	516	23.9	22.1;25.8	4,009,167	3,707,221;4,327,887

Variable (n)	Sample			Projection for the urban population (20 to 59 years)^b 92,168,985

	n^a	%	95%CI	n	95%CI
Care provided by a doctor (n = 12,300)	4,241	34.5	33.6;35.3	31,798,300	30,968,779;32,535,652
Needed care, despite not receiving it (n = 8,059)	167	2.1
Barriers to access
Reason why needed care (n = 167)
Thought they needed it because felt unwell	135	80.8	74.0;86.5	1,024,370	938,160;1,096,633
Follow-up on health problem	50	29.9	23.1;37.5	379,068	292,858;475,419
To have a check-up	29	17.4	12.0;24.0	220,594	152,134;304,268
To request tests/Examinations	19	11.4	7.0;17.2	144,527	88,745;218,059
To request a prescription	8	4.8	2.1;9.2	60,854	26,623;116,636
Cancer screening (n = 98)	4	4.1	1.1;10.1	51,979	13,946;128,046
To request a medical certificate	3	1.8	0.4;5.2	22820	5,071;65,925
To receive the results of tests	3	1.8	0.4;5.2	22,820	5,071;65,925
Prostate examination (n = 69)	1	1.5	0.03;7.8	19,017	380;98,887
To have an antenatal appointment (n = 98)	1	1.0	0.03;5.6	12,678	380;70,996
Other	12	7.2	3.8;12.2	91,280	48,176;154,670
Lack of access to care provided by a doctor (n = 4,290)^c	49	1.1	0.8;1.5	353,867	257,358;482,546
Did not attempt to make an appointment (n = 167)	118	70.7	63.1;77.4	896,324	799,972;981,265
Reason why did not attempt to make an appointment (n = 118)
Difficulty in getting an appointment on the SUS	63	53.4	44.0;62.6	478,637	394,382;561,099
Afraid/Did not want to	34	28.8	20.9;37.9	258,141	187,332;339,707
Family or work commitments	25	21.2	14.2;29.7	190,021	127,278;266,208
Unable to pay	24	20.4	13.5;28.7	182,850	121,004;257,245
Unable to go and make appointment	18	15.3	9.3;23.0	137,138	83,358;206,154
No doctor available at their usual health service	11	9.3	4.7;16.1	83,358	42,127;144,308
Health complaint got better	5	4.2	1.4;9.6	37,646	12,549;86,047
Other	17	14.5	8.6;22.1	129,967	77,084;198,088
Reason why care was not provided (n = 47)
No doctor available	20	42.6	28.3;57.8	158,242	105,123;214,704
No appointment available	19	40.4	26.4;55.7	150,070	98,066;206,904
Unable to pay	7	14.9	6.2;28.3	55,348	23,031;105,123
Service closed when care was sought	1	2.1	0.05;11.3	7,801	186;41,975
Problem outcome after not receiving care (n = 167)
Got worse	17	10.2	6.0;15.8	129,314	76,067;200,310
Just the same as before	84	50.3	42.5;58.1	637,696	538,808;736,583
Improved a little	31	18.5	13.0;25.3	234,540	164,812;320,749
Improved considerably	21	12.6	8.0;18.6	159,741	101,423;235,808
Cured/Problem solved	14	8.4	4.7;13.7	106,494	59,586;173,686
Barriers to continuity of care
Did not receive an explanation as to the reason for seeking care (n = 4,100)	3.035	74.0	72.7;75.4	23,530,742	23,117,364;23,975,918
Appointment ended without tests having been requested (n = 4,159)	2.376	57.1	55.6;58.6	18,156,829	17,679,855;18,633,804
Reason(s) why did not have some of the test(s) requested (n = 526)
Appointment made, but has not happened yet	279	53.0	48.7;57.4	7,229,979	6,643,396;7,830,204
Unable to get tests on the SUS and unable to pay	86	16.4	13.4;19.8	2,237,201	1,827,957;2,701,011
Unable to go and make appointment/Have tests	53	10.1	7.6;13.0	1,377,789	1,036,752;1,773,391
Did not want to	41	7.8	5.7;10.4	1,064,035	777,564;1,418,713
Not available in their city	23	4.4	2.8;6.5	600,225	381,961;886,696
Thought they did not need them	22	4.2	2.6;6.3	572,942	354,678;859,413
Other	82	15.6	12.6;19.0	2,128,069	1,718,825;2,591,879
Appointment ended without being referred to another service (n = 4,178)	3.881	92.9	92.1;93.7	29,540,621	29,286,234;29,795,007
Did not go to some of the referrals (n = 294)	100	34.0	28.6;39.7	767,611	645,696,276;896,298,677
Reason why did not go to some of the referrals (n = 100)
Appointment made, but has not happened yet	45	45.0	35.0;55.3	345,425	268,664;24,489
Unable to go and make appointment/Have them	12	12.0	6.4;20.0	92,113	49,127;153,522
Unable to get tests on the SUS and unable to pay	11	11.0	5.6;18.8	84,437	42,986;144,311
Did not want to	9	9.0	4.2;16.4	69,085	32,240;125,888
Thought they did not need them	4	4.0	1.1;9.9	30,704	8,444;75,993
Not available in their city	3	3.0	0.6;8.5	23,028	4,606;65,247
Other	22	22.0	14.3;31.4	168,874	109,768;241,030
Opinion about care received (n = 4,027)
Very bad	107	2.7	2.2;3.2	858,554	699,563;1,017,546
Poor	61	1.5	1.2;1.9	476,974	381,580;604,168
Regular	313	7.8	7.0;8.6	2,480,267	2,225,881;2,734,654
Good	2.169	53.8	52.3;55.4	17,107,485	16,630,511;17,616,258
Very good	1.377	34.2	32.7;35.7	10,875,019	10,398,044;11,351,993
Problem outcome after care was provided (n = 4,000)
Got worse	41	1.0	0.7;1.4	317,983	222,588;445,176
Just the same as before	1.293	32.3	30.9;33.8	10,270,851	9,825,675;10,747,825
Improved a little	848	21.2	19.9;22.5	6,741,240	6,327,862;7,154,617
Improved considerably	1.046	26.2	24.8;27.5	8,331,155	7,885,978;8,744,532
Cured/Problem solved	772	19.3	18.1;20.6	6,137,072	5,755,492;6,550,450

Variable (n)	Sample			Projection for the urban population (20 to 59 years)^b92,168,985

	n^a	%	IC95%	n	IC95%
Care provided by professional other than a doctor (n = 12,279)	1,61	13.1	12.5;13.8	12,074,137	11,521,123;12,719,320
Needed care, despite not receiving it (n = 10,666)	75	0.7
Barriers to access
Lack of access to health professional other than a doctor (n = 1,646)^c	33	2.0	1.4;2.8	246,417	178,070;356,141
Did not make an appointment (n = 75)	42	56.0	44.1;67.5	313,972	247,253;378,448
Reason why did not make appointment (n = 42)
Difficulty in getting an appointment on the SUS	24	57.1	41.0;72.3	179,278	128,728;227,002
Unable to pay	12	28.6	15.7;44.6	89,796	49,294;140,031
Family or work commitments	12	28.6	15.7;44.6	89,796	49,294;140,031
Unable to go and make appointment	9	21.4	10.3;36.8	67,190	32,339;115,542
This type of professional not available at their usual health service	8	19.0	8.6;34.1	59,655	27,002;107,064
Afraid/Did not want to	6	14.3	5.4;28.5	44,898	16,954;89,482
Health complaint got better	1	2.4	0.06;12.6	7,535	188;39,560
Other	2	4.8	0.6;16.2	15,071	1,884;50,863
Reason why care was not provided (n = 33)
No appointment available	9	27.3	13.3;45.5	67,347	32,810;112,245
Unable to pay	8	24.2	11.1;42.3	59,699	27,383;104,351
This type of professional not available at the service	5	15.4	5.1;31.9	37,991	12,581;78,695
Service closed when care was sought	1	3.0	0.08;15.8	7,401	197;38,977
Other	11	33.3	18.0;51.8	82,148	44,405;127,787
Problem outcome after not receiving care (n = 75)
Got worse	16	21.3	12.7;32.3	119,421	71,204;181,094
Just the same as before	46	61.3	49.4;72.4	343,687	276,968;405,921
Improved a little	10	13.3	6.6;23.2	74,568	34,004;130,074
Improved considerably	1	1.3	0.03;7.2	7,289	168;40,368
Cured/Problem solved	2	2.7	0.3;9.3	15,138	1,682;52,142
Barriers to continuity of care
Appointment ended without being referred to another service (n = 1,537)	1.474	95.9	94.8;96.8	11,579,097	11,446,282;11,687,765
Did not go to some of the referrals (n = 61)	25	41.0	28.6;54.3	202,966	141,581;268,807
Reason why did not go to some of the referrals (n = 25)
Appointment made, but has not happened yet	9	36.0	18.0;57.5	73,068	36,534;116,706
Unable to get tests on the SUS and unable to pay	5	20.0	6.8;40.7	40,593	13,802;82,607
Did not want to	4	16.0	4.5;36.1	32,475	9,133;73,271
Thought they did not need them	3	12.0	2.5;31.2	24,356	5,074;63,325
Unable to go and make appointment/Have them	3	12.0	2.5;31.2	24,356	5,074;63,325
Not available in their city	1	4.0	0.1;20.4	8,119	203;41,405
Other	3	12.0	2.5;31.2	24,356	5,074;63,325
Opinion about care received (n = 1,492)
Very bad	16	1.1	0.6;1.7	132,816	72,445;205,260
Poor	14	1.0	0.5;1.6	120,741	60,371;193,186
Regular	65	4.3	3.4;5.5	519,188	410,521;664,078
Good	758	50.8	48.2;53.4	6,133,662	5,819,734;6,447,589
Very good	639	42.8	40.3;45.4	5,167,731	4,865,877;5,481,658
Problem outcome after care was provided (n = 1,466)
Got worse	13	0.9	0.5;1.5	108,667	60,371;181.112
Just the same as before	271	18.5	16.5;28.6	2,233,715	1,992,233;3,453,203
Improved a little	234	16.0	14.1;17.9	1,931,862	1,702,453;2,161,271
Improved considerably	500	34.1	31.7;36.6	4,117,281	3,827,501;4,419,134
Cured/Problem solved	448	30.5	28.2;33.0	3,682,612	3,404,907;3,984,465

Variable (n)	Sample			Projection for the urban population (20 to 59 years)^b 92,168,985

	n^a	%	95%CI	n	95%CI
Domiciliary care (n = 12,281)	560	4.6	4.2;4.9	4,239,773	3,871,097;4,516,280
Needed care at home, despite not receiving it (n = 11,721)	62	0.5
Barriers to access
Reason why needed care (n = 62)
Transport difficulties	22	35.5	23.7;48.7	156,074	04,196;214,108
Confined to bed	18	29.0	18.2;42.0	127,497	80,016;184,651
Blood pressure problem	10	16.1	8.0;27.7	70,783	35,172;121,782
Had backache	8	12.9	5.7;23.9	56,714	25,060;105,075
Had leakage/Stroke/Ischaemia	5	8.1	2.7;17.8	35,611	11,870;78,257
Had a mental problem	5	8.1	2.7;17.8	35,611	11,870;78,257
Had rheumatism/Joint problems	5	8.1	2.7;17.8	35,611	11,870;78,257
Had heart problems	4	6.5	1.8;15.7	28,577	7,914;69,024
Had a neurological problem	3	4.8	1.0;13.5	21,103	440;59,352
Needed to get vaccinated	3	4.8	1.0;13.5	21,103	440;59,352
Had diabetes	2	3.2	0.4;11.2	14,069	1,759;49,240
Had been hospitalized in the last three months	2	3.2	0.4;11.2	14,069	1,759;49,240
Had had surgery recently	2	3.2	0.4;11.2	14,069	1,759;49,240
Had cancer	1	1.6	0.04;8.7	7,034	176;38,249
Had injured limbs or back	–	–	–	–	–
Lack of access to domiciliary care (n = 577)^c	17	2.9	1.7;4.7	126,447	74,124;204,931
Did not request domiciliary care (n = 62)	45	72.6	59.8;83.2	319,183	262,908;365,786
Reason why did not request domiciliary care (n = 45)
Service does not provide domiciliary care	31	68.9	53.4;81.8	219,917	170,444;261,092
No professional available to provide domiciliary care	25	55.6	40.0;70.4	177,466	127,673;224,705
Health complaint got better	7	15.6	6.5;29.5	49,793	20,747;94,159
Unable to go and make an appointment or request domiciliary care	6	13.3	5.1;26.8	42,451	16,278;85,541
Afraid/Did not want to	5	11.1	3.7;24.1	35,429	11,810;76,923
Service telephone always engaged or not working	2	4.4	0.5;15.2	14,044	1,596;48,516
Service does not have telephone	1	2.2	0.06;11.8	7,022	192;37,664
Other	6	13.3	5.1;26.8	42,451	16,278;85,541
Reason why domiciliary care was not provided (n = 17)
Sought care but health service did not reply	8	47.1	23.0;72.2	56,738	27,706;8,717,527
Sought care but health service did not have a professional available	8	47.1	23.0;72.2	56,738	27,706;8,717,527
Sought care but health service does not provide this type of care	7	41.2	18.4;67.1	49,631	22,165;8,101,746
Sought care but no appointment available	6	35.3	14.2;61.7	42,523	17,106;7,449,743
No SUS professional available and unable to pay privately	4	23.5	6.8;50.0	28,309	8,191;6,037,069
Sought care but the service was closed	1	5.6	0.1;28.7	6,746	120;3,465,277
Telephone always engaged (n = 17)	–	–	–	–	–
Other (n = 17)	–	–	–	–	–
Problem outcome after not receiving care (n = 62)
Got worse	10	16.1	8.0;27.7	70,783	35,172;121,782
Just the same as before	28	45.2	32.5;58.3	198,720	142,885;256,314
Improved a little	11	17.7	9.2;29.5	77,817	40,447;129,696
Improved considerably	10	16.1	8.0;27.7	70,783	35,172;121,782
Cured/Problem solved	3	4.8	1.0;13.5	21,103	4,396;59,352
Barriers to continuity of care
Did not receive an explanation as to the reason for seeking care (n = 537)	444	82.7	79.2;85.8	3,506,293	3,357,900;3,637,725
Received care but not referred to any other service (n = 550)	515	93.6	91.3;95.5	3,968,428	3,870,913;4,048,984
Did not go to some of the referrals (n = 35)	4	11.4	3.2;26.7	30,933	8,683;72,449
Reason why did not go to some of the referrals (n = 4)
Appointment made. but has not happened yet	1	25.0	0.6;80.6	7,733	186;24,932
Unable to get tests on SUS and unable to pay	–	–	–	–	–
Thought they did not need them	1	25.0	0.6;80.6	7,733	186;24,932
Did not want to	1	25.0	0.6;80.6	7,733	186;24,932
Unable to go and make appointment/Have them	1	25.0	0.6;80.6	7,733	186;24,932
Not available in their city	–	–	–	–	–
Other	1	25.0	0.6;80.6	7,733	186;24,932
Opinion about care received (n = 548)
Very bad	3	0.6	0.1;1.6	25,439	4,240;67,836
Poor	5	0.9	0.3;2.1	38,158	12,719;89,035
Regular	46	8.4	6.2;11.0	356,141	262,866;466,375
Good	350	63.8	59.7;67.9	2,704,975	2,531,145;2,878,806
Very good	144	26.3	22.6;30.2	1,115,060	958,189;1,280,412
Problem outcome after care was provided (n = 427)
Got worse	1	0.2	0.006;1.3	8,480	254;55,117
Just the same as before	222	52.0	47.1;56.8	2,204,682	1,996,933;2.408,191
Improved a little	52	12.2	9.2;15.7	517,252	390,059;665,644
Improved considerably	99	23.2	19.3;27.5	983,627	818,276;1,165,938
Cured/Problem solved	53	12.4	9.4;15.9	525,732	398,539;674,124

[1] Correspondence: Alitéia Santiago Dilélio. Departamento de Medicina Social – UFPEL. Av. Duque de Caxias, 250 3º andar Fragata. 96030-001 Pelotas, RS, Brasil. E-mail: aliteia@gmail.com

Brasil

Brasil

Lack of access and continuity of adult health care: a national population-based survey

Falta de acesso e de continuidade da atenção à saúde em adultos: inquérito nacional

OBJECTIVE

METHODS

RESULTS

CONCLUSIONS