Primary Care and Public Health Services Integration in Brazil’s Unified Health System

Objectives: We examined associations between transdisciplinary collaboration, evidence-based practice, and primary care and public health services integration in Brazil’s Family Health Strategy. We aimed to identify practices that facilitate service integration and evidence-based practice.

Methods: We collected cross-sectional data from community health workers, nurses, and physicians (n = 262). We used structural equation modeling to assess providers’ service integration and evidence-based practice engagement operationalized as latent factors. Predictors included endorsement of team meetings, access to and consultations with colleagues, familiarity with community, and previous research experience.

Results: Providers’ familiarity with community and team meetings positively influenced evidence-based practice engagement and service integration. More experienced providers reported more integration and engagement. Physicians reported less integration than did community health workers. Black providers reported less evidence-based practice engagement than did Pardo (mixed races) providers. After accounting for all variables, evidencebased practice engagement and service integration were moderately correlated.

Conclusions: Age and race ...

Barriers to healthcare coordination in market-based and decentralized public health systems: a qualitative study in healthcare networks of Colombia and Brazil

Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes ...

Lessons from Brazil: on the difficulties of building a universal health care system

A number of developing countries that are often referred to as emerging economies have turned their attention to addressing their public health issues in more comprehensive and systematic ways. While the trajectory of this particular initiative and similar ones elsewhere is yet to be determined, the aim of this piece is to draw some lessons from an emerging economy that, for contingent historical and political reasons, started building a universal public health care system earlier: Brazil. The key argument offered from the Brazilian experience is that building a robust public health care system based on the principles of universality and equity is a challenge of a political economy nature and one that ought to be met at multiple levels simultaneously. 

Continuity and coordination of care at the heart of integrated people-centred health services (IPCHS)

There are many descriptions of integrated care. I particularly relate to one framed by National Voices: ‘’My care is planned with people who work together to understand me and my carer(s), put me in control, coordinate and deliver services to achieve my best outcomes.”  It speaks of a collaborative approach to achieve what really matters to the individual and their carer(s) and places coordination of care and support at the heart of integrated care.  For without effective coordination, even the most holistic care plan still leads to fragmented care, duplication, waste and harm.  

Continuity and coordination are vital, now more than ever. With increasing specialisation in healthcare, people meet many providers and frequently move between various teams at different points in the system as they experience multiple episodes of health and social care. At best, this may be well intentioned pursuit of the best quality care from the ...

How do nurses support chronically ill clients’ participation and self-management in primary care? A cross-country qualitative study

In the context of the advancement of person-centered care models, the promotion of the participation of patients with chronic illness and complex care needs in the management of their care (self-management) is increasingly seen as a responsibility of primary care nurses. It is emphasized that nurses should consider the psychosocial dimensions of chronic illness and the client’s lifeworld. Little is known about how nurses shape this task in practice. The aim of this analysis is to examine how primary care nurses understand and shape the participation of patients with chronic illness and complex care needs regarding the promotion of self-management. Guided interviews were conducted with nurses practicing in primary care and key informants in Germany, Spain, and Brazil with a subsequent cross-case evaluation.