Assessment of primary health care received by the elderly and health related quality of life: a cross-sectional study

BMC Public Health

Sandra C Fuchs¹  Erno Harzheim¹  Flávio D Fuchs¹  Sinara L Rossato²  Vivian C Honorato dos Santos de Carvalho² 

[1] National Institute for Science and Technology for Health Technology Assessment, (IATS), Hospital de Clinicas de Porto Alegre, Ramiro Barcelos 2350, Clinical Research Center, CEP, 90035–003, Porto Alegre, RS, Brazil;Postgraduate Studies Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2600, Porto CEP, 90035-003, Alegre, RS, Brazil

关键词: Family medicine;    Hypertension;    Family health strategy;    Family health;    Quality of life;    Elderly;    Primary health care;   

Others  :  1162077
DOI  :  10.1186/1471-2458-13-605

 received in 2012-08-07, accepted in 2013-06-20,  发布年份 2013

【 摘 要 】

Background

Population aging leads to increased burden of chronic diseases and demand in public health. This study aimed to assess whether the score of Primary Health Care (PHC) is associated with a) the model of care - Family Health Strategy (FHS) vs. traditional care model (the Basic Health Units; BHU); b) morbid conditions such as - hypertension, diabetes mellitus, mental disorders, chronic pain, obesity and central obesity; c) quality of life in elderly individuals who received care in those units.

Methods

A survey was conducted among the elderly between August 2010 and August 2011, in Ilheus, Bahia. We interviewed elderly patients - 60 years or older - who consulted at BHU or FHS units in that day or participated in a group activity, and those who were visited at home by the staff of PHC, selected through a random sample. Demographic and socioeconomic characteristics, services’ attainment of primary care attributes, health problems and quality of life were investigated. The Short Form Health Survey (SF-12) was used to assess quality of life and PCATool to generate PHC scores. In addition, weight, height and waist circumference were measured. Trained research assistants, under supervision performed the data collection.

Results

A total of 511 elderly individuals were identified, two declined to participate, resulting in 509 individuals interviewed. The health care provided by the FHS has higher attainment of PHC attributes, in comparison to the BHU, resulting in lower prevalence of score below six. Except for hypertension and cardiovascular disease, other chronic problems were not independently associated with low scores in PHC. It was observed an independent and positive association between PHC score and the mental component of quality of life and an inverse association with the physical component.

Conclusions

This study showed higher PHC attributes attainment in units with FHS, regardless of the health problem. The degree of orientation to PHC increased the mental component score of quality of life.

【 授权许可】

   
2013 de Carvalho et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Beard JR, Biggs S, Bloom DE, Fried LP, Hogan P, Kalache A, Olshansky SJ (Eds): Global Population Ageing In Peril or Promise. Geneva: World Economic Forum; 2011.
• [2]Ezeh AC, Bongaarts J, Mberu B: Global population trends and policy options. Lancet 2012, 380:142-148.
• [3]Boeckxstaens P, De Graaf P: Primary care and care for older persons: position paper of the European Forum for Primary Care. Qual Prim Care 2011, 19:369-389.
• [4]Paim J, Travassos C, Almeida C, Bahia L, Macinko J: The Brazilian health system: history, advances, and challenges. Lancet 2011, 377:1778-1797.
• [5]Starfield B: Primary Care: balancing health needs, services and technology. 2nd edition. New York: Oxford University Press; 1998.
• [6]Barros AJD, Victora CG, César JA, Neumann NA, Bertoldi AD: Brazil: are health and nutrition programs reaching the neediest? In Reaching the Poor: with health, nutrition, and population services. Gwatkin DR, Wagstaff A, Yazbeck AS edition. Washington: The World Bank; 2005:281-30.
• [7]Rodnick JE: International Family Medicine Education. Fam Med 2005, 37:668-669.
• [8]Schmidt MI, Duncan BB, Silva GA, Menezes AM, Monteiro CA, Barreto SM, Chor D, Menezes P: Chronic non-communicable diseases in Brazil: burden and current challenges. Lancet 2011, 377:1949-1961.
• [9]Rodrigues MAP, Facchini LA, Piccini RX, Tomas E, Thumé E, Silveira DS, Siqueira FV, Paniz VMV: [Use of outpatient services by the elderly in the South and Northeast of Brazil]. Cad. Saúde Pública 2008, 24:2267-2278.
• [10]Cornwall A, Shankland A: Engaging citizens: lessons from building Brazil's national health system. Soc Sci Med 2008, 66:2173-2184.
• [11]Paskulin LMG, Valer DB: Vianna, LAC [Use and access of the elderly to primary health care services in Porto Alegre (RS, Brasil)]. Ciência & Saúde Coletiva 2011, 16:2935-2944.
• [12]Motta LB, Aguiar AC, Caldas CP: [The Family Health Strategy and healthcare for the elderly: experiences in three Brazilian cities]. Cad. Saúde Pública 2011, 27:779-786.
• [13]Lee JH: Development of the Korean primary care assessment tool-measuring user experience:tests of data quality and measurement performance. Int J Qual Health Care 2000, 21:103-111.
• [14]Harzheim E, Starfield S, Rajmil L, Álvarez-Dardet C, Stein AT: [Internal consistency and reliability of Primary Care Assessment Tool (PCATool-Brasil) for child health services]. Cad. Saúde Pública 2006, 22:1649-1659.
• [15]Harzheim E, Duncan BB, Stein AT, Cunha CRH, Gonçalves MR, Trindade TG, Oliveira MMC, Pinto MEB: Quality and effectiveness of different approaches to primary care delivery in Brazil. BMC Health Services Research 2006, 6:156. BioMed Central Full Text
• [16]Macinko J, Almeida C, Oliveira ES, Sá PK: Organization and delivery of primary health care services in Petropólis, Brazil. Int J Health Plann Mgmt 2004, 19:303-317.
• [17]Van Stralen CJ, Belisário SA, Stralen TBS, Lima AMD, Massote AW, Oliveira CL: [Perceptions of primary health care among users and health professionals: a comparison of units with and without family health care in Central-West Brazil. Cad. Saúde Pública 2008, 24(1):148-158.
• [18]Mendoza-Sassi RA, Cesar JA, Teixeira TP, Ravache C, Araújo GD, Silva TC: [Differences in prenatal care between health services under the Family Health Strategy and traditional primary care clinics in Rio Grande, Rio Grande do Sul State, Brazil]. Cad. Saúde Pública 2011, 27:787-796.
• [19]Anversa ETR, Bastos GAN, Nunes LN, Dal Pizzol TS: Qualidade do processo da assistência pré-natal: unidades básicas de saúde e unidades de Estratégia Saúde da Família em município no Sul do Brasil. Cad. Saúde Pública 2012, 28:789-800.
• [20]Owen SE, Sharp DJ, Shield JP: The Bristol Online Obesity Screening Tool: experience of using a screening tool for assessing obese children in primary care. Prim Health Care Res Dev. 2011, 12:293-300.
• [21]Ribeiro LCC, Rocha RL, Ramos-Jorge ML: Acolhimento às crianças na atenção primária à saúde: um estudo sobre a postura dos profissionais das equipes de saúde da família. Cad. Saúde Pública 2010, 26:2316-2322.
• [22]Ashworth M, Armstrong D: The relationship between general practice characteristics and quality of care: a national survey of quality indicators used in the UK Quality and Outcomes Framework, 2004–5. BMC Fam Pract. 2006, 7:68. BioMed Central Full Text
• [23]Van den Berg N, Meinke-Franze C, Fiss T, Hoffmann W: Changes in blood pressure in patients with hypertension in the context of delegated GP-home visits: a prospective implementation study. Blood Press Monit 2013., 15
• [24]Sigfrid LA, Turner C, Crook D, Ray S: Using the UK primary care Quality and Outcomes Framework to audit health care equity: preliminary data on diabetes management. J Public Health (Oxf). 2006, 28:221-225.
• [25]Bachmann MO, Eachus J, Hopper CD, Davey Smith G, Propper C, Pearson NJ, Williams S, Tallon D, Frankel S: Socio-economic inequalities in diabetes complications, control, attitudes and health service use: a cross-sectional study. Diabet Med. 2003, 20:921-929.
• [26]Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, Bullinger M, Kaasa S, Leplege A, Prieto L, Sullivan M: Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 1998, 51:1171-1178.
• [27]Ware JE, Kosinski M, Turner-Bowker DM, Gandek B, Lincoln RI: How to score version 2 of the SF-12 Health Survey. : QualityMetric Incorporated; 2002. http://www.sf-36.org/tools/sf12.shtml webcite]
• [28]Barros AJ, Hirakata VN: Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003, 3:21. BioMed Central Full Text
• [29]Gené-Badia J, Ascaso C, Escaramis-Babiano G, Catalán-Ramos A, Pujol-Ribera E, Sampietro-Colom L: Population and primary health-care team characteristics explain the quality of the service. Health Policy 2008, 86:335-344.
• [30]Lévesque JF, Haggerty J, Beninguissé G, Burge F, Gass D, Beaulieu MD, Pineault R, Santor D, Beaulieu C: Mapping the coverage of attributes in validated instruments that evaluate primary healthcare from the patient perspective. BMC Fam Pract 2012, 13:20. BioMed Central Full Text
• [31]Chen T, Li L: Influence of health-related quality of life on health service utilization in addition to socio-demographic and morbidity variables among primary care patients in China. Int J Public Health 2009, 54:325-332.
• [32]Wang HM, Beyer M, Gensichen J, Gerlach FM: Health-related quality of life among general practice patients with differing chronic diseases in Germany: cross-sectional survey. BMC Public Health 2008, 8:246. BioMed Central Full Text
• [33]Trevisol DJ, Moreira LB, Fuchs FD, Fuchs SC: Health-related quality of life is worse in individuals with hypertension under drug treatment: results of population-based study. J Hum Hypertens 2012, 26:374-380.
• [34]Kerkhoff AC, Moreira LB, Fuchs FD, Fuchs SC: Association between hypertension and musculoskeletal complaints: a population-based study. J Hypert 2012, 30:2112-2117.
• [35]Picon RV, Fuchs FD, Moreira LB, Fuchs SC: Prevalence of hypertension among elderly in urban Brazil: a systematic review with meta-analysis. Am J Hyper
• [36]Xavier FMF, Ferraz MPT, Marc N, Escosteguy NU, Moriguchi EH: Elderly people's definition of quality of life. Rev Bras Psiquiat 2003, 25:31-39.
• [37]Alexandre TS, Cordeiro RC, Ramos LR: Factors associated to quality of life in active elderly. Rev Saude Publica 2009, 43:613-621.
• [38]le Hoi V, Chuc NT, Lindholm L: Health-related quality of life, and its determinants, among older people in rural Vietnam. BMC Public Health 2010, 10:549. BioMed Central Full Text
• [39]Jayasinghe UW, Proudfoot J, Barton CA, Amoroso C, Holton C, Davies GP, Beilby J, Harris MF: Quality of life of Australian chronically-ill adults: patient and practice characteristics matter. Health Qual Life Outcomes. 2009, 7:50. BioMed Central Full Text
• [40]Bekkering GE, Bala MM, Reid K, Kellen E, Harker J, Riemsma R, Huygen FJ, Kleijnen J: Epidemiology of chronic pain and its treatment in The Netherlands. Neth J Med 2011, 69:141-153.
• [41]Antonopoulou MD, Alegakis AK, Hadjipavlou AG, Lionis CD: Studying the association between musculoskeletal disorders, quality of life and mental health. A primary care pilot study in rural Crete, Greece. BMC Musculoskelet Disord 2009, 10:143. BioMed Central Full Text
• [42]Shankar R, Tondon J, Gambhir IR, Tripathi CB: Health status of elderly population in rural area of Varanasi District. Indian Journal of Clinical Health 2007, 51:56-58.
• [43]Huguet N, Kaplan MS, Feeny D: Socioeconomic status and health-related quality of life among elderly people: results from the Joint Canada/United States Survey of Health. Soc Sci Med 2008, 66:803-810.
• [44]Kaplan MS, Huguet N, Feeny D, McFarland BH, Williams SS: Visits to family physicians or specialists by elderly persons in Canada and the United States: an exploratory comparative study. Int J Health Serv 2010, 40:139-149.