ArticleLancet regional health. Americas2021
The quality of alternative models of primary health care and morbidity and mortality in Brazil: a national longitudinal analysis.
Article in Lancet regional health. Americas, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
What it found
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Recommendations of the Brazilian Society of Nephrology for the management of chronic kidney disease in primary health care.Jornal brasileiro de nefrologiaGuideline
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- Trend of avoidable mortality due to circulatory system diseases and ischemic heart diseases in Rio Grande do Sul (2000-2023): an ecological analysis.Revista da Associacao Medica Brasileira (1992) · 2026Article
- Burden of Cardiovascular Diseases Attributable to Hypertension in Population Aged 60 Years or Older from 1990 to 2040 across BRICS-plus Countries (Egypt, Ethiopia, Iran, Saudi Arabia, United Arab Emirates, Brazil, Russia, India, China, and South Africa).High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2025Article
- Nurse-community health mediator pairs: a promising model for promoting the health of populations in remote areas of the French Amazon.Frontiers in public health · 2025Article
- Performance of contemporary cardiovascular risk stratification scores in Brazil: an evaluation in the ELSA-Brasil study.Open heart · 2024Article
- Inequalities in unmet need for health care services and medications in Brazil: a decomposition analysis.Lancet regional health. Americas · 2023Article
- Persistent inequalities in health care services utilisation in Brazil (1998-2019).International journal for equity in health · 2023Article
- Risk assessment of dietary factors in global pattern of ischemic heart disease mortality and disability-adjusted life years over 30 years.Frontiers in nutrition · 2023Article
- Socioeconomic and racial/ethnic inequalities in depression prevalence and the treatment gap in Brazil: A decomposition analysis.SSM - population health · 2022Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Evidence is limited on health benefits from quality improvement of primary healthcare (PHC) in low- and middle-income countries (LMICs). This study investigated whether increasing PHC quality in Brazil with highly-skilled health professionals and integrated community health workers (CHWs) was associated with reductions in hospitalizations and mortality beyond benefits derived from increasing access. Methods: Annual municipal-level data for 5,411 municipalities between 2000 and 2014 were analysed using fixed effects panel regressions. PHC quality was measured as: i) the proportion of consultations provided by highly-skilled health professionals (doctors and nurses); and ii) the proportion of visits provided by CHWs from multidisciplinary PHC teams. Models assessed associations between PHC quality and hospitalization and mortality from diabetes, cardiovascular disease (CVD), tuberculosis, leprosy, perinatal and maternal causes, and adjusted for PHC access, utilisation, presence of secondary care services, and socioeconomic factors. Findings: A one percentage point increase in the proportion of consultations provided by highly-skilled health professionals was associated with 0•019 fewer deaths from diabetes per 100,000 population (95%CI: -0•034, -0•003; p-value: 0.0167) and 0•029 fewer hospitalizations per 100,000 from leprosy (95%CI: -0•055, -0•002; p-value: 0.0321). A one percentage point increase in the proportion of care provided by CHWs from multidisciplinary PHC teams was associated with 0•025 fewer deaths from CVD per 100,000 (95%CI: -0•050, -0•001; p-value: 0.0442) and 0•148 fewer maternal hospital admissions per 100,000 (95%CI: -0•286, -0•010; p-value: 0.0356). No significant associations were found for the other twenty pairs of exposures and outcomes analysed. Interpretation: Investing in higher-quality PHC models with highly-skilled health professionals and integrated CHWs can deliver reductions in mortality and hospitalizations in LMICs. Funding: None.
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