Impact of COAP on access to primary care in Ceará and Mato Grosso do Sul through the analysis of interrupted time series
Main Author: | |
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Publication Date: | 2021 |
Other Authors: | , |
Format: | Article |
Language: | eng por |
Source: | Revista de Saúde Pública |
Download full: | https://www.revistas.usp.br/rsp/article/view/185589 |
Summary: | OBJECTIVE: To analyze the impact of implementing the Contrato Organizativo de Ação Pública (COAP – Public Action Organizational Contract) on the expansion of access to primary care in the states of Ceará and Mato Grosso do Sul. METHODS: We used the interrupted time series method to analyze the effect of COAP on primary care coverage (PCCov) and on avoidable hospitalization rates. To analyze the effects of increased PCCov on avoidable hospitalizations, we used non-segmented time series models. RESULTS: The results showed that implementing COAP had a positive impact on increased coverage in both cases, with did not happen in the control states. However, this impact was not reflected in the decrease in hospitalizations due to primary care sensitive conditions (HPCSC) or for acute preventable causes. When we analyzed the effects of the increase in PCCov on avoidable hospitalizations between 2009 and 2016, we observed that coverage had a positive impact on the decrease in the rate of HPCSC only in Ceará, although hospitalizations have a significant trend to decrease in time both in this state and in Mato Grosso do Sul, except for acute respiratory infections. CONCLUSIONS: The COAP continues to be the regulatory instrument of regionalization force, however, the results obtained by adhering to it in the expansion of primary care in Ceará and Mato Grosso do Sul makes us question whether the contractual model, as predicted, is the best instrument for advancing regionalization in the Brazilian Unified Health System. |
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Impact of COAP on access to primary care in Ceará and Mato Grosso do Sul through the analysis of interrupted time seriesImpacto do COAP sobre o acesso à atenção básica no Ceará e Mato Grosso do Sul por meio da análise de séries temporais interrompidasSistema Único de SaúdeRegionalizaçãoAtenção primária à saúdeEstudos de avaliação como assuntoAvaliação de programas e projetos de saúdeUnified Health SystemRegional health planningPrimary health careEvaluation studies as topicProgram evaluationOBJECTIVE: To analyze the impact of implementing the Contrato Organizativo de Ação Pública (COAP – Public Action Organizational Contract) on the expansion of access to primary care in the states of Ceará and Mato Grosso do Sul. METHODS: We used the interrupted time series method to analyze the effect of COAP on primary care coverage (PCCov) and on avoidable hospitalization rates. To analyze the effects of increased PCCov on avoidable hospitalizations, we used non-segmented time series models. RESULTS: The results showed that implementing COAP had a positive impact on increased coverage in both cases, with did not happen in the control states. However, this impact was not reflected in the decrease in hospitalizations due to primary care sensitive conditions (HPCSC) or for acute preventable causes. When we analyzed the effects of the increase in PCCov on avoidable hospitalizations between 2009 and 2016, we observed that coverage had a positive impact on the decrease in the rate of HPCSC only in Ceará, although hospitalizations have a significant trend to decrease in time both in this state and in Mato Grosso do Sul, except for acute respiratory infections. CONCLUSIONS: The COAP continues to be the regulatory instrument of regionalization force, however, the results obtained by adhering to it in the expansion of primary care in Ceará and Mato Grosso do Sul makes us question whether the contractual model, as predicted, is the best instrument for advancing regionalization in the Brazilian Unified Health System.OBJETIVO: Analisar o impacto da implementação do Contrato Organizativo de Ação Pública (COAP) sobre a ampliação do acesso à atenção básica nos estados do Ceará e Mato Grosso do Sul. MÉTODOS: Utilizou-se o método de séries temporais interrompidas para analisar o efeito do COAP sobre a cobertura da atenção básica (CobAB) e sobre as taxas de internação evitáveis. Para analisar os efeitos do aumento da CobAB sobre as internações evitáveis ao longo do tempo, foram utilizados modelos de séries temporais não segmentadas. RESULTADOS: Os resultados mostraram que a implementação do COAP teve impacto positivo sobre o aumento da cobertura nos dois casos, o que não aconteceu nos controles. Contudo, esse impacto não se refletiu na diminuição das taxas de internação por condições sensíveis à atenção básica (ICSAB) ou por causas evitáveis agudas. Quando analisamos os efeitos do aumento da CobAB sobre as internações evitáveis entre 2009 e 2016, observamos que a cobertura teve impacto positivo na diminuição da taxa de ICSAB apenas no Ceará, apesar de as internações terem tendência significativa de queda no tempo tanto neste estado quanto no Mato Grosso do Sul, exceto por infecções respiratórias agudas. CONCLUSÕES: O COAP continua sendo o instrumento regulador da regionalização vigente, contudo, os resultados obtidos pela adesão a ele na expansão da atenção básica no Ceará e no Mato Grosso do Sul fazem questionar se o modelo contratual, tal como previsto, é o melhor instrumento para o avanço da regionalização do Sistema Único de Saúde.Universidade de São Paulo. Faculdade de Saúde Pública2021-05-10info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdftext/xmlapplication/pdfhttps://www.revistas.usp.br/rsp/article/view/18558910.11606/s1518-8787.2021055003001Revista de Saúde Pública; Vol. 55 (2021); 20Revista de Saúde Pública; Vol. 55 (2021); 20Revista de Saúde Pública; v. 55 (2021); 201518-87870034-8910reponame:Revista de Saúde Públicainstname:Universidade de São Paulo (USP)instacron:USPengporhttps://www.revistas.usp.br/rsp/article/view/185589/171564https://www.revistas.usp.br/rsp/article/view/185589/171563https://www.revistas.usp.br/rsp/article/view/185589/171565Copyright (c) 2021 Débora Castanheira Pires, Mônica Rodrigues Campos, Isabel Martins Emmerrickhttp://creativecommons.org/licenses/by/4.0info:eu-repo/semantics/openAccessPires, Débora CastanheiraCampos, Mônica Rodrigues Emmerrick, Isabel Martins2021-05-11T16:22:52Zoai:revistas.usp.br:article/185589Revistahttps://www.revistas.usp.br/rsp/indexONGhttps://www.revistas.usp.br/rsp/oairevsp@org.usp.br||revsp1@usp.br1518-87870034-8910opendoar:2021-05-11T16:22:52Revista de Saúde Pública - Universidade de São Paulo (USP)false |
dc.title.none.fl_str_mv |
Impact of COAP on access to primary care in Ceará and Mato Grosso do Sul through the analysis of interrupted time series Impacto do COAP sobre o acesso à atenção básica no Ceará e Mato Grosso do Sul por meio da análise de séries temporais interrompidas |
title |
Impact of COAP on access to primary care in Ceará and Mato Grosso do Sul through the analysis of interrupted time series |
spellingShingle |
Impact of COAP on access to primary care in Ceará and Mato Grosso do Sul through the analysis of interrupted time series Pires, Débora Castanheira Sistema Único de Saúde Regionalização Atenção primária à saúde Estudos de avaliação como assunto Avaliação de programas e projetos de saúde Unified Health System Regional health planning Primary health care Evaluation studies as topic Program evaluation |
title_short |
Impact of COAP on access to primary care in Ceará and Mato Grosso do Sul through the analysis of interrupted time series |
title_full |
Impact of COAP on access to primary care in Ceará and Mato Grosso do Sul through the analysis of interrupted time series |
title_fullStr |
Impact of COAP on access to primary care in Ceará and Mato Grosso do Sul through the analysis of interrupted time series |
title_full_unstemmed |
Impact of COAP on access to primary care in Ceará and Mato Grosso do Sul through the analysis of interrupted time series |
title_sort |
Impact of COAP on access to primary care in Ceará and Mato Grosso do Sul through the analysis of interrupted time series |
author |
Pires, Débora Castanheira |
author_facet |
Pires, Débora Castanheira Campos, Mônica Rodrigues Emmerrick, Isabel Martins |
author_role |
author |
author2 |
Campos, Mônica Rodrigues Emmerrick, Isabel Martins |
author2_role |
author author |
dc.contributor.author.fl_str_mv |
Pires, Débora Castanheira Campos, Mônica Rodrigues Emmerrick, Isabel Martins |
dc.subject.por.fl_str_mv |
Sistema Único de Saúde Regionalização Atenção primária à saúde Estudos de avaliação como assunto Avaliação de programas e projetos de saúde Unified Health System Regional health planning Primary health care Evaluation studies as topic Program evaluation |
topic |
Sistema Único de Saúde Regionalização Atenção primária à saúde Estudos de avaliação como assunto Avaliação de programas e projetos de saúde Unified Health System Regional health planning Primary health care Evaluation studies as topic Program evaluation |
description |
OBJECTIVE: To analyze the impact of implementing the Contrato Organizativo de Ação Pública (COAP – Public Action Organizational Contract) on the expansion of access to primary care in the states of Ceará and Mato Grosso do Sul. METHODS: We used the interrupted time series method to analyze the effect of COAP on primary care coverage (PCCov) and on avoidable hospitalization rates. To analyze the effects of increased PCCov on avoidable hospitalizations, we used non-segmented time series models. RESULTS: The results showed that implementing COAP had a positive impact on increased coverage in both cases, with did not happen in the control states. However, this impact was not reflected in the decrease in hospitalizations due to primary care sensitive conditions (HPCSC) or for acute preventable causes. When we analyzed the effects of the increase in PCCov on avoidable hospitalizations between 2009 and 2016, we observed that coverage had a positive impact on the decrease in the rate of HPCSC only in Ceará, although hospitalizations have a significant trend to decrease in time both in this state and in Mato Grosso do Sul, except for acute respiratory infections. CONCLUSIONS: The COAP continues to be the regulatory instrument of regionalization force, however, the results obtained by adhering to it in the expansion of primary care in Ceará and Mato Grosso do Sul makes us question whether the contractual model, as predicted, is the best instrument for advancing regionalization in the Brazilian Unified Health System. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-05-10 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://www.revistas.usp.br/rsp/article/view/185589 10.11606/s1518-8787.2021055003001 |
url |
https://www.revistas.usp.br/rsp/article/view/185589 |
identifier_str_mv |
10.11606/s1518-8787.2021055003001 |
dc.language.iso.fl_str_mv |
eng por |
language |
eng por |
dc.relation.none.fl_str_mv |
https://www.revistas.usp.br/rsp/article/view/185589/171564 https://www.revistas.usp.br/rsp/article/view/185589/171563 https://www.revistas.usp.br/rsp/article/view/185589/171565 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2021 Débora Castanheira Pires, Mônica Rodrigues Campos, Isabel Martins Emmerrick http://creativecommons.org/licenses/by/4.0 info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2021 Débora Castanheira Pires, Mônica Rodrigues Campos, Isabel Martins Emmerrick http://creativecommons.org/licenses/by/4.0 |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf text/xml application/pdf |
dc.publisher.none.fl_str_mv |
Universidade de São Paulo. Faculdade de Saúde Pública |
publisher.none.fl_str_mv |
Universidade de São Paulo. Faculdade de Saúde Pública |
dc.source.none.fl_str_mv |
Revista de Saúde Pública; Vol. 55 (2021); 20 Revista de Saúde Pública; Vol. 55 (2021); 20 Revista de Saúde Pública; v. 55 (2021); 20 1518-8787 0034-8910 reponame:Revista de Saúde Pública instname:Universidade de São Paulo (USP) instacron:USP |
instname_str |
Universidade de São Paulo (USP) |
instacron_str |
USP |
institution |
USP |
reponame_str |
Revista de Saúde Pública |
collection |
Revista de Saúde Pública |
repository.name.fl_str_mv |
Revista de Saúde Pública - Universidade de São Paulo (USP) |
repository.mail.fl_str_mv |
revsp@org.usp.br||revsp1@usp.br |
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1787713241073319936 |