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State of art in classification/ registration medical data in Brazil. Gustavo Gusso President of SBMFC MD, MClSc , PhD, FFPH. BRAZIL: Demographic aspects. Territorial dimensions: 26 states, 1 Federal District , and 5.564 cities ( with political , fical and administrative autonomy ).
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State of art in classification/ registration medical data in Brazil Gustavo Gusso Presidentof SBMFC MD, MClSc, PhD, FFPH
BRAZIL: Demographicaspects Territorial dimensions: 26 states, 1 Federal District, and 5.564 cities (withpolitical, ficalandadministrativeautonomy). 200 millionsinhabitants: 42,6% in Southeast 27,7% in Northeast 14,6% in South 8,0% in North 7,1% na in Center-West Fonte: IBGE
Human Development Index HDI - Brazil - 2000 HDI= 0,80 (70 position) BRAZIL: Social context
“UniqueHealth System” (SUS) – 1988/91 • Universality • Integrality • Equity • Social Control • Decentralization: PHC is Mayors responsability
Brazilian Health System: 20 years old Services provided by Públic Health System => 63.000 primary health care centers => 2 billions of procedures (include consultations) in primary care/ year => 725,4 millions ambulatorial procedures in specialized care/ year => 5.800 Hospitals units (441.000 beds) => 11,7 millions hispitalizations/ year
Our Goal Brazilian Health System Net
Countries with more than 100 milionsinhabitants • China • Índia • USA • Indonésia • Brazil • Paquistan • Bangladesh • Russia • Japan • Nigéria • México Whichhas na universal publichealth system? Whichonehas GP as gatekeeper?
Health System in Latin America • Brazil was one of the few countries who chose Beveridgian way • Most countries has different access to different work classes – more similiar to Bismarckian model
FamilyHealthProgram: 1994 - 2010 1998 2000 2002 2004 2006 2008
Family Health Program • 32000 teams • 100.000 inhabitants • 50% of all Brazilian population ( 25% Private system and 25% Bolchevique model)
Family Health Program • Captation finance + Incentive per team • Team: • GP or Family Doctor • Nurse • Assitant Nurse • Health Community Agents • 2400 to 4000 people
Strenghts of Brazilian Primary Health Care • The decision of the society for public health system (1988 Constitution) • The development after 1994 of a Primary Health System called in Brazil Family Health Program • Excellent immunization program (reaching more than 96% of all population), public rescue and transplantation services in public hospitals.
Evidences of Strenghts A 10% increase in Family Health Program coverage was associated with a 4.5% decrease in IMR, controlling for all other health determinants (p,0.01).
Weakness of Brazilian Primary Health Care • Payment by salary for Family Health Teams components • Each Family Health Teams covering 3000 people on average (up to 4000) • Family Health Teams covering a geographical area (patients has few options to choose their family doctor) • Most generalists from Family Health Teams not well trained
Weakness of Brazilian Primary Health Care • By constitution the role of Primary Health Care, as to run Family Health Teams, is exclusive to mayors and there is few involvement of governor of states. • Brazil spends 8,4% of its Gross National Product in Health System but 58,4% is private and 41,6% is public. • Private system (30% uses) dictate the culture of health as a product
Weakness of Brazilian Primary Health Care • There is no clear decision of upper classes if they want a strong public health system with universal coverage or strong private insurance companies. • Universities doesn´t have Primary Health Care and family medicine as core issues
ICPC in Brazil • Brazilwaspartofpilotof ICPC in 80`s (Ruy Laurenti) • Buyrights – 5 prices (2006/2008) • Translation (2008) • Publishandfree for download – www.sbmfc.org.br (2009)
ICPC in Brazil • Workshops in meetings (2009) • Politicalintervention (2009/2011) • TranHis for researchepurpose (2011 - )
One research • 29 doctors • Filled one form in all consultations during one week of each season • In the form the main question was: • What was the reason(s) for encounter • What was the problem you detected for each group of reason for encounter • 5698 consultation
Table 16: Most frequent problems when reason for encounter was fever
Table 19: Most frequent reasons for encounter when problem was Upper Respiratory Infection Acute
29 RFE = more than 50% of all encounters 28 Problems = more than 50% of all encounters • 1,625 RFE/ encounter 1, 475 Problems/ encounter • From most frequent problems in 39,6% one disease was diagnostiqued (if we consider hypertension, tabacco abuse, obesity as risk factors) • Data similar to other studied but patients different = episode is essential
Limitations • It was paper based so encounter based and not episode (although I could estimate pre test probability because I confronted RFE and problems) • It is only mandatory to register ICD 10 in Brazil for hospitalization and referrals purposes (as to specialists or for some exam)
Limitations • There is one really poor PHC System to collect data as pneumonia in children less than 5 years old and strokes • There are hundreds of systems to collect data regarding mortality (SIM), pap smears (SisColo), disease of compulsory notification (as dengue and malaria) – surveillence system • DataSus – www.datasus.gov.br
Opportunities • Growing interest for “GP technology” • Quickly informatization of system • Demand for technology as Episodes • Certification of EMR: work for Municipalities as Rio de janeiro and São Paulo and Ministry of Health (mayors demand and pay for it)
