PLoS ONE (Jan 2019)

Impact of distance education on primary health care indicators in central Brazil: An ecological study with time trend analysis.

  • Mara Lisiane Moraes Dos Santos,
  • Edilson José Zafalon,
  • Rafael Aiello Bomfim,
  • Vera Lucia Kodjaoglanian,
  • Silvia Helena Mendonça de Moraes,
  • Debora Dupas Gonçalves do Nascimento,
  • Carlos Antonio de Souza Telles Santos,
  • Albert Schiaveto de Souza,
  • Alessandro Diogo De-Carli

DOI
https://doi.org/10.1371/journal.pone.0214485
Journal volume & issue
Vol. 14, no. 3
p. e0214485

Abstract

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OBJECTIVE:The objective of this study was to verify whether the inclusion of professionals who completed a specialized distance learning course in family health teams is associated with rates of hospitalization for primary healthcare-sensitive conditions and better monitoring of chronic conditions in municipalities within the state of Mato Grosso do Sul, Brazil. METHODS:Negative binomial regression models with fixed effects were used for the 79 municipalities in the state, with repeated observations for the selected years (2009-2015). For our reference, the parameter "Municipality Ratio" was the number of professionals who completed the course divided by the total number of PHC professionals in the municipality. This ratio has been cumulative over the years. No reference values were found in the scientific literature, so three cutoff points were used for tertile distribution: T3:high (0.35-1.00), T2:intermediate (0.02-0.33), and T1:Low (0.00-0.01). In order to avoid capturing biased results, the analysis was also performed for the years before the specialization course was offered (2009 and 2010). RESULTS:Indicators of the share of hospitalizations for primary care-sensitive conditions (overall rate and specific rates for asthma, gastroenteritis, and heart failure) decreased during the study period when related to a high and intermediate proportion of professionals who completed the specialization course, and the same was seen for indicators of chronic conditions (diabetic and hypertensive patients) who were registered, monitored and group care. CONCLUSION:The specialization course impacted important indicators related to the attributions of primary health care professionals, considering that decreases in hospitalizations for primary care sensitive causes (overall rate of sensitive causes, specific rates for asthma, gastroenteritis and heart failure) were seen in the territories where professionals who completed this course worked, along with increased registration and monitoring of diabetic and hypertensive patients.