巴西大规模儿童发展家访计划对使用医疗服务的影响。

IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Eduardo Viegas da Silva, Fernando Pires Hartwig, Aisha Yousafzai, Andréa Dâmaso Bertoldi, Joseph Murray
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引用次数: 0

摘要

儿童早期发展干预措施与初级医疗保健服务之间的合作有助于促进社会弱势家庭接受医疗保健服务。本研究旨在评估巴西一项大规模家访计划[Primira Infância Melhor (PIM)]对预防性医疗服务(产前检查、儿童健康检查、牙医检查和疫苗接种)和康复性医疗服务(急诊室就诊和住院治疗)的实际使用效果。我们在一项基于人口的出生队列研究中开展了一项准实验。干预组首先定义为所有在 6 个月大之前参加过 PIM 的儿童,然后对怀孕期间或出生后 6 个月大之前参加过 PIM 的儿童进行分层。根据 27 个混杂因素对接受 PIM 的儿童与对照组进行倾向性评分配对,以估计对产前至 2 岁期间医疗服务使用的影响。在结果准泊松回归中采用了双重调整。没有证据表明,6 个月以内随时开始的 PIM(262 对)或出生后才注册的儿童(133 对)对 6 个月以后的结果有影响。如果在怀孕期间开始实施该计划(129 对),适当产前检查的比例会提高 13%(比例比 = 1.13;95% 置信区间为 1.01-1.27),但对使用任何其他医疗服务没有影响。敏感性分析表明,参与该计划的时间越长,访视者的流动率越低,对产前访视的影响就越大。PIM 与初级医疗保健之间的整合不足以影响与医疗服务接触的总体模式。尽管如此,产前家访显示出在发育的敏感时期增加与保健服务接触的潜力,这表明有必要在分娩前启动此类方案,因为此时产妇有更多的时间接受护理,而且有利于家庭参与服务网络。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The effects of a large-scale home visiting programme for child development on use of health services in Brazil.

Partnership between early childhood development interventions and primary health care services can help catalyse health care uptake by socially vulnerable families. This study aimed to assess the real-life effects of a large-scale home visiting programme [Primeira Infância Melhor (PIM)] in Brazil on the use of preventive (prenatal visits, well child visits, dentist visits and vaccination) and recovery (emergency room visits and hospitalization) health services. A quasi-experiment nested in a population-based birth cohort study was conducted. The intervention group was firstly defined as all children enrolled in PIM up to age 6 months, and afterwards stratified between those enrolled during pregnancy or after birth up to 6 months. Children receiving PIM were matched with controls on propensity scores based on 27 confounders to estimate effects on health service use from prenatal to age 2 years. Double adjustment was applied in outcome Quasi-Poisson regressions. No evidence was found for effects of PIM starting anytime up to 6 months (262 pairs), or for the children enrolled only after birth (133 pairs), on outcomes occurring after age 6 months. When the programme started during pregnancy (129 pairs), there was a 13% higher prevalence of adequate prenatal visits (prevalence ratio = 1.13; 95% confidence interval 1.01-1.27), but no effect on use of any other health service. Sensitivity analyses suggested longer participation in the programme with reduced visitor turnover might improve its impact on prenatal visits. Integration between PIM and primary health care was not adequate to affect overall patterns of contacts with health services. Nevertheless, prenatal home visits showed potential to increase health service contact during a sensitive period of development, indicating the need to start such programmes before birth, when there is more time for maternal care, and family engagement in a network of services is facilitated.

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来源期刊
Health policy and planning
Health policy and planning 医学-卫生保健
CiteScore
6.00
自引率
3.10%
发文量
98
审稿时长
6 months
期刊介绍: Health Policy and Planning publishes health policy and systems research focusing on low- and middle-income countries. Our journal provides an international forum for publishing original and high-quality research that addresses questions pertinent to policy-makers, public health researchers and practitioners. Health Policy and Planning is published 10 times a year.
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