Organization and performance of primary care during the pandemic: a cross-sectional study based on municipal population size¹
DOI:
https://doi.org/10.4025/ciencuidsaude.v24i1.75443Keywords:
COVID-19, Primary health care, Public health surveillance, Health management, DemographyAbstract
Objective: to analyze the organization and care provided by Primary Health Care (PHC) for suspected or confirmed cases of COVID-19 in Brazilian municipalities, according to population size. Methodology: a cross-sectional, analytical, and exploratory approach, with 1,474 PHC managers responding to a questionnaire via Google Forms between April and September 2022. The analyzes used prevalence ratios and Poisson regression with random effects. Results: in small municipalities (sizes 1 and 2), the availability of face shields was 11% more prevalent (p<0.01), and the availability of testing facilities and staff was 8% higher (p=0.02) than in municipalities of size 3 or 4. In these locations, care in a separate ward was 35% more frequent (p<0.01), prior bed verification was 78% more common (p<0.01), and active surveillance was 28% higher (p<0.01). Symptom review every 48 hours was 52% more prevalent (p<0.01). On the other hand, the adoption of clinical protocols for flu-like syndromes was 9% lower (p=0.01). Medium-sized municipalities (3 and 4) had lower availability of aprons (p=0.03) and disinfection between visits (p<0.01), as well as worse follow-up indicators. Population size influenced the PHC response. which was more agile in small municipalities and more complex in large ones.
¹Derived from the dissertation titled Safe Surgery Saves Lives Program as a Global Challenge of the World Health Organization: overview of surgical site infection prevention measures adopted in large hospitals in Minas Gerais, presented to the Graduate Program in Nursing at the Federal University of Minas Gerais, 2019.
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References
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18. Tan X, Liu C, Wu H. Reflections on China's primary care response to COVID-19: roles, limitations and implications. Prim Health Care Res Dev. 2022 Aug 5;23:e46. doi: https://10.1017/S1463423622000378.
19. Giatti LL, Ribeiro RA, Nava AFD. Emerging complexities and rising omission: Contrasts among socio-ecological contexts of infectious diseases, research and policy in Brazil. Genetics and Molecular Biology. 2021; 44(1)[s.1]e20200229. doi: https://doi.org/10.1590/1678-4685-GMB-2020-0229
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22. Pozzatti A, Farias LW. From emergency to structure: ways to fight Covid-19 via international cooperation in health from Brazil.Rev. Bras. Polit. Int.2022;65(1). doi: https://doi.org/10.1590/0034-7329202200106
23. Pasquale S, Gregorio GL, Caterina A, Francesco C, Beatrice PM, Vicenzo P et al. COVID-19 in low-and middle-income countries (LMICs): a narrative review from prevention to vaccination strategy. Vaccines. 2021;9(12):1477. doi: https://doi.org/10.3390/vaccines9121477
24. Du Z, Tian L, Jin DY. Understanding the impact of rapid antigen tests on SARS-CoV-2 transmission in the fifth wave of COVID-19 in Hong Kong in early 2022. Emerging Microbes & Infections. 2022;11(1):1394–1401. doi: https://doi.org/10.1080/22221751.2022.2076616
25. Requia WJ, Kondo EK, Adams MD, Gold DR, Struchiner CJ. Risk of the Brazilian health care system over 5572 municipalities to exceed health care capacity due to the 2019 novel coronavirus (COVID-19). Science of the Total Environment. 2020;[s.1]730:139-44. doi: https://doi.org/10.1016/j.scitotenv.2020.139144
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27. Palamim CVC, Marson FAL. Covid-19–The availability of ICU beds in Brazil during the onset of the pandemic. Annalsof Global Health. 2020;86(1):100. doi: https://doi.org/10.5334/aogh.3025
28. Silva LL, Dutra AC, Andrade L, Iora PH, Ramajo GLR, Gualda IAP, et al. Emergency care gap in Brazil: geographical accessibility as a proxy of response capacity to tackle COVID-19. Frontiers in Public Health. 2021;9. doi: https://doi.org/10.3389/fpubh.2021.740284
29. Massuda A, Malik AN, Vecina-Neto G, Tasca R, Ferreira-Junior WC. The resilience of the Brazilian National Health System in the face of the COVID-19 pandemic. Cadernos EBAPE. 2021;19(spe). doi: https://doi.org/10.1590/1679-395120200185
2. Lui L, Lima LL, Aguiar R, Machado JA, Albert C. A potência do SUS no enfrentamento à Covid-19: alocação de recursos e ações nos municípios brasileiros. Trabalho, Educação e Saúde. 2022;20:e00247178. doi: https://doi.org/10.1590/1981-7746-ojs00247
3. Silva BRGD, Corrêa APV, Uehara SCDSA. Primary health care organization in the Covid-19 pandemic: scoping review. RevSaude Publica. 2022;56:94. doi: https://10.11606/s1518-8787.2022056004374.
4. Tan X, Liu C, Wu H. Reflections on China's primary care response to COVID-19: roles, limitations and implications. Prim Health Care Res Dev. 2022;23:e46. doi: https://10.1017/S1463423622000378.
5. Huang J, Gopalan A, Muelly E, Hsueh L, Millman A, Graetz Iet al. Primary care video and telephone telemedicine during the COVID-19 pandemic: treatment and follow-up health care utilization. Am J Manag Care. 2023;29(1):e13-e17. doi: https://10.37765/ajmc.2023.89307
6. Barros RDD, Aquino R, Souza LEPF. Evolução da estrutura e resultados da Atenção Primária à Saúde no Brasil entre 2008 e 2019. CienSaude Colet. 2022;27:4289-4301. doi: https://doi.org/10.1590/1413-812320222711.02272022
7. Viana ALDÃ, Rocha JSY, Elias PE, Ibañez N, Novaes MH. Models of primary health care in large cities in the State of São Paulo: effectiveness, efficaciousness, sustainability and governableness. Cien Saude Colet. 2006;11(3):577. doi: https://doi.org/10.1590/S1413-81232006000300009
8. Lui L, Lima LL, Aguiar R, Machado JA, Albert C. A potência do SUS no enfrentamento à Covid-19: alocação de recursos e ações nos municípios brasileiros. Trabalho, Educação e Saúde. 2022;20:e00247178. doi: https://doi.org/10.1590/1981-7746-ojs00247
9. Instituto Brasileiro de Geografia e Estatística (IBGE). Perfil de Informações Básicas Municipais. Perfil dos Municípios Brasileiros, Livro, 2017. Rio de Janeiro: IBGE; 2017. Disponível em: https://biblioteca.ibge.gov.br/visualizacao/livros/liv101595.pdf
10. Ministério da Saúde (BR). Secretaria de Atenção Primária à Saúde. Protocolo de Manejo Clínico do Coronavírus (COVID-19) na Atenção Primária à Saúde. Versão 9. Brasília: Ministério da Saúde; 2020. 41 p. Disponível em:https://portaldeboaspraticas.iff.fiocruz.br/biblioteca/protocolo-de-manejo-clinico-do-coronavirus-covid-19-na-atencao-primaria-a-saude/
11. Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702-6. doi: https://doi.org/10.1093/aje/kwh090
12. Farsalinos K, Poulas K, Kouretas D, Vantarakis A, Leotsinids M, Kouvelas D, et al. Improved strategies to counter the COVID-19 pandemic: Lockdowns vs. primary and community healthcare. Toxicology Reports. 2021;sl,8:1-9. doi: https://doi.org/10.1016/j.toxrep.2020.12.001
13. Teixeira AD, Postali FAS, Ferreira-Batista NN, Diaz MDM, Moreno-Serra R. The role of primary healthcare amid the COVID-19 pandemic: Evidence from the Family Health Strategy in Brazil. SocSci Med. 2024;359:117221. doi: https://10.1016/j.socscimed.2024.117221
14. Vieira-Meyer APG, Forte FDS, Maia MG. Community health workers perspective on the COVID-19 impact on primary health care in Northeastern Brazil. Cad Saúde Pública. 2023;39(7). doi: https://doi.org/10.1590/0102-311XEN007223
15. Massuda A, Malik AN, Vecina-Neto G, Tasca R, Ferreira-Junior WC. The resilience of the Brazilian National Health System in the face of the COVID-19 pandemic. Cadernos EBAPE. 2021;19(spe). doi: https://doi.org/10.1590/1679-395120200185
16. Assefa Y, Gilks CG, Reid S, Pas R, Gete DG, Damme WV. Analysis of the COVID-19 pandemic: lessons towards a more effective response to public health emergencies. Globalization and Health. 2022[s.l.],18,(1):1-12. doi: https://doi.org/10.1186/s12992-022-00805-9
17. Tenreiro P, Ramalho A, Santos P. COVID-19 patients followed in Portuguese Primary Care: a retrospective cohort study based on the national case series. Fam Pract. 2022;39(1):52-58. doi: https://10.1093/fampra/cmab098. PMID: 34448861.
18. Tan X, Liu C, Wu H. Reflections on China's primary care response to COVID-19: roles, limitations and implications. Prim Health Care Res Dev. 2022 Aug 5;23:e46. doi: https://10.1017/S1463423622000378.
19. Giatti LL, Ribeiro RA, Nava AFD. Emerging complexities and rising omission: Contrasts among socio-ecological contexts of infectious diseases, research and policy in Brazil. Genetics and Molecular Biology. 2021; 44(1)[s.1]e20200229. doi: https://doi.org/10.1590/1678-4685-GMB-2020-0229
20. Grigera J. Adding insult to injury: the Covidâ€19 crisis strikes latinamerica. DevelopmentandChange. 2022;53(6):1335-61. doi: https://doi.org/10.1111/dech.12740
21. Miskolci R. Beyond science denialism: disinformation during the Covid-19 pandemic. Sociologias. 2023;25:1-26. doi: http://doi.org/10.1590/18070337-123090EN
22. Pozzatti A, Farias LW. From emergency to structure: ways to fight Covid-19 via international cooperation in health from Brazil.Rev. Bras. Polit. Int.2022;65(1). doi: https://doi.org/10.1590/0034-7329202200106
23. Pasquale S, Gregorio GL, Caterina A, Francesco C, Beatrice PM, Vicenzo P et al. COVID-19 in low-and middle-income countries (LMICs): a narrative review from prevention to vaccination strategy. Vaccines. 2021;9(12):1477. doi: https://doi.org/10.3390/vaccines9121477
24. Du Z, Tian L, Jin DY. Understanding the impact of rapid antigen tests on SARS-CoV-2 transmission in the fifth wave of COVID-19 in Hong Kong in early 2022. Emerging Microbes & Infections. 2022;11(1):1394–1401. doi: https://doi.org/10.1080/22221751.2022.2076616
25. Requia WJ, Kondo EK, Adams MD, Gold DR, Struchiner CJ. Risk of the Brazilian health care system over 5572 municipalities to exceed health care capacity due to the 2019 novel coronavirus (COVID-19). Science of the Total Environment. 2020;[s.1]730:139-44. doi: https://doi.org/10.1016/j.scitotenv.2020.139144
26. Santos RVS, Moura HSD, Delpino FM, Nascimento MC, Ramos ACV, Berra TZ, et al. Concordância à s medidas de flexibilização durante a pandemia de covid-19 no Brasil. CiêncCuid Saúde. 2023;22:e66049. doi: https://doi.org/10.4025/ciencuidsaude.v22i0.66049
27. Palamim CVC, Marson FAL. Covid-19–The availability of ICU beds in Brazil during the onset of the pandemic. Annalsof Global Health. 2020;86(1):100. doi: https://doi.org/10.5334/aogh.3025
28. Silva LL, Dutra AC, Andrade L, Iora PH, Ramajo GLR, Gualda IAP, et al. Emergency care gap in Brazil: geographical accessibility as a proxy of response capacity to tackle COVID-19. Frontiers in Public Health. 2021;9. doi: https://doi.org/10.3389/fpubh.2021.740284
29. Massuda A, Malik AN, Vecina-Neto G, Tasca R, Ferreira-Junior WC. The resilience of the Brazilian National Health System in the face of the COVID-19 pandemic. Cadernos EBAPE. 2021;19(spe). doi: https://doi.org/10.1590/1679-395120200185
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2025-12-28
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Organization and performance of primary care during the pandemic: a cross-sectional study based on municipal population size¹. (2025). Ciência, Cuidado E Saúde, 24(1). https://doi.org/10.4025/ciencuidsaude.v24i1.75443
