Imperial College London
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ProfessorChristopherMillett

Faculty of Medicine, School of Public Health

Professor of Public Health
 
 
 
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Contact

 

c.millett Website

 
 
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Location

 

Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Citation

BibTex format

@article{Mrejen:2021:10.1016/j.lana.2021.100034,
author = {Mrejen, M and Rocha, R and Millett, C and Hone, T},
doi = {10.1016/j.lana.2021.100034},
journal = {The Lancet Regional Health - Americas},
pages = {1--9},
title = {The quality of alternative models of primary health care and morbidity and mortality in Brazil: a national longitudinal analysis},
url = {http://dx.doi.org/10.1016/j.lana.2021.100034},
volume = {4},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BackgroundEvidence is limited on health benefits from quality improvement of primary healthcare (PHC) in low- and middle-income countries (LMICs). This study investigated whether increasing PHC quality in Brazil with highly-skilled health professionals and integrated community health workers (CHWs) was associated with reductions in hospitalizations and mortality beyond benefits derived from increasing access.MethodsAnnual municipal-level data for 5,411 municipalities between 2000 and 2014 were analysed using fixed effects panel regressions. PHC quality was measured as: i) the proportion of consultations provided by highly-skilled health professionals (doctors and nurses); and ii) the proportion of visits provided by CHWs from multidisciplinary PHC teams. Models assessed associations between PHC quality and hospitalization and mortality from diabetes, cardiovascular disease (CVD), tuberculosis, leprosy, perinatal and maternal causes, and adjusted for PHC access, utilisation, presence of secondary care services, and socioeconomic factors.FindingsA one percentage point increase in the proportion of consultations provided by highly-skilled health professionals was associated with 0•019 fewer deaths from diabetes per 100,000 population (95%CI: -0•034, -0•003; p-value: 0.0167) and 0•029 fewer hospitalizations per 100,000 from leprosy (95%CI: -0•055, -0•002; p-value: 0.0321). A one percentage point increase in the proportion of care provided by CHWs from multidisciplinary PHC teams was associated with 0•025 fewer deaths from CVD per 100,000 (95%CI: -0•050, -0•001; p-value: 0.0442) and 0•148 fewer maternal hospital admissions per 100,000 (95%CI: -0•286, -0•010; p-value: 0.0356). No significant associations were found for the other twenty pairs of exposures and outcomes analysed.InterpretationInvesting in higher-quality PHC models with highly-skilled health professionals and integrated CHWs can deliver reductions in
AU  - Mrejen,M
AU  - Rocha,R
AU  - Millett,C
AU  - Hone,T
DO  - 10.1016/j.lana.2021.100034
EP  - 9
PY  - 2021///
SN  - 2667-193X
SP  - 1
TI  - The quality of alternative models of primary health care and morbidity and mortality in Brazil: a national longitudinal analysis
T2  - The Lancet Regional Health - Americas
UR  - http://dx.doi.org/10.1016/j.lana.2021.100034
UR  - https://www.sciencedirect.com/science/article/pii/S2667193X21000260?via%3Dihub
UR  - http://hdl.handle.net/10044/1/91083
VL  - 4
ER  -
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