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ToolsLloyd-Sherlock, Peter, Fialho de Carvalho, Poliana, Giacomin, Karla and Sempé, Lucas (2023) Addressing pressures on health services in Belo Horizonte, Brazil through community-based care for poor older people: a qualitative study. Lancet Regional Health-Americas, 27. ISSN 2667-193X
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Abstract
Background: In low and middle-income countries, there is growing interest in managing pressures on health services through community interventions for older people. Evidence on the effects of such interventions is scarce. We draw on qualitative data to examine these effects for a specific scheme, Programa Maior Cuidado (PMC) in the Brazilian city of Belo Horizonte. Methods: Building on quantitative findings reported elsewhere, we use qualitative data to develop and test theories of change. These include data from 50 meetings with policymakers, managers and staff in 30 health centres and social assistance posts. Data collection was embedded in key informant interaction and knowledge coproduction. Data include participant and non-participant observation, focus groups and semi-structured interviews with key informants, as well as older people and carers from seven families. Findings: The data reveal three theories of change. Theory 1 is PMC maintains older people's health which reduces their need for inpatient or outpatient care. We find strong evidence to support this, through effects on use of medication, chronic disease management and risk prevention. Theory 2 is PMC promotes timely intervention by anticipating health problems, thus reducing demand for emergency and acute care. We find some evidence for this, but it was limited by limited availability of timely treatment or referral beyond PMC. Theory 3 is PMC facilitates hospital discharge. We find limited evidence for this, reflecting a lack of formal liaison between PMC and hospitals. Interpretation: Schemes like PMC have potential to reduce pressures on health service utilisation by older people, if they are well articulated with wider health services. Funding: Medical Research Council, Newton Fund and Brazilian Council of State Funding Agencies.
| Item Type: | Article |
|---|---|
| Additional Information: | Funding Information: Medical Research Council (MR/R024219/1), Newton Fund and Brazilian Council of State Funding Agencies. The funding sources had no such involvement in the conduct of the research or preparation of the article. |
| Uncontrolled Keywords: | long-term care,older people,primary health care,internal medicine,health policy,public health, environmental and occupational health ,/dk/atira/pure/subjectarea/asjc/2700/2724 |
| Faculty \ School: | Faculty of Social Sciences > School of Global Development (formerly School of International Development) Faculty of Social Sciences > School of Social Work |
| UEA Research Groups: | Faculty of Social Sciences > Research Groups > Life Course, Migration and Wellbeing Faculty of Social Sciences > Research Groups > Health and Disease |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 01 Nov 2023 03:30 |
| Last Modified: | 29 Oct 2024 00:52 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/93521 |
| DOI: | 10.1016/j.lana.2023.100619 |
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