Primary care and public health services integration in Brazil's unified health system

Abstract

Objectives: We examined associations between transdisciplinary collaboration, evidence-based practice, and primary care and public health services integration in Brazil's Family Health Strategy. We aimed to identify practices that facilitate service integration and evidence-based practice.

Methods: We collected cross-sectional data from community health workers, nurses, and physicians (n = 262). We used structural equation modeling to assess providers' service integration and evidence-based practice engagement operationalized as latent factors. Predictors included endorsement of team meetings, access to and consultations with colleagues, familiarity with community, and previous research experience.

Results: Providers' familiarity with community and team meetings positively influenced evidence-based practice engagement and service integration. More experienced providers reported more integration and engagement. Physicians reported less integration than did community health workers. Black providers reported less evidence-based practice engagement than did Pardo (mixed races) providers. After accounting for all variables, evidence-based practice engagement and service integration were moderately correlated.

Conclusions: Age and race of providers, transdisciplinary collaboration, and familiarity with the community are significant variables that should inform design and implementation of provider training. Promising practices that facilitate service integration in Brazil may be used in other countries.

FIGURE 1—

Integration model path diagram summarizing conceptual associations: Family Health Strategy, Mesquita and Santa Luzia, Brazil, 2008–2010.