Relação entre a estrutura de qualidade dos cuidados de saúde primários portugueses e a mortalidade: um estudo observacional

Abstract

According to the World Health Organization, Primary Health Care (CSP) is the first level of contact of citizens with the National Health System. They provide essential care that must be accessible to the entire community. Health systems based on a good PHC network achieve better health outcomes at a lower cost. Throughout the evolution of CSP in Portugal, we were able to distinguish three generations of CS and in the last generation the USF appeared. The organizational evolution of the USF is based on three models, with different levels of autonomy and corresponding to different degrees of compensation - Models A, B and C. Until 2017, the focus of contractualization in the CSP was the negotiation of established indicators and their goals. However, in 2017, the contracting process underwent an important strategic reformulation, becoming based on a new conceptual model that removes the focus from the negotiation of indicator targets, to the evolutionary path in the pursuit of health results, in a context of good results. practices and management of integrated paths in health, as well as in the performance of organizations, considering their different areas and dimensions. The main utility of the indicator has become the demonstration of the evolution, continuous monitoring and evaluation of the Functional Units (FU). This performance evaluation is based on a multidimensional matrix that brings together an integrated view of the global performance of each FU typology (GDI - Global Performance Index). According to the IDG values, the FUs have different levels of performance. The FUs with superior performances are given financial incentives, while the UFs with lower performances are included in monitoring processes. The main objective of this study is to try to understand if a better evaluation of the global performance of the FUs in mainland Portugal is associated with a real benefit in the health of their users. That is, whether a higher GDI value (better performance) is associated with a lower all-cause mortality rate; whether better compliance with certain indicators of chronic pathology control (diabetes mellitus, Arterial Hypertension, cancer screening) is associated with a lower mortality rate from this same pathology; and whether there are differences in mortality between USF models A, B and UCSP.