Qualidade na Atenção Primária Acesso livre

Abstrato

Healthcare model based on personalised attention: impact on maternal mortality and health system quality

Gustavo H Marin, Martin Silberman, Monica Sarijulis, Belen Ozaeta, Jaime Henen Chem D

BackgroundLatin America’s public healthcare model has traditionally offered health services on demand including provision for the most deprived inhabitants. However, this care model has not provided the expected improvement in health conditions or equity for the indigent population. AimTo compare maternal health indicators between previous services and a new healthcare model based on personalised care and a named healthcare worker. MethodsPregnant women in La Plata, Argentina were observed during two periods: a control period using a historical model and an intervention period where a new healthcare model was provided, each period lasting 12 months. Indicators of the quality of antenatal care services were measured, including mortality rate, number of pregnancy related consultations, vaccination coverage, gestational age at delivery, newborn weight, laboratory and scan monitoring, early pregnancy detection and type of delivery. Results The number of patients undergoing antenatal surveillance increased almost five-fold during the period of the new healthcare model. Also the rate of early detection of pregnancy, average number of health consultations and vaccination coverage were significantly higher with the new model compared with previous care. Maternal gestation at delivery increased from 37.4_3.8% to 39.3_2.5% weeks (P0.001) and neonatal weight increased from 3048_612 g to 3301_580 g (P=0.003). There were no maternal deaths in the intervention group compared with seven deaths in the control group. Child mortality rate was 13.7 and 11.8 per 1000 for control and intervention groups respectively (P=0.039). ConclusionsA named responsible health worker and personalised care helped contribute to improvements in quality of antenatal care in the health system.