Tools
Tools
Rigoli, Felix, Mascarenhas, Sergio, Alves, Domingos, Canelas, Tiago and Duarte, Geraldo (2019) 'Tracking pregnant women displacements in Sao Paulo, Brazil: a complex systems approach to regionalization through the emergence of patterns'. BMC Medicine, Vol 17, e184.
|
Text
Tracking pregnant women displacements in Sao Paulo Brazil.pdf - Published Version Available under License Creative Commons Attribution. Download (4MB) | Preview |
Abstract
Background
The healthcare system can be understood as the dynamic result of the interaction of hospitals, patients, providers, and government configuring a complex network of reciprocal influences. In order to better understand such a complex system, the analysis must include characteristics that are feasible to be studied in order to redesign its functioning. The analysis of the emergent patterns of pregnant women flows crossing municipal borders for birth-related hospitalizations in a region of São Paulo, Brazil, allowed to examine the functionality of the regional division in the state using a complex systems approach and to propose answers to the dilemma of concentration vs. distribution of maternal care regional services in the context of the Brazilian Unified Health System (SUS).
Methods
Cross-sectional research of the areas of influence of hospitals using spatial interaction methods, recording the points of origin and destination of the patients and exploring the emergent patterns of displacement.
Results
The resulting functional region is broader than the limits established in the legal provisions, verifying that 85% of patients move to hospitals with high technology to perform normal deliveries and cesarean sections. The region has high independence rates and behaves as a “service exporter.” Patients going to centrally located hospitals travel twice as long as patients who receive care in other municipalities even when the patients’ conditions do not demand technologically sophisticated services. The effects of regulation and the agents’ preferences reinforce the tendency to refer patients to centrally located hospitals.
Conclusions
Displacement of patients during delivery may affect indicators of maternal and perinatal health. The emergent pattern of movements allowed examining the contradiction between wider deployments of services versus concentration of highly specialized resources in a few places. The study shows the potential of this type of analysis applied to other type of patients’ flows, such as cancer or specialized surgery, as tools to guide the regionalization of the Brazilian Health System.
| Item Type: | Article |
|---|---|
| Subjects: | WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WA Public Health > Health Administration and Organization > WA 540 National and state health administration WQ Obstetrics > Pregnancy > WQ 200 General works |
| Faculty: Department: | Biological Sciences > Vector Biology Department |
| Digital Object Identifer (DOI): | https://doi.org/10.1186/s12916-019-1416-4 |
| Depositing User: | Daisy Byrne |
| Date Deposited: | 08 Oct 2019 10:10 |
| Last Modified: | 09 Oct 2019 13:24 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/12684 |
Statistics
Actions (login required)
 |
Edit Item |