title: The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013).
abstract: A usual source of care (USC) has been conceptualized as having a health provider or place available for patients to consult when sick or in need of medical care. Having a USC is a means to achieve longitudinality of care with Primary Health Care (PHC) providers. Brazil has made enormous progress in PHC and thus provides an important opportunity to investigate USC in a middle-income country context.
  
  
  
  This study uses data from a nationally representative household survey, the 2013 National Health Survey (n = 62,986), to describe the prevalence of having a USC in Brazil and to investigate to what extent the Family Health Strategy (FHS) has contributed to USC prevalence. Analyses include descriptive, bivariate and multivariable Poisson regression.
  
  
  
  Show very high rates of people reporting any type of USC (74.4 %) and more than one third reporting PHC as their USC. Household enrolment in the FHS was positively associated with having any USC (PR:1.09; 95 % CI: 1.07-1.12) and a stronger association with having PHC as the regular source of care (PR:1.63;95 % CI:1.54-1.73). FHS enrolment was negatively associated with reporting emergency/urgent care facilities as one's USC (PR: 0.67; 95 % CI: 0.59-0.76). The association between the more consolidated FHS with having a USC was strongest in the poorest regions of the country (North, Northeast and Central-West). Having PHC as one's USC showed a positive dose-response relationship with the FHS in all regions, especially in the Central-West.
  
  
  
  Our results have important implications for the health care model in Brazil and in other countries, especially those seeking to base their national health systems more strongly on primary health care. The study suggests expanding primary health care can increase the establishment of a USC which can help assure better monitoring of chronic conditions and attention to patient needs.
authors.affiliation: Institute of Collective Health/Federal University of Bahia, Brazil. Rua Basílio da Gama, s/n, Campus Universitário do Canela, 40110-040, Salvador, Bahia, Brazil. ines.dourado@gmail.com.
authors.forename: Inês
authors.initials: I
authors.lastname: Dourado
authors.affiliation: Institute of Collective Health/Federal University of Bahia, Brazil. Rua Basílio da Gama, s/n, Campus Universitário do Canela, 40110-040, Salvador, Bahia, Brazil.
authors.forename: Maria Guadalupe
authors.initials: MG
authors.lastname: Medina
authors.affiliation: Institute of Collective Health/Federal University of Bahia, Brazil. Rua Basílio da Gama, s/n, Campus Universitário do Canela, 40110-040, Salvador, Bahia, Brazil.
authors.forename: Rosana
authors.initials: R
authors.lastname: Aquino
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D001938:Brazil; D002908:Chronic Disease; D003153:Community Health Services; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005192:Family Health; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D011203:Poverty; D011320:Primary Health Care; D012111:Residence Characteristics; D019472:Universal Health Insurance; D055815:Young Adult
keywords: Brazil; Family health strategy; National health survey; Primary health care; Usual source of care (USC)