Care accessibility and availability for hypertensive patients in primary health care in a remote rural municipality in the state of Amazonas, Brazil, 2019

This single-case study aimed to evaluate access the geographic accessibility and availability of primary health care (PHC) in a remote rural municipality in Amazonas Stater, Brazil, to control systemic arterial hypertension. A thematic analysis was conducted to interpret the content of 11 semi-structured interviews with municipal managers, PHC professionals, and hypertensive healthcare users. Geographical accessibility is associated with river mobility, transportation availability, users’ financial travelling condition, and the presence of services near riverine communities, whereas availability to diagnose and monitor hypertensive patients depend on the presence of healthcare providers, medications, and equipment and the integration of PHC with the local health care network. Although access to health is more complex than our research goals, the evaluated dimensions show weaknesses which are exacerbated by a context marked by socio-spatial disparities and absent public policies, compromising the guarantee of individuals’ right to health.

本项单案例研究旨在评估巴西亚马孙州某偏远农村市镇的初级卫生保健（Primary Health Care, PHC）地理可及性与服务可获得性，以服务于系统性动脉高血压的防控工作。研究采用主题分析法（thematic analysis），对面向市镇管理者、初级卫生保健从业人员及高血压就医群体开展的11场半结构化访谈（semi-structured interviews）的内容进行解读。结果显示，地理可及性与内河出行条件、交通供给情况、受访者的出行经济负担，以及沿河社区周边的服务布局息息相关；而针对高血压患者的诊断与监测服务可获得性，则取决于医疗人员配备、药品与设备供给状况，以及初级卫生保健体系与本地医疗网络的整合程度。尽管健康可达性的内涵远超本研究的预设目标，但本次评估的维度仍揭示了诸多短板：社会空间不平等与公共政策缺位的现实进一步加剧了这些短板，进而损害了个体健康权的保障。