Spatial analysis of the quality of Primary Health Care in Brazil

ABSTRACT This article aims to analyze the spatial distribution of the Primary Health Care (ABS) teams evaluated by the National Program for Access and Quality Improvement in Primary Health Care (PMAQ-AB) according to the categories of performance for certification in the Program. A spatial distribution profile of the municipalities according to the PMAQ-AB evaluation was carried out, as well as the identification of spatial patterns from a spatial correlation indicator to evaluate the degree of space influence for the certification of ABS teams. It was found presence of spatial patterns in relation to ABS quality. Municipalities with low values in the indicator, whose neighbors are also low, are found in most of the states of Acre, Amazonas, Roraima and Amapá, as well as in Rio de Janeiro and Espírito Santo. High-high standard clusters were observed in the municipalities of São Paulo, Minas Gerais and Rio Grande do Sul, especially in Santa Catarina. The identification of the spatial quality standards of ABS can be a valuable resource for the further PMAQ-AB development. It will be possible, thus, to develop analyses that incorporate variables with explanatory potential for the spatial patterns of ABS quality found in Brazilian municipalities.

摘要：本研究旨在依据国家基层医疗可及性与质量提升计划（PMAQ-AB）的认证绩效分类标准，分析该计划评估的基层医疗（Primary Health Care, ABS）团队的空间分布特征。本研究基于PMAQ-AB的评估结果绘制了各市政辖区的空间分布图谱，并通过空间相关性指标识别空间分布模式，以评估ABS团队认证所需的空间影响程度。研究发现，ABS团队的服务质量存在显著的空间分布模式：指标值偏低且邻接辖区同样偏低的市政区域，主要分布于阿克里州、亚马逊州、罗赖马州、阿马帕州的大部分区域，以及里约热内卢州和圣埃斯皮里图州；高值-高值聚类集群则集中于圣保罗州、米纳斯吉拉斯州和南里奥格兰德州的市政辖区，尤以圣卡塔琳娜州最为显著。对ABS团队服务质量空间分布特征的识别，可为PMAQ-AB计划的后续发展提供重要参考依据。借此可进一步构建纳入具备解释潜力变量的分析框架，深入探究巴西各市政辖区内ABS团队服务质量空间分布模式的形成机制。