The Utilization of Home Care by the Elderly in Brazil's Primary Health Care System

Objectives. We assessed the utilization of home care by the elderly in Brazil after implementation of the Family Health Strategy (FHS). Methods. Data were derived from a cross-sectional study in a southern city in Brazil. Using the chi(2) test and a logistic regression with different levels of determination, we tested the hypothesis that the FHS increased the utilization of home care compared with utilization under the Traditional Primary Health Care (TPHC) system. Results. We interviewed 1593 residents aged 60 years and older. Home care utilization under the FHS was 2.7 times the rate of utilization under the TPHC (95% confidence interval = 1.5, 4.7; P=.001), and utilization increased among the older group, the less educated, those with history of hospitalization, and those with functional limitations. Conclusions. Improvement in access to care resulted in greater utilization of home care. Our findings have policy implications that include expanding the coverage of the FHS throughout big cities where coverage is limited. These findings are important because the population is aging and the family strategy operates in poorer areas; thus, it can promote equity in access to home health care among the elderly. (Am J Public Health. 2011;101:868-874. doi:10.2105/AJPH.2009.184648)