The recent article “Primary Care and Public Health Services Integration in Brazil’s Unified Health System” highlights practices that may facilitate service integration and evidence-based practice in the Estrategia Sauda Da Familia (ESF). Specifically the authors concluded that ESF provider engagement was increased when the providers valued and used patient input. Through the use of surveys they were able to assess the outcomes of service integration and evidence-based practice (EBP) engagement and developed a model that emphasizes providers’ use of research findings to guide assessment and treatment.1
A primary conclusion of the authors is that patients should be the primary drivers of EBP. I agree with the author’s conclusions that EBP engagement can be enhanced when provider’s value and use patient input, but also note that the evidence indicates that this effect is small.2 The authors assumed that providers used research to guide EBP when developing their model. However, physicians in particular, who were not well represented in this study, often do not apply EBP in a timely manner.3 A more robust sample of physicians would be helpful to understand if the similarities and differences between provider groups are representative of the ESF and comparable to provider groups in other countries.
The model proposed by the authors is a useful framework that can be applied to other health care systems including those in the United States. Knowing that the use of external influences such as patient input can contribute to changes in practice, I would suggest the model also include feedback loops to providers of qualitative data and consider the use of quantitative data for desired outcomes.
The stated implications of the study of a policy to increase provider knowledge of how to engage patients is useful, but must take into consideration factors such as providers trust in the data, timeliness, intensity of feedback, and outcome expectancy of the patients served that are known to influence provider practices.4
References
- 1.Pinto RM, Wall M, Yu G, Penido C, Schmidt C. Primary care and public health services integration in Brazil’s unified health system. Am J Public Health. 2012;102(11):e69–e76 [DOI] [PMC free article] [PubMed] [Google Scholar]
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