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Doctoral Thesis
DOI
https://doi.org/10.11606/T.6.2023.tde-28082023-144657
Document
Author
Full name
Djalma Adão Barbosa Junior
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2023
Supervisor
Committee
Franca Junior, Ivan (President)
Nascimento, Marilene Cabral do
Pedroso, Marcel de Moraes
Silva, Antônio Augusto Moura da
Title in Portuguese
A oferta de práticas integrativas e complementares cresce na crise: uma abordagem de ciência de dados
Keywords in Portuguese
Aprendizagem de Máquina
Causalidade
Ciência de Dados
Oferta de Serviços de Saúde
Práticas Integrativas e Complementares
Abstract in Portuguese
Utilizando dados do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ) observamos, com uma análise descritiva, que a oferta de Práticas Integrativas e Complementares (PICs) na Atenção Básica do Sistema Único de Saúde, pelas Equipes de Saúde da Família (eSF) cresceu continuamente entre 2012 e 2018, período marcado por crise econômica e política. Por outro lado, o crescimento da oferta de PICs não foi uniforme entre as regiões do país, sendo menor nas regiões Centro-Oeste e Norte. Observamos que a oferta de PICs está associada à região, ao porte municipal e ao IDH municipal. Observamos também que a oferta de PICs é maior quando há Núcleo de Apoio à Saúde da Família estruturado no município, quando as eSF participam do Programa Academia da Saúde e quando o gestor da saúde não é formado em medicina. Receber apoio do gestor municipal de saúde, receber ações de educação permanente e realizar planejamento das suas ações também está associado à oferta de PICs pelas eSF. Além disso, utilizando uma estrutura de análise causal baseada no uso de gráficos acíclicos direcionados e análise de sensibilidade, concluímos que a formação do gestor influencia diretamente a oferta de PICs, privilegiando gestores formados em odontologia e psicologia. Utilizando uma abordagem de aprendizagem de máquina, identificamos modelos capazes de prever a oferta de PICs (área sob a curva ROC variando entre 0,70 e 0,88) pelas eSF. Estes modelos mostraram que, dentre outras características, o tamanho populacional, o IDH municipal e a distribuição de renda são relevantes em prever a expansão da oferta de PICs.
Title in English
The delivery of integrative and complementary practices grows in times of crisis: a data science approach
Keywords in English
Causality
Complementary and Integrative Practices
Data Science
Healthcare Delivery
Machine Learning
Abstract in English
Using data from the National Program for Improving Access and Quality of Primary Care (PMAQ), we observed, through descriptive analysis, that the provision of Integrative and Complementary Practices (ICPs) in the Basic Care of the Unified Health System, by Family Health Teams (FHTs), grew continuously between 2012 and 2018, a period marked by economic and political crisis. On the other hand, the growth in the provision of ICPs was not uniform across the country's regions, being lower in the Central-West and Northern regions. We observed that the provision of ICPs is associated with the region, municipal size, and municipal Human Development Index (HDI). We also noted that the provision of ICPs is higher when there is a structured Family Health Support Center in the municipality, when FHTs participate in the Health Academy Program, and when the health manager is not a medical professional. Receiving support from the municipal health manager, undergoing continuous education actions, and planning their actions are also associated with the provision of ICPs by FHTs. Additionally, using a causal analysis framework based on directed acyclic graphs and sensitivity analysis, we concluded that the managers education directly influences ICP provision, favoring managers with backgrounds in dentistry and psychology. Using a machine learning approach, we identified models capable of predicting the provision of ICPs (area under the ROC curve ranging between 0.70 and 0.88) by FHTs. These models showed that, among other characteristics, population size, municipal HDI, and income distribution are relevant in predicting the expansion of ICP provision.
 
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Publishing Date
2023-08-30
 
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