Social determinants and access to health services in patients with COVID-19: a cross-sectional study.
Maria Williany Silva Ventura, Francisca Elisângela Teixeira Lima, Paula Dos Santos Brito and 3 others
PMID 38466908WHAT IT FOUND
Among 968 patients with COVID-19 in northeastern Brazil, reported poorer access was common at age extremes, in non-white patients, and in those with low schooling, low income, or public-service care.
It did not test whether addressing these factors improves care.
Key findings
01Low scores predominated at the extremes of age, in the 20–29 and 60–94 year groups.
02Non-white skin color was linked to lower scores for use, information system, and available services.
03People seen in public health services had higher percentages of low scores for utilization, accessibility, care system, information system, and available services.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study included only patients over 19 who had been seen at a health service for COVID-19, so it excludes children and people who never accessed care. People who were unable to respond, did not answer after three attempts, or died were excluded, so the most severely affected patients may be missing. Collection was partly online, so patients without a mobile phone or internet were less likely to be reached. Health department spreadsheets had missing data and incorrect telephone numbers, and 377 of 968 patients did not answer the income item. The sample size differed between the three states, with more acceptances and responses in Maranhão than in Pernambuco and Ceará. The design was cross-sectional and self-reported, so it reports associations rather than proof that one factor caused another.
The easy way to misread this
Do not read these associations as proof that public services caused poorer access or that nurse-led screening will fix it. The study was cross-sectional, used self-reported perceptions, and excluded patients who could not be contacted or did not respond.