Fonte Usual de Cuidados: conceitos, métodos e fatores determinantes na avaliação da atenção primária

Martins, Maísa Mônica Flores; Prado, Nília Maria de Brito Lima; Vilasbôas, Ana Luiza Queiroz; Aquino, Rosana

doi:10.1590/2358-28982024e28812p

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REVISÃO • Saúde debate 48 (spe2) 09 Dez 20242024 • https://doi.org/10.1590/2358-28982024E28812P copiar

Fonte Usual de Cuidados: conceitos, métodos e fatores determinantes na avaliação da atenção primária

Usual Source of Care: concepts, methods and determining factors in the assessment of primary care

Sobre os autores

RESUMO

Este estudo teve por objetivo sistematizar, na literatura científica nacional e internacional, os conceitos de Fonte Usual de Cuidados (FUC), as abordagens metodológicas utilizadas e os fatores determinantes relacionados com o seu reconhecimento pelos usuários dos serviços de saúde. Trata-se de uma revisão de escopo. A busca foi realizada nas bases de dados Web of Science, Scopus, Science Direct e PubMed, sem restrição de período de publicação e idiomas. Critérios de elegibilidade: estudos originais que respondiam à pergunta de investigação definida previamente e disponíveis nas bases de dados. Foram identificados 632 artigos, dos quais 41 constituíram a amostra final deste estudo. Esta revisão constatou que, ser do sexo feminino, raça/cor branca, maior renda, escolaridade e ter seguro saúde estiveram associados ao reconhecimento de uma FUC. Evidências semelhantes foram observadas para FUC Atenção Primária à Saúde (APS), além de estudos destacarem outros determinantes que demonstram maior vulnerabilidade dos indivíduos. A partir dos fatores determinantes, observaram-se desigualdades no reconhecimento de uma FUC na maioria dos países, variando em relação aos contextos organizacionais dos sistemas de saúde, o qual evidencia que os sistemas universais são favoráveis para o reconhecimento de uma FUC.

PALAVRAS-CHAVE
Atenção Primária à Saúde; Serviços de saúde; Sistemas de saúde

ABSTRACT

This study aimed to systematize, in the national and international scientific literature, the concepts of Usual Source of Care (FUC), the methodological approaches used and the determining factors related to its recognition by users of health services. This is a scoping review. The search was carried out in the Web of Science, Scopus, Science Direct and PubMed databases, without restriction of publication period and languages. Eligibility criteria: original studies that answered the previously defined research question and available in the databases. A total of 632 articles were identified, of which 41 constituted the final sample of this study. This review found that being female, white race/color, higher income, education and having health insurance were associated with the recognition of a FUC. Similar evidence was observed for FUC Primary Health Care (PHC), in addition to studies highlighting other determinants that demonstrate greater vulnerability of individuals. Based on the determining factors, there were inequalities in the recognition of a FUC in most countries, varying in relation to the organizational contexts of the health systems, which shows that the universal systems are favorable for the recognition of a FUC.

KEYWORDS
Primary Health Care; Health services; Health systems

Introdução

Uma Fonte Usual de Cuidados (FUC) é definida como um provedor ou um estabelecimento de saúde, como um consultório médico ou um serviço de saúde, a qual normalmente o indivíduo procura quando está doente ou precisando de aconselhamento sobre sua saúde^{¹1 Stewart KA, Ristvedt S, Brown KM, et al. Giving voice to black men: guidance for increasing the likelihood of having a usual source of care. Am J Mens Health. 2019;13(3):1557988319856738. DOI: https://doi.org/10.1177/1557988319856738
https://doi.org/10.1177/1557988319856738...

2 Tsai J, Shi L, Yu WL, et al. Usual source of care and the quality of medical care experiences: a cross-sectional survey of patients from a Taiwanese Community. Med Care. 2010;48(7):628-34. DOI: https://doi.org/10.1097/MLR.0b013e3181dbdf76
https://doi.org/10.1097/MLR.0b013e3181db...

3 Du Z, Liao Y, Chen CC, et al. Usual source of care and the quality of primary care: a survey of patients in Guangdong province, China. Int J Equity Health. 2015;14:60. DOI: https://doi.org/10.1186/s12939-015-0189-4
https://doi.org/10.1186/s12939-015-0189-...

4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-...

5 Stransky ML. Two-year stability and change in access to and reasons for lacking a usual source of care among working-age US adults. Public Health Rep. 2017;132(6):660-8. DOI: https://doi.org/10.1177/0033354917735322
https://doi.org/10.1177/0033354917735322... -⁶6 Sung NJ, Lee JH. Association between types of usual source of care and user perception of overall health care service quality in Korea. Korean. J Fam Med. 2019;40(3):143-50. DOI: https://doi.org/10.4082/kjfm.17.0093
https://doi.org/10.4082/kjfm.17.0093...}. O reconhecimento de uma FUC pelos usuários tem sido objeto de análise na literatura internacional^{¹1 Stewart KA, Ristvedt S, Brown KM, et al. Giving voice to black men: guidance for increasing the likelihood of having a usual source of care. Am J Mens Health. 2019;13(3):1557988319856738. DOI: https://doi.org/10.1177/1557988319856738
https://doi.org/10.1177/1557988319856738... ,³3 Du Z, Liao Y, Chen CC, et al. Usual source of care and the quality of primary care: a survey of patients in Guangdong province, China. Int J Equity Health. 2015;14:60. DOI: https://doi.org/10.1186/s12939-015-0189-4
https://doi.org/10.1186/s12939-015-0189-... ,⁷7 Berk ML, Bernstein AB. Regular source of care and the minority aged. J Am Geriatr Soc. 1982;30(4):251-4. DOI: https://doi.org/10.1111/j.1532-5415.1982.tb07096.x
https://doi.org/10.1111/j.1532-5415.1982...

8 Rohrer JE, Kruse G, Zhang Y. Hispanic ethnicity, rural residence, and regular source of care. J Community Health. 2004;29(1):1-13. DOI: https://doi.org/10.1023/b:johe.0000007441.84668.ac
https://doi.org/10.1023/b:johe.000000744...

9 Devoe JE, Saultz JW, Krois L. A medical home versus temporary housing: the importance of a stable usual source of care among low-income children. Pediatrics. 2009;124(5):1363-71. DOI: https://doi.org/10.1542/peds.2008-3141
https://doi.org/10.1542/peds.2008-3141... -¹⁰10 Devoe JE, Tillotson CJ, Wallace LS, et al. Parent and child usual source of care and children’s receipt of health care services. Ann Fam Med. 2011;9(6):504-13. DOI: https://doi.org/10.1370/afm.1300
https://doi.org/10.1370/afm.1300...}, em que estudos têm apontado a sua associação com o aumento das taxas de acesso e da satisfação dos usuários com os serviços de saúde^{⁹9 Devoe JE, Saultz JW, Krois L. A medical home versus temporary housing: the importance of a stable usual source of care among low-income children. Pediatrics. 2009;124(5):1363-71. DOI: https://doi.org/10.1542/peds.2008-3141
https://doi.org/10.1542/peds.2008-3141...}, sendo também utilizada como uma medida de acesso^{⁸8 Rohrer JE, Kruse G, Zhang Y. Hispanic ethnicity, rural residence, and regular source of care. J Community Health. 2004;29(1):1-13. DOI: https://doi.org/10.1023/b:johe.0000007441.84668.ac
https://doi.org/10.1023/b:johe.000000744...}.

Os sistemas universais de saúde, principalmente aqueles baseados em serviços de Atenção Primária à Saúde (APS) que buscam assegurar o acesso e o primeiro contato, apresentam resultados promissores para a saúde dos indivíduos e demandam menos dos demais níveis de atenção^{¹¹11 Mendes EV. As redes de atenção à saúde. Brasília, DF: Organização Pan-Americana da Saúde; 2011. 549 p.}. Na APS, a manutenção de uma relação contínua do usuário com um serviço ou um provedor individual é considerada um forte indicador de acesso, sendo associada com aumento de serviços preventivos, redução no uso dos serviços de emergências e diminuição do tempo de internação hospitalar^{⁹9 Devoe JE, Saultz JW, Krois L. A medical home versus temporary housing: the importance of a stable usual source of care among low-income children. Pediatrics. 2009;124(5):1363-71. DOI: https://doi.org/10.1542/peds.2008-3141
https://doi.org/10.1542/peds.2008-3141... ,¹²12 Weber EJ, Showstack JA, Hunt KA, et al. Does lack of a usual source of care or health insurance increase the likelihood of an emergency department visit? Results of a national population-based study. Ann Emerg Med. 2005;45(4):4-12. DOI: https://doi.org/10.1016/j.annemergmed.2004.06.023
https://doi.org/10.1016/j.annemergmed.20...

13 Xu KT. Usual source of care in preventive service use: a regular doctor versus a regular site. Health Serv Res. 2002;37(6):1509-29. DOI: https://doi.org/10.1111/1475-6773.10524
https://doi.org/10.1111/1475-6773.10524...

14 Piehl MD, Clemens CJ, Joines JD. “Narrowing the gap”: decreasing Emergency Department use by children enrolled in the Medicaid program by improving access to primary care. Arch Pediatr Adolesc Med. 2000;154:791-5. DOI: https://doi.org/10.1001/archpedi.154.8.791
https://doi.org/10.1001/archpedi.154.8.7...

15 Ryan S, Riley A, Kang M, et al. The effects of regular source of care and health need on medical care use among rural adolescents. Arch Pediatr Adolesc Med. 2001;155(2):184-90. DOI: https://doi.org/10.1001/archpedi.155.2.184
https://doi.org/10.1001/archpedi.155.2.1...

16 Kiran T, Moineddin R, Kopp A, et al. Emergency Department Use and Enrollment in a Medical Home Providing After-Hours Care. Ann Fam Med. 2018;16(5). DOI: https://doi.org/10.1370%2Fafm.2291
https://doi.org/10.1370%2Fafm.2291... -¹⁷17 Devoe JE, Petering R, Krois L. A usual source of care: Supplement or substitute for health insurance among low-income children? Med Care. 2008;46(10):1041-8. DOI: https://doi.org/10.1097/MLR.0b013e3181866443
https://doi.org/10.1097/MLR.0b013e318186...}. Além disso, os indivíduos que têm uma fonte usual de APS durante sua vida apresentam maior satisfação com a atenção à saúde recebida^{¹¹11 Mendes EV. As redes de atenção à saúde. Brasília, DF: Organização Pan-Americana da Saúde; 2011. 549 p.}.

O reconhecimento, pelos usuários, de uma FUC na APS está associado com a melhoria da qualidade do cuidado e, por conseguinte, com as condições de saúde dos indivíduos, uma vez que ela contribui para o fortalecimento dos vínculos da relação de responsabilização e de confiança entre usuários e equipe de saúde; aumenta a possibilidade de diagnóstico e tratamentos mais acurados, além de uma maior resolubilidade dos problemas de saúde^{¹⁸18 Kim KM, Jeon H, Lee JH. Having a physician rather than a place as a usual source of care would be better - from 2012 Korea health panel data. J Korean Med Sci. 2017;32(1):4-12. DOI: https://doi.org/10.3346/jkms.2017.32.1.4
https://doi.org/10.3346/jkms.2017.32.1.4...

19 Starfield B. Atenção Primária: equilíbrio entre necessidades de saúde, serviços e tecnologia. Brasília, DF: UNESCO; Ministério da Saúde; 2002.-²⁰20 Frank BRB, Viera CS, Ross C, et al. Avaliação da longitudinalidade em unidades de Atenção Primária à Saúde. Saúde debate. 2015;39(105):400-10. DOI: https://doi.org/10.1590/0103-110420151050002008.
https://doi.org/10.1590/0103-11042015105...}. Dos atributos da APS identificados por Starfield^{¹⁹19 Starfield B. Atenção Primária: equilíbrio entre necessidades de saúde, serviços e tecnologia. Brasília, DF: UNESCO; Ministério da Saúde; 2002.}, a longitudinalidade é parte crucial para os serviços desse nível de atenção à saúde, sendo definida como a presença de uma fonte usual de cuidado observada por meio da identificação de um médico, de uma equipe, de profissionais de saúde ou um local específico de atenção^{²¹21 Macinko J, Mendonça CS. Estratégia Saúde da Família, um forte modelo de Atenção Primária à Saúde que traz resultados. Saúde debate. 2018;42(esp1):18-37. DOI: https://doi.org/10.1590/0103-11042018S102.
https://doi.org/10.1590/0103-11042018S10...}.

O termo FUC, entretanto, é pouco utilizado na literatura nacional, tampouco há um consenso quanto a sua forma de definição e abordagem metodológica nos estudos internacionais. Assim, conhecer os conceitos empregados e sua operacionalização, bem como os determinantes individuais e contextuais que influenciam nesse reconhecimento, é de grande relevância para a avaliação da atenção à saúde, posto que tem uma forte relação com a avaliação do atributo da longitudinalidade do cuidado e, consequentemente, com a efetividade da atenção à saúde. Sendo assim, este estudo tem por objetivo sistematizar, na literatura científica nacional e internacional, os conceitos de FUC, as abordagens metodológicas utilizadas e os fatores determinantes relacionados com o seu reconhecimento pelos usuários dos serviços de saúde.

Metodologia

Trata-se de uma revisão de escopo, uma estratégia metodológica amplamente empregada em revisões que buscam mapear as evidências de um objeto, a fim de subsidiar estudos mais aprofundados sobre a temática^{²²22 Peters MDJ, Godfrey C, Mcinerney P, et al. Capítulo 11: revisões do escopo. In: Aromataris E, Munn Z, editores. JBI Manual for Evidence Synthesis. [Adelaide]: JBI; 2020. DOI: https://doi.org/10.46658/JBIMES-20-12
https://doi.org/10.46658/JBIMES-20-12...}. Foi elaborada segundo o método proposto pelo Joanna Briggs Institute Reviewers’ Manual^{²³23 Joanna Briggs Institute. Reviewer’s manual 2015: methodology for JBI scoping reviews. Adelaide: University of Adelaide; 2015.,²⁴24 Peters MDJ, Marnie C, Tricco AC, et al. Updated Methodological Guidance for the Conduct of Scoping Reviews. JBI Evidence Implementation. 2020;18(10):2119-2126. DOI: https://doi.org/10.11124/JBIES-20-00167
https://doi.org/10.11124/JBIES-20-00167...} e que tem como base as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews^{²⁵25 Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-73. DOI: https://doi.org/10.7326/m18-0850
https://doi.org/10.7326/m18-0850...}, com as seguintes perguntas de investigação: quais os conceitos e os métodos de pesquisa utilizados pela literatura para investigar o reconhecimento de uma FUC? E quais os fatores determinantes para o reconhecimento de uma FUC?

Foram realizadas buscas eletrônicas de artigos nas bases de dados: Web of Science, Scopus, Science Direct e PubMed, sendo considerado os seguintes descritores: “Primary Health Care”, “Primary Care”, e “ Usual Source of Care”. Os descritores foram definidos mediante consulta aos Descritores em Ciências da Saúde (DeCS) e Medical Subject Heading (MeSH), e “Usual Source of Care” foi utilizado como termo por não existir registro nas bases consultadas. Para a pesquisa bibliográfica, foram utilizadas as seguintes estratégias de busca: a) na base PubMed: ((“Primary Health Care” [Title/Abstract] OR “Primary Care” [Title/Abstract])) AND “Usual Source of Care” [Title/Abstract]; b) na base Scopus, foi mediante a busca por: Article title, Abstract, Keywords: ((“Atenção primária à saúde” OU “Atenção primária”) AND (“Fonte habitual de cuidados”)); c) na base Web of Science, a busca foi orientada pela chave: Tópico (TS)=((“Primary Health Care” OR “Primary Care”) AND (“Usual Source of Care”)); e d) na base Science Direct, Find articles with these terms: “Primary Health Care” AND “Usual Source of Care”.

Como critérios de elegibilidade, foram considerados estudos originais que respondiam às perguntas de investigação definidas previamente e disponíveis nas bases de dados destacadas anteriormente. Com o propósito de conhecer a totalidade dos artigos existentes, não houve restrição para grupos populacionais de interesse, também não foi estabelecido limites quanto ao idioma do estudo, tipo, local de realização do estudo ou ano de publicação. Estudos realizados em grupos populacionais específicos, como portadores de doenças crônicas e em cuidados paliativos, foram excluídos da seleção. Além disso, foram excluídos os artigos de revisão bibliográfica e de relato de casos, bem como documentos no formato de teses, dissertações, monografias e editoriais. Todas as buscas foram realizadas no dia 6 de fevereiro de 2020.

As bases de dados foram consultadas, e os artigos, transferidos para o software Endnote on-line. Após o armazenamento, foram removidos os registros de duplicidade, e duas pesquisadoras independentes selecionaram os artigos por meio da leitura de títulos e resumos, obedecendo aos critérios de inclusão e exclusão predefinidos. Os casos em desacordo foram resolvidos por consenso ou decisão de um terceiro pesquisador.

Em seguida, os textos completos foram reunidos para avaliação. Os seguintes dados foram extraídos dos estudos: autor, ano de publicação, país de realização do estudo, período de realização do estudo, fonte de dados, tipo do estudo, população-alvo, seguro saúde, conceito de FUC, forma de operacionalização do questionamento de FUC, tipo da variável FUC, fatores determinantes de FUC e base de dados.

Resultados

Foram identificados 632 artigos, sendo que 291 foram excluídos por estarem repetidos nas bases de dados. Após análise dos títulos e resumos, 255 artigos foram excluídos por não atenderem aos critérios de elegibilidade da pesquisa. Foram selecionados 86 para leitura e análise na íntegra, e, destes, 45 artigos foram excluídos: 22 estudos por não responderem às perguntas de investigação; 17 por terem como população específica do estudo indivíduos com doenças crônicas; 4 pela indisponibilidade de acesso do texto completo, e em 2 estudos, a FUC foi apenas condicionante para seleção da amostra. A amostra final foi composta por 41 artigos (figura 1).

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Figura 1
Diagrama de fluxo da seleção de artigos para a revisão de escopo

Em relação à distribuição dos estudos segundo o país de origem, 80,5% dos estudos foram conduzidos nos Estados Unidos da América (EUA), seguidos da Coreia do Sul (9,8%), da China e do Brasil (ambos com 4,9%). Os estudos foram publicados desde o ano de 1982 até 2019, sendo que cerca de 70,7% foram publicados nos últimos dez anos (tabela 1).

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Tabela 1
Distribuição dos estudos selecionados segundo país de realização do estudo, período de publicação, tipo de estudo, população do estudo, tipo da variável FUC e informações sobre seguro saúde

Quando analisados o tipo de estudo ou a metodologia utilizada, verificou-se que 80,5% dos estudos foram conduzidos por intermédio de um desenho epidemiológico transversal, sendo que 5 desses estudos (12,1%) utilizaram o método transversal seriado, 14,6% foram estudos longitudinais e apenas 1 estudo se baseou em uma abordagem qualiquantitativa (2,4%). Com relação à população dos estudos, 58,5% dos estudos tiveram como população-alvo os indivíduos adultos; 19,5%, crianças; e 9,8%, adolescentes ou idosos. Quanto às características de definição e análise dos estudos, foi possível verificar uma importante concentração do emprego da variável FUC como variável dependente (desfecho) (63,4%) (tabela 1).

Qual o conceito e operacionalização do termo Fonte Usual de Cuidados?

No quadro 1, buscou-se sistematizar os conceitos empregados e a forma de operacionalização da pergunta utilizada para a investigação de FUC pelos estudos selecionados. Conforme a literatura investigada, cerca de 14 estudos não apresentaram um conceito estabelecido para FUC^{¹⁰10 Devoe JE, Tillotson CJ, Wallace LS, et al. Parent and child usual source of care and children’s receipt of health care services. Ann Fam Med. 2011;9(6):504-13. DOI: https://doi.org/10.1370/afm.1300
https://doi.org/10.1370/afm.1300... ,²⁶26 Newacheck PW, Stoddard JJ, Hughes DC, et al. Health insurance and access to primary care for children. N Engl J Med. 1998;338(8):513-9. DOI: https://doi.org/10.1056/nejm199802193380806
https://doi.org/10.1056/nejm199802193380...

27 Moy E, Bartman BA, Clancy CM, et al. Changes in usual sources of medical care between 1987 and 1992. J Health Care Poor Underserved. 1998;9(2):126-39. DOI: https://doi.org/10.1353/hpu.2010.0305
https://doi.org/10.1353/hpu.2010.0305...

28 Klein JD, Wilson KM, Mcnulty M, et al. Access to medical care for adolescents: results from the 1997 commonwealth fund survey of the health of adolescent girls. J Adolesc Health. 1999;25(2):120-30. DOI: https://doi.org/10.1016/s1054-139x(98)00146-3
https://doi.org/10.1016/s1054-139x(98)00...

29 Wilson KM, Klein JD. Adolescents who use the emergency department as their usual source of care. Arch Pediatr Adolesc Med. 2000;154(4):361-5. DOI: https://doi.org/10.1001/archpedi.154.4.361
https://doi.org/10.1001/archpedi.154.4.3...

30 Mckee MD, Fletcher J. Primary care for urban adolescent girls from ethnically diverse populations: foregone care and access to confidential care. J Health Care Poor Underserved. 2006;17(4):759-74. DOI: https://doi.org/10.1353/hpu.2006.0131
https://doi.org/10.1353/hpu.2006.0131...

31 Martin BC, Shi L, Ward RD. Race, gender, and language concordance in the primary care setting. Int J Health Care Qual Assur. 2009;22(4):340-52. DOI: https://doi.org/10.1108/09526860910964816
https://doi.org/10.1108/0952686091096481...

32 Devoe JE, Tillotson CJ, Wallace LS, et al. Is health insurance enough? A usual source of care may be more important to ensure a child receives preventive health counseling. Matern Child Health J. 2012;16(2):306-15. DOI: https://doi.org/10.1007%2Fs10995-011-0762-4
https://doi.org/10.1007%2Fs10995-011-076...

33 Macinko J, Lima-Costa MF. Horizontal equity in health care utilization in Brazil, 1998-2008. Int J Equity Health. 2012;11:33. DOI: https://doi.org/10.1186%2F1475-9276-11-33
https://doi.org/10.1186%2F1475-9276-11-3...

34 Shi LY, Lebrun-Harris LA, Daly CA, et al. ngo-metzger, q. Reducing Disparities in Access to Primary Care and Patient Satisfaction with Care: The Role of Health Centers. J Health Care Poor Underserved. 2013;24(1):56-66. DOI: https://doi.org/10.1353/hpu.2013.0022
https://doi.org/10.1353/hpu.2013.0022...

35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025
https://doi.org/10.1016/j.ajog.2015.04.0...

36 Arnett MJ, Thorpe Jr RJ, Gaskin DJ, et al. Race, medical mistrust, and segregation in primary care as usual source of care: findings from the exploring health disparities in integrated communities study. J Urban Health. 2016;93(3):456-67. DOI: https://doi.org/10.1007/s11524-016-0054-9
https://doi.org/10.1007/s11524-016-0054-...

37 Nothelle SK, Boyd C, Sheehan O, et al. Factors associated with loss of usual source of care among older adults. Ann Fam Med. 2018;16(6):538-45. DOI: https://doi.org/10.1370/afm.2283
https://doi.org/10.1370/afm.2283... -³⁸38 Chaiyachati KH, Hom JK, Wong C, et al. Access to Primary and Dental Care Among Adults Newly Enrolled in Medicaid. Am J Manag Care. 2019;25(3):135-9.}. Entre os conceitos/definições utilizados, houve uma maior predominância, em torno de 13 estudos, que definiram FUC como um provedor ou lugar em particular quando o indivíduo geralmente vai quando está doente, precisando de conselhos sobre saúde ou precisando de cuidados médicos^{¹1 Stewart KA, Ristvedt S, Brown KM, et al. Giving voice to black men: guidance for increasing the likelihood of having a usual source of care. Am J Mens Health. 2019;13(3):1557988319856738. DOI: https://doi.org/10.1177/1557988319856738
https://doi.org/10.1177/1557988319856738... ,⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-...

5 Stransky ML. Two-year stability and change in access to and reasons for lacking a usual source of care among working-age US adults. Public Health Rep. 2017;132(6):660-8. DOI: https://doi.org/10.1177/0033354917735322
https://doi.org/10.1177/0033354917735322... -⁶6 Sung NJ, Lee JH. Association between types of usual source of care and user perception of overall health care service quality in Korea. Korean. J Fam Med. 2019;40(3):143-50. DOI: https://doi.org/10.4082/kjfm.17.0093
https://doi.org/10.4082/kjfm.17.0093... ,¹⁸18 Kim KM, Jeon H, Lee JH. Having a physician rather than a place as a usual source of care would be better - from 2012 Korea health panel data. J Korean Med Sci. 2017;32(1):4-12. DOI: https://doi.org/10.3346/jkms.2017.32.1.4
https://doi.org/10.3346/jkms.2017.32.1.4... ,³⁹39 Guendelman S, Wyn R, Tsai YW. Children of working low-income families in California: does parental work benefit children’s insurance status, access, and utilization of primary health care? Health Serv Res. 2000;35(2);417-41.

40 Devoe JE, Tillotson CJ, Wallace LS, et al. The Effects of health insurance and a usual source of care on a child’s receipt of health care. J Pediatr Health Care. 2012;26(5):e25-e35. DOI: https://doi.org/10.1016/j.pedhc.2011.01.003
https://doi.org/10.1016/j.pedhc.2011.01....

41 Jerant A, Bertakis KD, Fenton JJ, et al. Gender of physician as the usual source of care and patient health care utilization and mortality. J Am Board Fam Med. 2013;26(2):138-48. DOI: https://doi.org/10.3122/jabfm.2013.02.120198
https://doi.org/10.3122/jabfm.2013.02.12...

42 An AR, Kim K, Lee JH, et al. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey. BMC Fam Pract. 2016;17(1):167. DOI: https://doi.org/10.1186/s12875-016-0555-3
https://doi.org/10.1186/s12875-016-0555-...

43 Khan A, Thapa JR, Zhang D. Preventive dental checkups and their association with access to usual source of care among rural and urban adult residents. J Rural Health. 2017;33(4):419-26. DOI: https://doi.org/10.1111/jrh.12271.
https://doi.org/10.1111/jrh.12271...

44 Liaw W, Jetty A, Petterson S, et al. Trends in the types of usual sources of care: a shift from people to places or nothing at all. Health Serv Res. 2018;53(4):2346-67. DOI: https://doi.org/10.1111/1475-6773.12753.
https://doi.org/10.1111/1475-6773.12753...

45 Chaiyachati KH, Hom JK, Hubbard RA, et al. Evaluating the association between the built environment and primary care access for new medicaid enrollees in an urban environment using walk and transit scores. Prev Med Rep. 2017;9:24-8. DOI: https://doi.org/10.1016/j.pmedr.2017.12.001.
https://doi.org/10.1016/j.pmedr.2017.12.... -⁴⁶46 Kim D, Kim S, Park HK, et al. Effect of having a usual source of care on medical expenses - using the korea health panel data. J Korean Med Sci. 2019;34(35):e229. DOI: https://doi.org/10.3346/jkms.2019.34.e229
https://doi.org/10.3346/jkms.2019.34.e22...} (quadro 1).

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Quadro 1
Sistematização dos conceitos e a operacionalização da pergunta sobre a existência ou reconhecimento de uma Fonte Usual de Cuidados

Outros estudos deram enfoque especificamente a um lugar/serviço de saúde, sendo então definido como consultório médico específico, clínica, centro de saúde ou outro lugar para onde o indivíduo costuma ir quando está doente, precisando de conselhos de saúde ou de cuidados primários^{²2 Tsai J, Shi L, Yu WL, et al. Usual source of care and the quality of medical care experiences: a cross-sectional survey of patients from a Taiwanese Community. Med Care. 2010;48(7):628-34. DOI: https://doi.org/10.1097/MLR.0b013e3181dbdf76
https://doi.org/10.1097/MLR.0b013e3181db... ,³3 Du Z, Liao Y, Chen CC, et al. Usual source of care and the quality of primary care: a survey of patients in Guangdong province, China. Int J Equity Health. 2015;14:60. DOI: https://doi.org/10.1186/s12939-015-0189-4
https://doi.org/10.1186/s12939-015-0189-... ,⁷7 Berk ML, Bernstein AB. Regular source of care and the minority aged. J Am Geriatr Soc. 1982;30(4):251-4. DOI: https://doi.org/10.1111/j.1532-5415.1982.tb07096.x
https://doi.org/10.1111/j.1532-5415.1982... ,⁴⁷47 Stockwell MS, Findley SE, Irigoyen M, et al. Change in parental reasons for use of an urban pediatric emergency department in the past decade. Pediatr Emerg Care. 2010;26(3):181-5. DOI: https://doi.org/10.1097/pec.0b013e3181d1dfc7
https://doi.org/10.1097/pec.0b013e3181d1...

48 Davis MA, Guo C, Titler MG, et al. Advanced practice clinicians as a usual source of care for adults in the United States. Nursing Outlook. 2017;65(1):41-9. DOI: https://doi.org/10.1016/j.outlook.2016.07.006
https://doi.org/10.1016/j.outlook.2016.0... -⁴⁹49 Rew L, Resnick M, Beuhring T. Usual sources, patterns of utilization, and foregone health care among Hispanic adolescents. J Adolesc Health. 1999;25(6):407-13. DOI: https://doi.org/10.1016/s1054-139x(98)00159-1
https://doi.org/10.1016/s1054-139x(98)00...} (quadro 1).

Além dessas definições, cinco estudos referiram como um indicador que avalia acesso, sendo que o acesso foi definido como a capacidade de um indivíduo obter serviços de saúde quando preciso^{⁸8 Rohrer JE, Kruse G, Zhang Y. Hispanic ethnicity, rural residence, and regular source of care. J Community Health. 2004;29(1):1-13. DOI: https://doi.org/10.1023/b:johe.0000007441.84668.ac
https://doi.org/10.1023/b:johe.000000744... ,¹⁷17 Devoe JE, Petering R, Krois L. A usual source of care: Supplement or substitute for health insurance among low-income children? Med Care. 2008;46(10):1041-8. DOI: https://doi.org/10.1097/MLR.0b013e3181866443
https://doi.org/10.1097/MLR.0b013e318186... ,⁵⁰50 Devoe JE, Saultz JW, Krois L, et al. A medical home versus temporary housing: The importance of a stable usual source of care. Pediatrics. 2009;124(5):1363-71. DOI: https://doi.org/10.1542/peds.2008-3141
https://doi.org/10.1542/peds.2008-3141...

51 Choi S. Longitudinal changes in access to health care by immigrant status among older adults: The importance of health insurance as a mediator. Gerontologist. 2011;51(2):156-69. DOI: https://doi.org/10.1542/peds.2008-3141
https://doi.org/10.1542/peds.2008-3141...

52 Cunningham PJ. Many medicaid beneficiaries receive care consistent with attributes of patient-centered medical homes. Health Aff (Millwood). 2015;34(7):1105-12. DOI: https://doi.org/10.1377/hlthaff.2015.0141
https://doi.org/10.1377/hlthaff.2015.014... -⁵³53 Cross S, Kelly P. Access to care based on state nurse practitioner practice regulation: secondary data analysis results in the medicare population. J Am Assoc Nurse Pract. 2015;27(1):21-30. DOI: https://doi.org/10.1002/2327-6924.12191
https://doi.org/10.1002/2327-6924.12191...}, e um estudo como um facilitador para o indivíduo obter cuidados de saúde quando necessários^{⁵⁴54 Hammond WP, Matthews D, Smith GC. Psychosocial factors associated with routine health examination scheduling and receipt among African American men. J Natl Med Assoc. 2010;102(4):276-89. DOI: https://doi.org/10.1016/s0027-9684(15)30600-3
https://doi.org/10.1016/s0027-9684(15)30...}. Um estudo desenvolvido nos EUA destacou FUC como um componente do conceito de casa médica (Patient-centered Medical Home - PCMH), amplamente utilizado para melhorar a qualidade do atendimento^{⁵⁵55 Lau JS, Adams SH, Irwin Jr CE, et al. Receipt of preventive health services in young adults. J Adolesc Health. 2013;52(1):42-9. DOI: https://doi.org/10.1016/j.jadohealth.2012.04.017
https://doi.org/10.1016/j.jadohealth.201...} (quadro 1).

Com relação às formas de operacionalização da pergunta para investigar a existência ou o reconhecimento de uma FUC, observou-se variabilidade nas questões com diferenças pouco substanciais. Cerca de 20 estudos utilizaram o questionamento baseado na existência de um local, o que reflete o conceito da maioria deles. Destes, 13 estudos operacionalizaram a pergunta da seguinte forma: ‘Há algum consultório médico, clínica, centro de saúde ou outro lugar que você geralmente vai se estiver doente ou precisando de aconselhamento sobre sua saúde?’^{⁵5 Stransky ML. Two-year stability and change in access to and reasons for lacking a usual source of care among working-age US adults. Public Health Rep. 2017;132(6):660-8. DOI: https://doi.org/10.1177/0033354917735322
https://doi.org/10.1177/0033354917735322... ,¹⁸18 Kim KM, Jeon H, Lee JH. Having a physician rather than a place as a usual source of care would be better - from 2012 Korea health panel data. J Korean Med Sci. 2017;32(1):4-12. DOI: https://doi.org/10.3346/jkms.2017.32.1.4
https://doi.org/10.3346/jkms.2017.32.1.4... ,²⁷27 Moy E, Bartman BA, Clancy CM, et al. Changes in usual sources of medical care between 1987 and 1992. J Health Care Poor Underserved. 1998;9(2):126-39. DOI: https://doi.org/10.1353/hpu.2010.0305
https://doi.org/10.1353/hpu.2010.0305... ,²⁹29 Wilson KM, Klein JD. Adolescents who use the emergency department as their usual source of care. Arch Pediatr Adolesc Med. 2000;154(4):361-5. DOI: https://doi.org/10.1001/archpedi.154.4.361
https://doi.org/10.1001/archpedi.154.4.3... ,³⁰30 Mckee MD, Fletcher J. Primary care for urban adolescent girls from ethnically diverse populations: foregone care and access to confidential care. J Health Care Poor Underserved. 2006;17(4):759-74. DOI: https://doi.org/10.1353/hpu.2006.0131
https://doi.org/10.1353/hpu.2006.0131... ,³²32 Devoe JE, Tillotson CJ, Wallace LS, et al. Is health insurance enough? A usual source of care may be more important to ensure a child receives preventive health counseling. Matern Child Health J. 2012;16(2):306-15. DOI: https://doi.org/10.1007%2Fs10995-011-0762-4
https://doi.org/10.1007%2Fs10995-011-076... ,³⁶36 Arnett MJ, Thorpe Jr RJ, Gaskin DJ, et al. Race, medical mistrust, and segregation in primary care as usual source of care: findings from the exploring health disparities in integrated communities study. J Urban Health. 2016;93(3):456-67. DOI: https://doi.org/10.1007/s11524-016-0054-9
https://doi.org/10.1007/s11524-016-0054-... ,³⁸38 Chaiyachati KH, Hom JK, Wong C, et al. Access to Primary and Dental Care Among Adults Newly Enrolled in Medicaid. Am J Manag Care. 2019;25(3):135-9.,⁴²42 An AR, Kim K, Lee JH, et al. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey. BMC Fam Pract. 2016;17(1):167. DOI: https://doi.org/10.1186/s12875-016-0555-3
https://doi.org/10.1186/s12875-016-0555-... ,⁴⁴44 Liaw W, Jetty A, Petterson S, et al. Trends in the types of usual sources of care: a shift from people to places or nothing at all. Health Serv Res. 2018;53(4):2346-67. DOI: https://doi.org/10.1111/1475-6773.12753.
https://doi.org/10.1111/1475-6773.12753...

45 Chaiyachati KH, Hom JK, Hubbard RA, et al. Evaluating the association between the built environment and primary care access for new medicaid enrollees in an urban environment using walk and transit scores. Prev Med Rep. 2017;9:24-8. DOI: https://doi.org/10.1016/j.pmedr.2017.12.001.
https://doi.org/10.1016/j.pmedr.2017.12.... -⁴⁶46 Kim D, Kim S, Park HK, et al. Effect of having a usual source of care on medical expenses - using the korea health panel data. J Korean Med Sci. 2019;34(35):e229. DOI: https://doi.org/10.3346/jkms.2019.34.e229
https://doi.org/10.3346/jkms.2019.34.e22... ,⁴⁸48 Davis MA, Guo C, Titler MG, et al. Advanced practice clinicians as a usual source of care for adults in the United States. Nursing Outlook. 2017;65(1):41-9. DOI: https://doi.org/10.1016/j.outlook.2016.07.006
https://doi.org/10.1016/j.outlook.2016.0...} (quadro 1).

Dois estudos investigaram FUC considerando apenas a existência de um profissional médico ou um outro profissional de saúde, por exemplo: há algum médico que você considera seu médico regular, isto é, um médico que você costuma consultar quando está doente ou precisando de aconselhamento sobre sua saúde?^{²⁸28 Klein JD, Wilson KM, Mcnulty M, et al. Access to medical care for adolescents: results from the 1997 commonwealth fund survey of the health of adolescent girls. J Adolesc Health. 1999;25(2):120-30. DOI: https://doi.org/10.1016/s1054-139x(98)00146-3
https://doi.org/10.1016/s1054-139x(98)00... ,³⁷37 Nothelle SK, Boyd C, Sheehan O, et al. Factors associated with loss of usual source of care among older adults. Ann Fam Med. 2018;16(6):538-45. DOI: https://doi.org/10.1370/afm.2283
https://doi.org/10.1370/afm.2283...}, ou há um médico ou outro profissional de saúde que você costuma ir quando está doente?^{³3 Du Z, Liao Y, Chen CC, et al. Usual source of care and the quality of primary care: a survey of patients in Guangdong province, China. Int J Equity Health. 2015;14:60. DOI: https://doi.org/10.1186/s12939-015-0189-4
https://doi.org/10.1186/s12939-015-0189-...}, entre outras abordagens que consideram FUC apenas como a figura de um profissional de saúde (quadro 1).

Outrossim, oito estudos consideram a existência do profissional médico e do local de saúde, como: existe um médico ou lugar que você costuma ir se estiver doente ou precisando de conselhos sobre sua saúde?^{²2 Tsai J, Shi L, Yu WL, et al. Usual source of care and the quality of medical care experiences: a cross-sectional survey of patients from a Taiwanese Community. Med Care. 2010;48(7):628-34. DOI: https://doi.org/10.1097/MLR.0b013e3181dbdf76
https://doi.org/10.1097/MLR.0b013e3181db... ,⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-... ,⁶6 Sung NJ, Lee JH. Association between types of usual source of care and user perception of overall health care service quality in Korea. Korean. J Fam Med. 2019;40(3):143-50. DOI: https://doi.org/10.4082/kjfm.17.0093
https://doi.org/10.4082/kjfm.17.0093... ,⁸8 Rohrer JE, Kruse G, Zhang Y. Hispanic ethnicity, rural residence, and regular source of care. J Community Health. 2004;29(1):1-13. DOI: https://doi.org/10.1023/b:johe.0000007441.84668.ac
https://doi.org/10.1023/b:johe.000000744... ,³⁹39 Guendelman S, Wyn R, Tsai YW. Children of working low-income families in California: does parental work benefit children’s insurance status, access, and utilization of primary health care? Health Serv Res. 2000;35(2);417-41.,⁴¹41 Jerant A, Bertakis KD, Fenton JJ, et al. Gender of physician as the usual source of care and patient health care utilization and mortality. J Am Board Fam Med. 2013;26(2):138-48. DOI: https://doi.org/10.3122/jabfm.2013.02.120198
https://doi.org/10.3122/jabfm.2013.02.12... ,⁴³43 Khan A, Thapa JR, Zhang D. Preventive dental checkups and their association with access to usual source of care among rural and urban adult residents. J Rural Health. 2017;33(4):419-26. DOI: https://doi.org/10.1111/jrh.12271.
https://doi.org/10.1111/jrh.12271... ,⁵³53 Cross S, Kelly P. Access to care based on state nurse practitioner practice regulation: secondary data analysis results in the medicare population. J Am Assoc Nurse Pract. 2015;27(1):21-30. DOI: https://doi.org/10.1002/2327-6924.12191
https://doi.org/10.1002/2327-6924.12191...} (quadro 1).

Três estudos questionam apenas a disponibilidade de uma FUC, como: você tem uma FUC?^{¹⁰10 Devoe JE, Tillotson CJ, Wallace LS, et al. Parent and child usual source of care and children’s receipt of health care services. Ann Fam Med. 2011;9(6):504-13. DOI: https://doi.org/10.1370/afm.1300
https://doi.org/10.1370/afm.1300... ,³¹31 Martin BC, Shi L, Ward RD. Race, gender, and language concordance in the primary care setting. Int J Health Care Qual Assur. 2009;22(4):340-52. DOI: https://doi.org/10.1108/09526860910964816
https://doi.org/10.1108/0952686091096481... ,⁵¹51 Choi S. Longitudinal changes in access to health care by immigrant status among older adults: The importance of health insurance as a mediator. Gerontologist. 2011;51(2):156-69. DOI: https://doi.org/10.1542/peds.2008-3141
https://doi.org/10.1542/peds.2008-3141...}. Outro estudo relaciona a presença de uma FUC com a cobertura de seguro saúde^{⁴⁰40 Devoe JE, Tillotson CJ, Wallace LS, et al. The Effects of health insurance and a usual source of care on a child’s receipt of health care. J Pediatr Health Care. 2012;26(5):e25-e35. DOI: https://doi.org/10.1016/j.pedhc.2011.01.003
https://doi.org/10.1016/j.pedhc.2011.01....}, e apenas um estudo não apresentou um questionamento definido^{³⁴34 Shi LY, Lebrun-Harris LA, Daly CA, et al. ngo-metzger, q. Reducing Disparities in Access to Primary Care and Patient Satisfaction with Care: The Role of Health Centers. J Health Care Poor Underserved. 2013;24(1):56-66. DOI: https://doi.org/10.1353/hpu.2013.0022
https://doi.org/10.1353/hpu.2013.0022...} (quadro 1).

O conceito e a forma de operacionalização da pergunta para avaliar a disponibilidade ou reconhecimento de uma FUC não apresentaram diferenças ou especificidades quando observados por população etária.

Os determinantes do reconhecimento de uma FUC

Dos estudos analisados, 12 deles investigaram, como população-alvo, crianças e adolescentes, sendo observados fatores determinantes para o reconhecimento da existência de uma FUC. Dentre as características demográficas, destacaram-se: idade mais jovens^{⁹9 Devoe JE, Saultz JW, Krois L. A medical home versus temporary housing: the importance of a stable usual source of care among low-income children. Pediatrics. 2009;124(5):1363-71. DOI: https://doi.org/10.1542/peds.2008-3141
https://doi.org/10.1542/peds.2008-3141... ,¹⁰10 Devoe JE, Tillotson CJ, Wallace LS, et al. Parent and child usual source of care and children’s receipt of health care services. Ann Fam Med. 2011;9(6):504-13. DOI: https://doi.org/10.1370/afm.1300
https://doi.org/10.1370/afm.1300... ,²⁸28 Klein JD, Wilson KM, Mcnulty M, et al. Access to medical care for adolescents: results from the 1997 commonwealth fund survey of the health of adolescent girls. J Adolesc Health. 1999;25(2):120-30. DOI: https://doi.org/10.1016/s1054-139x(98)00146-3
https://doi.org/10.1016/s1054-139x(98)00...}, e ser do sexo feminino^{²⁸28 Klein JD, Wilson KM, Mcnulty M, et al. Access to medical care for adolescents: results from the 1997 commonwealth fund survey of the health of adolescent girls. J Adolesc Health. 1999;25(2):120-30. DOI: https://doi.org/10.1016/s1054-139x(98)00146-3
https://doi.org/10.1016/s1054-139x(98)00... ,⁴⁹49 Rew L, Resnick M, Beuhring T. Usual sources, patterns of utilization, and foregone health care among Hispanic adolescents. J Adolesc Health. 1999;25(6):407-13. DOI: https://doi.org/10.1016/s1054-139x(98)00159-1
https://doi.org/10.1016/s1054-139x(98)00...}. Entre os fatores socioeconômicos, observaram-se raça/cor branca^{²⁸28 Klein JD, Wilson KM, Mcnulty M, et al. Access to medical care for adolescents: results from the 1997 commonwealth fund survey of the health of adolescent girls. J Adolesc Health. 1999;25(2):120-30. DOI: https://doi.org/10.1016/s1054-139x(98)00146-3
https://doi.org/10.1016/s1054-139x(98)00...} e não hispânicos^{⁹9 Devoe JE, Saultz JW, Krois L. A medical home versus temporary housing: the importance of a stable usual source of care among low-income children. Pediatrics. 2009;124(5):1363-71. DOI: https://doi.org/10.1542/peds.2008-3141
https://doi.org/10.1542/peds.2008-3141...}, maior nível de escolaridade dos pais^{¹⁰10 Devoe JE, Tillotson CJ, Wallace LS, et al. Parent and child usual source of care and children’s receipt of health care services. Ann Fam Med. 2011;9(6):504-13. DOI: https://doi.org/10.1370/afm.1300
https://doi.org/10.1370/afm.1300... ,³²32 Devoe JE, Tillotson CJ, Wallace LS, et al. Is health insurance enough? A usual source of care may be more important to ensure a child receives preventive health counseling. Matern Child Health J. 2012;16(2):306-15. DOI: https://doi.org/10.1007%2Fs10995-011-0762-4
https://doi.org/10.1007%2Fs10995-011-076...}, pai empregado^{³⁹39 Guendelman S, Wyn R, Tsai YW. Children of working low-income families in California: does parental work benefit children’s insurance status, access, and utilization of primary health care? Health Serv Res. 2000;35(2);417-41.}, e boas condições de renda^{¹⁰10 Devoe JE, Tillotson CJ, Wallace LS, et al. Parent and child usual source of care and children’s receipt of health care services. Ann Fam Med. 2011;9(6):504-13. DOI: https://doi.org/10.1370/afm.1300
https://doi.org/10.1370/afm.1300... ,³²32 Devoe JE, Tillotson CJ, Wallace LS, et al. Is health insurance enough? A usual source of care may be more important to ensure a child receives preventive health counseling. Matern Child Health J. 2012;16(2):306-15. DOI: https://doi.org/10.1007%2Fs10995-011-0762-4
https://doi.org/10.1007%2Fs10995-011-076... ,⁴⁰40 Devoe JE, Tillotson CJ, Wallace LS, et al. The Effects of health insurance and a usual source of care on a child’s receipt of health care. J Pediatr Health Care. 2012;26(5):e25-e35. DOI: https://doi.org/10.1016/j.pedhc.2011.01.003
https://doi.org/10.1016/j.pedhc.2011.01....}.

O seguro saúde foi utilizado pela grande maioria dos estudos para avaliar o reconhecimento de uma FUC, comparando a condição de segurado (sim ou não) ou o tipo de seguro (público ou privado). Observa-se alta concentração de estudos comparando as condições de indivíduos segurados e não segurados (58,5%). Entre os estudos que avaliaram crianças e adolescentes, seis deles analisaram a variável seguro saúde como um determinante para o reconhecimento de uma FUC, sendo que dois dos estudos indicam seguro privado ou público^{³²32 Devoe JE, Tillotson CJ, Wallace LS, et al. Is health insurance enough? A usual source of care may be more important to ensure a child receives preventive health counseling. Matern Child Health J. 2012;16(2):306-15. DOI: https://doi.org/10.1007%2Fs10995-011-0762-4
https://doi.org/10.1007%2Fs10995-011-076... ,⁴⁰40 Devoe JE, Tillotson CJ, Wallace LS, et al. The Effects of health insurance and a usual source of care on a child’s receipt of health care. J Pediatr Health Care. 2012;26(5):e25-e35. DOI: https://doi.org/10.1016/j.pedhc.2011.01.003
https://doi.org/10.1016/j.pedhc.2011.01....}; dois estudos, seguro privado^{²⁶26 Newacheck PW, Stoddard JJ, Hughes DC, et al. Health insurance and access to primary care for children. N Engl J Med. 1998;338(8):513-9. DOI: https://doi.org/10.1056/nejm199802193380806
https://doi.org/10.1056/nejm199802193380... ,³⁹39 Guendelman S, Wyn R, Tsai YW. Children of working low-income families in California: does parental work benefit children’s insurance status, access, and utilization of primary health care? Health Serv Res. 2000;35(2);417-41.}; e dois estudos, seguro público^{¹⁷17 Devoe JE, Petering R, Krois L. A usual source of care: Supplement or substitute for health insurance among low-income children? Med Care. 2008;46(10):1041-8. DOI: https://doi.org/10.1097/MLR.0b013e3181866443
https://doi.org/10.1097/MLR.0b013e318186... ,⁹9 Devoe JE, Saultz JW, Krois L. A medical home versus temporary housing: the importance of a stable usual source of care among low-income children. Pediatrics. 2009;124(5):1363-71. DOI: https://doi.org/10.1542/peds.2008-3141
https://doi.org/10.1542/peds.2008-3141...} (quadro 2).

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Quadro 2
Distribuição dos fatores determinantes no reconhecimento de uma FUC e o tipo de FUC segundo a população-alvo de crianças e adolescentes

O reconhecimento de uma FUC entre as crianças e adolescentes esteve associado com fatores relacionados com estado de saúde, hábitos e comportamentos de vida, como a atividade sexual ativa^{³⁰30 Mckee MD, Fletcher J. Primary care for urban adolescent girls from ethnically diverse populations: foregone care and access to confidential care. J Health Care Poor Underserved. 2006;17(4):759-74. DOI: https://doi.org/10.1353/hpu.2006.0131
https://doi.org/10.1353/hpu.2006.0131...} e estado de saúde bom ou excelente^{²⁸28 Klein JD, Wilson KM, Mcnulty M, et al. Access to medical care for adolescents: results from the 1997 commonwealth fund survey of the health of adolescent girls. J Adolesc Health. 1999;25(2):120-30. DOI: https://doi.org/10.1016/s1054-139x(98)00146-3
https://doi.org/10.1016/s1054-139x(98)00...}; e com relação aos serviços de saúde, com a confiança no profissional de saúde^{³⁰30 Mckee MD, Fletcher J. Primary care for urban adolescent girls from ethnically diverse populations: foregone care and access to confidential care. J Health Care Poor Underserved. 2006;17(4):759-74. DOI: https://doi.org/10.1353/hpu.2006.0131
https://doi.org/10.1353/hpu.2006.0131...}, acesso as ações preventivas e necessidades atendidas^{¹⁰10 Devoe JE, Tillotson CJ, Wallace LS, et al. Parent and child usual source of care and children’s receipt of health care services. Ann Fam Med. 2011;9(6):504-13. DOI: https://doi.org/10.1370/afm.1300
https://doi.org/10.1370/afm.1300...} (quadro 2).

Apenas três estudos avaliaram o tipo de FUC, entre as crianças e adolescentes, sendo que o sexo feminino esteve associado à FUC de APS^{²⁸28 Klein JD, Wilson KM, Mcnulty M, et al. Access to medical care for adolescents: results from the 1997 commonwealth fund survey of the health of adolescent girls. J Adolesc Health. 1999;25(2):120-30. DOI: https://doi.org/10.1016/s1054-139x(98)00146-3
https://doi.org/10.1016/s1054-139x(98)00...}. Para a FUC de emergência, observou-se associação com indivíduos do sexo masculino^{²⁸28 Klein JD, Wilson KM, Mcnulty M, et al. Access to medical care for adolescents: results from the 1997 commonwealth fund survey of the health of adolescent girls. J Adolesc Health. 1999;25(2):120-30. DOI: https://doi.org/10.1016/s1054-139x(98)00146-3
https://doi.org/10.1016/s1054-139x(98)00...}, raça/cor afro-americanos, menor escolaridade dos pais, residentes na zona rural e não disponibilidade de um seguro saúde^{²⁹29 Wilson KM, Klein JD. Adolescents who use the emergency department as their usual source of care. Arch Pediatr Adolesc Med. 2000;154(4):361-5. DOI: https://doi.org/10.1001/archpedi.154.4.361
https://doi.org/10.1001/archpedi.154.4.3...}, e confiança dos pais no pediatra da emergência^{⁴⁷47 Stockwell MS, Findley SE, Irigoyen M, et al. Change in parental reasons for use of an urban pediatric emergency department in the past decade. Pediatr Emerg Care. 2010;26(3):181-5. DOI: https://doi.org/10.1097/pec.0b013e3181d1dfc7
https://doi.org/10.1097/pec.0b013e3181d1...} (quadro 2).

Nos estudos que tiveram como população-alvo adultos, idosos e população geral (29 estudos), foram observados como fatores determinantes mais frequentes no reconhecimento e disponibilidade de uma FUC: sete estudos identificaram a idade mais avançada (acima de 60 anos)^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-... ,⁶6 Sung NJ, Lee JH. Association between types of usual source of care and user perception of overall health care service quality in Korea. Korean. J Fam Med. 2019;40(3):143-50. DOI: https://doi.org/10.4082/kjfm.17.0093
https://doi.org/10.4082/kjfm.17.0093...

7 Berk ML, Bernstein AB. Regular source of care and the minority aged. J Am Geriatr Soc. 1982;30(4):251-4. DOI: https://doi.org/10.1111/j.1532-5415.1982.tb07096.x
https://doi.org/10.1111/j.1532-5415.1982... -⁸8 Rohrer JE, Kruse G, Zhang Y. Hispanic ethnicity, rural residence, and regular source of care. J Community Health. 2004;29(1):1-13. DOI: https://doi.org/10.1023/b:johe.0000007441.84668.ac
https://doi.org/10.1023/b:johe.000000744... ,¹⁸18 Kim KM, Jeon H, Lee JH. Having a physician rather than a place as a usual source of care would be better - from 2012 Korea health panel data. J Korean Med Sci. 2017;32(1):4-12. DOI: https://doi.org/10.3346/jkms.2017.32.1.4
https://doi.org/10.3346/jkms.2017.32.1.4... ,⁴²42 An AR, Kim K, Lee JH, et al. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey. BMC Fam Pract. 2016;17(1):167. DOI: https://doi.org/10.1186/s12875-016-0555-3
https://doi.org/10.1186/s12875-016-0555-... ,⁴⁶46 Kim D, Kim S, Park HK, et al. Effect of having a usual source of care on medical expenses - using the korea health panel data. J Korean Med Sci. 2019;34(35):e229. DOI: https://doi.org/10.3346/jkms.2019.34.e229
https://doi.org/10.3346/jkms.2019.34.e22...}; oito estudos, ser do sexo feminino^{²2 Tsai J, Shi L, Yu WL, et al. Usual source of care and the quality of medical care experiences: a cross-sectional survey of patients from a Taiwanese Community. Med Care. 2010;48(7):628-34. DOI: https://doi.org/10.1097/MLR.0b013e3181dbdf76
https://doi.org/10.1097/MLR.0b013e3181db... ,⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-... ,⁶6 Sung NJ, Lee JH. Association between types of usual source of care and user perception of overall health care service quality in Korea. Korean. J Fam Med. 2019;40(3):143-50. DOI: https://doi.org/10.4082/kjfm.17.0093
https://doi.org/10.4082/kjfm.17.0093... ,⁸8 Rohrer JE, Kruse G, Zhang Y. Hispanic ethnicity, rural residence, and regular source of care. J Community Health. 2004;29(1):1-13. DOI: https://doi.org/10.1023/b:johe.0000007441.84668.ac
https://doi.org/10.1023/b:johe.000000744... ,¹⁸18 Kim KM, Jeon H, Lee JH. Having a physician rather than a place as a usual source of care would be better - from 2012 Korea health panel data. J Korean Med Sci. 2017;32(1):4-12. DOI: https://doi.org/10.3346/jkms.2017.32.1.4
https://doi.org/10.3346/jkms.2017.32.1.4... ,⁴¹41 Jerant A, Bertakis KD, Fenton JJ, et al. Gender of physician as the usual source of care and patient health care utilization and mortality. J Am Board Fam Med. 2013;26(2):138-48. DOI: https://doi.org/10.3122/jabfm.2013.02.120198
https://doi.org/10.3122/jabfm.2013.02.12... ,⁴²42 An AR, Kim K, Lee JH, et al. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey. BMC Fam Pract. 2016;17(1):167. DOI: https://doi.org/10.1186/s12875-016-0555-3
https://doi.org/10.1186/s12875-016-0555-... ,⁴⁸48 Davis MA, Guo C, Titler MG, et al. Advanced practice clinicians as a usual source of care for adults in the United States. Nursing Outlook. 2017;65(1):41-9. DOI: https://doi.org/10.1016/j.outlook.2016.07.006
https://doi.org/10.1016/j.outlook.2016.0...}, estado civil casado^{⁸8 Rohrer JE, Kruse G, Zhang Y. Hispanic ethnicity, rural residence, and regular source of care. J Community Health. 2004;29(1):1-13. DOI: https://doi.org/10.1023/b:johe.0000007441.84668.ac
https://doi.org/10.1023/b:johe.000000744...}, e divorciados/separados ou viúvos^{⁶6 Sung NJ, Lee JH. Association between types of usual source of care and user perception of overall health care service quality in Korea. Korean. J Fam Med. 2019;40(3):143-50. DOI: https://doi.org/10.4082/kjfm.17.0093
https://doi.org/10.4082/kjfm.17.0093... ,¹⁸18 Kim KM, Jeon H, Lee JH. Having a physician rather than a place as a usual source of care would be better - from 2012 Korea health panel data. J Korean Med Sci. 2017;32(1):4-12. DOI: https://doi.org/10.3346/jkms.2017.32.1.4
https://doi.org/10.3346/jkms.2017.32.1.4... ,⁴²42 An AR, Kim K, Lee JH, et al. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey. BMC Fam Pract. 2016;17(1):167. DOI: https://doi.org/10.1186/s12875-016-0555-3
https://doi.org/10.1186/s12875-016-0555-...} (quadro 3).

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Quadro 3
Distribuição dos fatores determinantes no reconhecimento de uma FUC e o tipo de FUC segundo a população-alvo de adultos

Quanto às características socioeconômicas, houve associação com as características de raça/cor branca^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-... ,⁷7 Berk ML, Bernstein AB. Regular source of care and the minority aged. J Am Geriatr Soc. 1982;30(4):251-4. DOI: https://doi.org/10.1111/j.1532-5415.1982.tb07096.x
https://doi.org/10.1111/j.1532-5415.1982... ,⁸8 Rohrer JE, Kruse G, Zhang Y. Hispanic ethnicity, rural residence, and regular source of care. J Community Health. 2004;29(1):1-13. DOI: https://doi.org/10.1023/b:johe.0000007441.84668.ac
https://doi.org/10.1023/b:johe.000000744... ,⁴⁸48 Davis MA, Guo C, Titler MG, et al. Advanced practice clinicians as a usual source of care for adults in the United States. Nursing Outlook. 2017;65(1):41-9. DOI: https://doi.org/10.1016/j.outlook.2016.07.006
https://doi.org/10.1016/j.outlook.2016.0...}, e não hispânicos^{²⁷27 Moy E, Bartman BA, Clancy CM, et al. Changes in usual sources of medical care between 1987 and 1992. J Health Care Poor Underserved. 1998;9(2):126-39. DOI: https://doi.org/10.1353/hpu.2010.0305
https://doi.org/10.1353/hpu.2010.0305... ,⁴¹41 Jerant A, Bertakis KD, Fenton JJ, et al. Gender of physician as the usual source of care and patient health care utilization and mortality. J Am Board Fam Med. 2013;26(2):138-48. DOI: https://doi.org/10.3122/jabfm.2013.02.120198
https://doi.org/10.3122/jabfm.2013.02.12... ,⁴⁴44 Liaw W, Jetty A, Petterson S, et al. Trends in the types of usual sources of care: a shift from people to places or nothing at all. Health Serv Res. 2018;53(4):2346-67. DOI: https://doi.org/10.1111/1475-6773.12753.
https://doi.org/10.1111/1475-6773.12753...}, com maior nível de escolaridade^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-... ,²⁷27 Moy E, Bartman BA, Clancy CM, et al. Changes in usual sources of medical care between 1987 and 1992. J Health Care Poor Underserved. 1998;9(2):126-39. DOI: https://doi.org/10.1353/hpu.2010.0305
https://doi.org/10.1353/hpu.2010.0305... ,³³33 Macinko J, Lima-Costa MF. Horizontal equity in health care utilization in Brazil, 1998-2008. Int J Equity Health. 2012;11:33. DOI: https://doi.org/10.1186%2F1475-9276-11-33
https://doi.org/10.1186%2F1475-9276-11-3... ,⁴¹41 Jerant A, Bertakis KD, Fenton JJ, et al. Gender of physician as the usual source of care and patient health care utilization and mortality. J Am Board Fam Med. 2013;26(2):138-48. DOI: https://doi.org/10.3122/jabfm.2013.02.120198
https://doi.org/10.3122/jabfm.2013.02.12...}, bem como para o baixo nível de escolaridade^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-... ,⁶6 Sung NJ, Lee JH. Association between types of usual source of care and user perception of overall health care service quality in Korea. Korean. J Fam Med. 2019;40(3):143-50. DOI: https://doi.org/10.4082/kjfm.17.0093
https://doi.org/10.4082/kjfm.17.0093... ,¹⁸18 Kim KM, Jeon H, Lee JH. Having a physician rather than a place as a usual source of care would be better - from 2012 Korea health panel data. J Korean Med Sci. 2017;32(1):4-12. DOI: https://doi.org/10.3346/jkms.2017.32.1.4
https://doi.org/10.3346/jkms.2017.32.1.4... ,⁴²42 An AR, Kim K, Lee JH, et al. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey. BMC Fam Pract. 2016;17(1):167. DOI: https://doi.org/10.1186/s12875-016-0555-3
https://doi.org/10.1186/s12875-016-0555-...}, boas condições de renda^{²⁷27 Moy E, Bartman BA, Clancy CM, et al. Changes in usual sources of medical care between 1987 and 1992. J Health Care Poor Underserved. 1998;9(2):126-39. DOI: https://doi.org/10.1353/hpu.2010.0305
https://doi.org/10.1353/hpu.2010.0305... ,³³33 Macinko J, Lima-Costa MF. Horizontal equity in health care utilization in Brazil, 1998-2008. Int J Equity Health. 2012;11:33. DOI: https://doi.org/10.1186%2F1475-9276-11-33
https://doi.org/10.1186%2F1475-9276-11-3... ,⁴¹41 Jerant A, Bertakis KD, Fenton JJ, et al. Gender of physician as the usual source of care and patient health care utilization and mortality. J Am Board Fam Med. 2013;26(2):138-48. DOI: https://doi.org/10.3122/jabfm.2013.02.120198
https://doi.org/10.3122/jabfm.2013.02.12... ,⁵²52 Cunningham PJ. Many medicaid beneficiaries receive care consistent with attributes of patient-centered medical homes. Health Aff (Millwood). 2015;34(7):1105-12. DOI: https://doi.org/10.1377/hlthaff.2015.0141
https://doi.org/10.1377/hlthaff.2015.014...} e de moradia, sendo que quatro dos estudos que ressaltaram o local de residência indicaram a área urbana como fator favorável para o reconhecimento de uma FUC^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-... ,²⁷27 Moy E, Bartman BA, Clancy CM, et al. Changes in usual sources of medical care between 1987 and 1992. J Health Care Poor Underserved. 1998;9(2):126-39. DOI: https://doi.org/10.1353/hpu.2010.0305
https://doi.org/10.1353/hpu.2010.0305... ,³³33 Macinko J, Lima-Costa MF. Horizontal equity in health care utilization in Brazil, 1998-2008. Int J Equity Health. 2012;11:33. DOI: https://doi.org/10.1186%2F1475-9276-11-33
https://doi.org/10.1186%2F1475-9276-11-3... ,⁴¹41 Jerant A, Bertakis KD, Fenton JJ, et al. Gender of physician as the usual source of care and patient health care utilization and mortality. J Am Board Fam Med. 2013;26(2):138-48. DOI: https://doi.org/10.3122/jabfm.2013.02.120198
https://doi.org/10.3122/jabfm.2013.02.12...}. Ainda com relação às características socioeconômicas, observa-se que cerca de sete estudos ressaltaram essa associação com a disponibilidade do seguro saúde^{⁵5 Stransky ML. Two-year stability and change in access to and reasons for lacking a usual source of care among working-age US adults. Public Health Rep. 2017;132(6):660-8. DOI: https://doi.org/10.1177/0033354917735322
https://doi.org/10.1177/0033354917735322... ,⁸8 Rohrer JE, Kruse G, Zhang Y. Hispanic ethnicity, rural residence, and regular source of care. J Community Health. 2004;29(1):1-13. DOI: https://doi.org/10.1023/b:johe.0000007441.84668.ac
https://doi.org/10.1023/b:johe.000000744... ,¹⁸18 Kim KM, Jeon H, Lee JH. Having a physician rather than a place as a usual source of care would be better - from 2012 Korea health panel data. J Korean Med Sci. 2017;32(1):4-12. DOI: https://doi.org/10.3346/jkms.2017.32.1.4
https://doi.org/10.3346/jkms.2017.32.1.4... ,³³33 Macinko J, Lima-Costa MF. Horizontal equity in health care utilization in Brazil, 1998-2008. Int J Equity Health. 2012;11:33. DOI: https://doi.org/10.1186%2F1475-9276-11-33
https://doi.org/10.1186%2F1475-9276-11-3... ,³⁴34 Shi LY, Lebrun-Harris LA, Daly CA, et al. ngo-metzger, q. Reducing Disparities in Access to Primary Care and Patient Satisfaction with Care: The Role of Health Centers. J Health Care Poor Underserved. 2013;24(1):56-66. DOI: https://doi.org/10.1353/hpu.2013.0022
https://doi.org/10.1353/hpu.2013.0022... ,⁴⁴44 Liaw W, Jetty A, Petterson S, et al. Trends in the types of usual sources of care: a shift from people to places or nothing at all. Health Serv Res. 2018;53(4):2346-67. DOI: https://doi.org/10.1111/1475-6773.12753.
https://doi.org/10.1111/1475-6773.12753... ,⁵¹51 Choi S. Longitudinal changes in access to health care by immigrant status among older adults: The importance of health insurance as a mediator. Gerontologist. 2011;51(2):156-69. DOI: https://doi.org/10.1542/peds.2008-3141
https://doi.org/10.1542/peds.2008-3141...} (quadro 3).

Outras características encontradas nos estudos com população de adultos e idosos foi a condição do estado de saúde, hábitos de vida e problemas de saúde, sendo considerados como determinantes um bom estado de saúde^{²⁷27 Moy E, Bartman BA, Clancy CM, et al. Changes in usual sources of medical care between 1987 and 1992. J Health Care Poor Underserved. 1998;9(2):126-39. DOI: https://doi.org/10.1353/hpu.2010.0305
https://doi.org/10.1353/hpu.2010.0305... ,³⁸38 Chaiyachati KH, Hom JK, Wong C, et al. Access to Primary and Dental Care Among Adults Newly Enrolled in Medicaid. Am J Manag Care. 2019;25(3):135-9.,⁴⁶46 Kim D, Kim S, Park HK, et al. Effect of having a usual source of care on medical expenses - using the korea health panel data. J Korean Med Sci. 2019;34(35):e229. DOI: https://doi.org/10.3346/jkms.2019.34.e229
https://doi.org/10.3346/jkms.2019.34.e22... ,⁵²52 Cunningham PJ. Many medicaid beneficiaries receive care consistent with attributes of patient-centered medical homes. Health Aff (Millwood). 2015;34(7):1105-12. DOI: https://doi.org/10.1377/hlthaff.2015.0141
https://doi.org/10.1377/hlthaff.2015.014...}, não ser fumante^{⁴¹41 Jerant A, Bertakis KD, Fenton JJ, et al. Gender of physician as the usual source of care and patient health care utilization and mortality. J Am Board Fam Med. 2013;26(2):138-48. DOI: https://doi.org/10.3122/jabfm.2013.02.120198
https://doi.org/10.3122/jabfm.2013.02.12...}, apresentar doença física ou mental^{²2 Tsai J, Shi L, Yu WL, et al. Usual source of care and the quality of medical care experiences: a cross-sectional survey of patients from a Taiwanese Community. Med Care. 2010;48(7):628-34. DOI: https://doi.org/10.1097/MLR.0b013e3181dbdf76
https://doi.org/10.1097/MLR.0b013e3181db...}. Além disso, cerca de cinco estudos destacaram a presença de doenças crônicas^{⁵5 Stransky ML. Two-year stability and change in access to and reasons for lacking a usual source of care among working-age US adults. Public Health Rep. 2017;132(6):660-8. DOI: https://doi.org/10.1177/0033354917735322
https://doi.org/10.1177/0033354917735322... ,⁸8 Rohrer JE, Kruse G, Zhang Y. Hispanic ethnicity, rural residence, and regular source of care. J Community Health. 2004;29(1):1-13. DOI: https://doi.org/10.1023/b:johe.0000007441.84668.ac
https://doi.org/10.1023/b:johe.000000744... ,¹⁸18 Kim KM, Jeon H, Lee JH. Having a physician rather than a place as a usual source of care would be better - from 2012 Korea health panel data. J Korean Med Sci. 2017;32(1):4-12. DOI: https://doi.org/10.3346/jkms.2017.32.1.4
https://doi.org/10.3346/jkms.2017.32.1.4... ,⁴²42 An AR, Kim K, Lee JH, et al. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey. BMC Fam Pract. 2016;17(1):167. DOI: https://doi.org/10.1186/s12875-016-0555-3
https://doi.org/10.1186/s12875-016-0555-... ,⁴⁶46 Kim D, Kim S, Park HK, et al. Effect of having a usual source of care on medical expenses - using the korea health panel data. J Korean Med Sci. 2019;34(35):e229. DOI: https://doi.org/10.3346/jkms.2019.34.e229
https://doi.org/10.3346/jkms.2019.34.e22...} (quadro 3).

Com relação às características dos serviços de saúde que favorecem o reconhecimento de uma FUC pelos adultos e idosos, destacam-se a facilidade de agendamento, a realização de exames de rotina^{⁵⁴54 Hammond WP, Matthews D, Smith GC. Psychosocial factors associated with routine health examination scheduling and receipt among African American men. J Natl Med Assoc. 2010;102(4):276-89. DOI: https://doi.org/10.1016/s0027-9684(15)30600-3
https://doi.org/10.1016/s0027-9684(15)30...} e a confiança^{¹1 Stewart KA, Ristvedt S, Brown KM, et al. Giving voice to black men: guidance for increasing the likelihood of having a usual source of care. Am J Mens Health. 2019;13(3):1557988319856738. DOI: https://doi.org/10.1177/1557988319856738
https://doi.org/10.1177/1557988319856738...} (quadro 3).

Para a população de adultos e idosos, cerca de oito estudos analisaram o reconhecimento de uma FUC segundo o tipo, sendo identificados, como fatores associados com maior frequência: a FUC de APS, a idade com 45 anos ou mais^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-...}, ser do sexo feminino^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-...}, solteiro^{³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025
https://doi.org/10.1016/j.ajog.2015.04.0...}, raça/cor branca^{³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025
https://doi.org/10.1016/j.ajog.2015.04.0... ,³⁶36 Arnett MJ, Thorpe Jr RJ, Gaskin DJ, et al. Race, medical mistrust, and segregation in primary care as usual source of care: findings from the exploring health disparities in integrated communities study. J Urban Health. 2016;93(3):456-67. DOI: https://doi.org/10.1007/s11524-016-0054-9
https://doi.org/10.1007/s11524-016-0054-...}, e pardos ou indígenas^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-... ,³⁶36 Arnett MJ, Thorpe Jr RJ, Gaskin DJ, et al. Race, medical mistrust, and segregation in primary care as usual source of care: findings from the exploring health disparities in integrated communities study. J Urban Health. 2016;93(3):456-67. DOI: https://doi.org/10.1007/s11524-016-0054-9
https://doi.org/10.1007/s11524-016-0054-...}, menor nível de escolaridade^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-...}, desempregada^{³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025
https://doi.org/10.1016/j.ajog.2015.04.0...}, crescimento econômico dos pobres^{³³33 Macinko J, Lima-Costa MF. Horizontal equity in health care utilization in Brazil, 1998-2008. Int J Equity Health. 2012;11:33. DOI: https://doi.org/10.1186%2F1475-9276-11-33
https://doi.org/10.1186%2F1475-9276-11-3...}, residir na zona rural^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-... ,³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025
https://doi.org/10.1016/j.ajog.2015.04.0...}, e ter seguro privado de saúde^{⁴⁸48 Davis MA, Guo C, Titler MG, et al. Advanced practice clinicians as a usual source of care for adults in the United States. Nursing Outlook. 2017;65(1):41-9. DOI: https://doi.org/10.1016/j.outlook.2016.07.006
https://doi.org/10.1016/j.outlook.2016.0...}. Entre os fatores determinantes associados ao reconhecimento de uma FUC de emergência, identificam-se: ser afro-americanos/não brancos^{⁷7 Berk ML, Bernstein AB. Regular source of care and the minority aged. J Am Geriatr Soc. 1982;30(4):251-4. DOI: https://doi.org/10.1111/j.1532-5415.1982.tb07096.x
https://doi.org/10.1111/j.1532-5415.1982...}, crescimento econômico de grupos populacionais considerados ricos^{³³33 Macinko J, Lima-Costa MF. Horizontal equity in health care utilization in Brazil, 1998-2008. Int J Equity Health. 2012;11:33. DOI: https://doi.org/10.1186%2F1475-9276-11-33
https://doi.org/10.1186%2F1475-9276-11-3...}, e relação de desconfiança entre usuário/profissional^{³⁶36 Arnett MJ, Thorpe Jr RJ, Gaskin DJ, et al. Race, medical mistrust, and segregation in primary care as usual source of care: findings from the exploring health disparities in integrated communities study. J Urban Health. 2016;93(3):456-67. DOI: https://doi.org/10.1007/s11524-016-0054-9
https://doi.org/10.1007/s11524-016-0054-...}. Para a FUC consultório com especialista, destacam-se como determinantes mais frequentes: ser da faixa etária mais jovens^{³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025
https://doi.org/10.1016/j.ajog.2015.04.0...}, do sexo feminino^{³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025
https://doi.org/10.1016/j.ajog.2015.04.0...}, da raça/cor branca^{³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025
https://doi.org/10.1016/j.ajog.2015.04.0... ,³⁶36 Arnett MJ, Thorpe Jr RJ, Gaskin DJ, et al. Race, medical mistrust, and segregation in primary care as usual source of care: findings from the exploring health disparities in integrated communities study. J Urban Health. 2016;93(3):456-67. DOI: https://doi.org/10.1007/s11524-016-0054-9
https://doi.org/10.1007/s11524-016-0054-...}, com boas condições de renda^{³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025
https://doi.org/10.1016/j.ajog.2015.04.0...} e disponibilidade de seguro privado de saúde^{³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025
https://doi.org/10.1016/j.ajog.2015.04.0...} (quadro 3).

Discussão

Os resultados desta revisão oferecem um panorama sobre a aplicabilidade do termo FUC na literatura internacional desde a década de 1980, destacando-se as questões conceituais, a forma de operacionalização da pergunta de investigação, bem como os fatores determinantes do reconhecimento de uma FUC. A revisão proporcionou uma diversidade de cenários de investigação, análises e realidades demográficas, socioeconômicas e organizacionais de diferentes sistemas de saúde.

A análise das categorias e dos contextos envolvidos com a temática FUC revelou uma visão ampla de questões e desafios pouco explorados no Brasil, especialmente, com o uso da terminologia FUC, mas também evidenciou a importância de alguns fatores determinantes para a disponibilidade de uma FUC^{³3 Du Z, Liao Y, Chen CC, et al. Usual source of care and the quality of primary care: a survey of patients in Guangdong province, China. Int J Equity Health. 2015;14:60. DOI: https://doi.org/10.1186/s12939-015-0189-4
https://doi.org/10.1186/s12939-015-0189-... ,³⁴34 Shi LY, Lebrun-Harris LA, Daly CA, et al. ngo-metzger, q. Reducing Disparities in Access to Primary Care and Patient Satisfaction with Care: The Role of Health Centers. J Health Care Poor Underserved. 2013;24(1):56-66. DOI: https://doi.org/10.1353/hpu.2013.0022
https://doi.org/10.1353/hpu.2013.0022... ,⁵²52 Cunningham PJ. Many medicaid beneficiaries receive care consistent with attributes of patient-centered medical homes. Health Aff (Millwood). 2015;34(7):1105-12. DOI: https://doi.org/10.1377/hlthaff.2015.0141
https://doi.org/10.1377/hlthaff.2015.014... ,⁵³53 Cross S, Kelly P. Access to care based on state nurse practitioner practice regulation: secondary data analysis results in the medicare population. J Am Assoc Nurse Pract. 2015;27(1):21-30. DOI: https://doi.org/10.1002/2327-6924.12191
https://doi.org/10.1002/2327-6924.12191...}.

Ressalta-se que a bibliografia revisada apresentou algumas variações na forma de definição e operacionalização do termo FUC, sendo utilizadas referências a um local ou a um profissional de saúde, especialmente, o médico; bem como estudos que consideram ambas as informações. É importante ressaltar que, apesar de o período de publicação dos estudos ser consideravelmente dilatado, em torno de quase 40 anos, não foi possível verificar nenhuma tendência temporal no tipo de questões utilizadas, havendo uma variabilidade na literatura que pode estar relacionada com o tipo de dado utilizado, uma vez que muitos estudos utilizaram dados em painéis ou inquéritos a partir de dados secundários.

Na literatura, não existe um consenso entre as características que influenciam no reconhecimento de uma FUC. Os determinantes associados entre os grupos populacionais apresentam semelhanças para os fatores demográficos, socioeconômicos e de saúde, havendo uma preponderância de características que ressaltam maior atenção à saúde ou melhores condições sociais e econômicas, como: ser do sexo feminino, raça/cor branca, maior nível de escolaridade, boas condições de renda e de moradia, ter seguro saúde, e um bom estado de saúde.

Dentre as divergências dos determinantes entre os grupos etários, destacam-se as crianças e os adolescentes, a idade mais jovem^{⁹9 Devoe JE, Saultz JW, Krois L. A medical home versus temporary housing: the importance of a stable usual source of care among low-income children. Pediatrics. 2009;124(5):1363-71. DOI: https://doi.org/10.1542/peds.2008-3141
https://doi.org/10.1542/peds.2008-3141... ,¹⁰10 Devoe JE, Tillotson CJ, Wallace LS, et al. Parent and child usual source of care and children’s receipt of health care services. Ann Fam Med. 2011;9(6):504-13. DOI: https://doi.org/10.1370/afm.1300
https://doi.org/10.1370/afm.1300... ,²⁸28 Klein JD, Wilson KM, Mcnulty M, et al. Access to medical care for adolescents: results from the 1997 commonwealth fund survey of the health of adolescent girls. J Adolesc Health. 1999;25(2):120-30. DOI: https://doi.org/10.1016/s1054-139x(98)00146-3
https://doi.org/10.1016/s1054-139x(98)00...}, a atividade sexual ativa^{³⁰30 Mckee MD, Fletcher J. Primary care for urban adolescent girls from ethnically diverse populations: foregone care and access to confidential care. J Health Care Poor Underserved. 2006;17(4):759-74. DOI: https://doi.org/10.1353/hpu.2006.0131
https://doi.org/10.1353/hpu.2006.0131...}, a confiança no profissional de saúde^{³⁰30 Mckee MD, Fletcher J. Primary care for urban adolescent girls from ethnically diverse populations: foregone care and access to confidential care. J Health Care Poor Underserved. 2006;17(4):759-74. DOI: https://doi.org/10.1353/hpu.2006.0131
https://doi.org/10.1353/hpu.2006.0131... ,⁴⁷47 Stockwell MS, Findley SE, Irigoyen M, et al. Change in parental reasons for use of an urban pediatric emergency department in the past decade. Pediatr Emerg Care. 2010;26(3):181-5. DOI: https://doi.org/10.1097/pec.0b013e3181d1dfc7
https://doi.org/10.1097/pec.0b013e3181d1...} e o acesso às ações preventivas^{¹⁰10 Devoe JE, Tillotson CJ, Wallace LS, et al. Parent and child usual source of care and children’s receipt of health care services. Ann Fam Med. 2011;9(6):504-13. DOI: https://doi.org/10.1370/afm.1300
https://doi.org/10.1370/afm.1300...}. Enquanto para os adultos e idosos, foi observada a idade mais avançada^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-... ,⁶6 Sung NJ, Lee JH. Association between types of usual source of care and user perception of overall health care service quality in Korea. Korean. J Fam Med. 2019;40(3):143-50. DOI: https://doi.org/10.4082/kjfm.17.0093
https://doi.org/10.4082/kjfm.17.0093...

7 Berk ML, Bernstein AB. Regular source of care and the minority aged. J Am Geriatr Soc. 1982;30(4):251-4. DOI: https://doi.org/10.1111/j.1532-5415.1982.tb07096.x
https://doi.org/10.1111/j.1532-5415.1982... -⁸8 Rohrer JE, Kruse G, Zhang Y. Hispanic ethnicity, rural residence, and regular source of care. J Community Health. 2004;29(1):1-13. DOI: https://doi.org/10.1023/b:johe.0000007441.84668.ac
https://doi.org/10.1023/b:johe.000000744... ,¹⁸18 Kim KM, Jeon H, Lee JH. Having a physician rather than a place as a usual source of care would be better - from 2012 Korea health panel data. J Korean Med Sci. 2017;32(1):4-12. DOI: https://doi.org/10.3346/jkms.2017.32.1.4
https://doi.org/10.3346/jkms.2017.32.1.4... ,⁴²42 An AR, Kim K, Lee JH, et al. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey. BMC Fam Pract. 2016;17(1):167. DOI: https://doi.org/10.1186/s12875-016-0555-3
https://doi.org/10.1186/s12875-016-0555-... ,⁴⁶46 Kim D, Kim S, Park HK, et al. Effect of having a usual source of care on medical expenses - using the korea health panel data. J Korean Med Sci. 2019;34(35):e229. DOI: https://doi.org/10.3346/jkms.2019.34.e229
https://doi.org/10.3346/jkms.2019.34.e22...}; para alguns estudos, o baixo nível de escolaridade^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-... ,⁶6 Sung NJ, Lee JH. Association between types of usual source of care and user perception of overall health care service quality in Korea. Korean. J Fam Med. 2019;40(3):143-50. DOI: https://doi.org/10.4082/kjfm.17.0093
https://doi.org/10.4082/kjfm.17.0093... ,¹⁸18 Kim KM, Jeon H, Lee JH. Having a physician rather than a place as a usual source of care would be better - from 2012 Korea health panel data. J Korean Med Sci. 2017;32(1):4-12. DOI: https://doi.org/10.3346/jkms.2017.32.1.4
https://doi.org/10.3346/jkms.2017.32.1.4... ,⁴²42 An AR, Kim K, Lee JH, et al. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey. BMC Fam Pract. 2016;17(1):167. DOI: https://doi.org/10.1186/s12875-016-0555-3
https://doi.org/10.1186/s12875-016-0555-...}, o estado civil solteiro/divorciado/viúvo^{⁶6 Sung NJ, Lee JH. Association between types of usual source of care and user perception of overall health care service quality in Korea. Korean. J Fam Med. 2019;40(3):143-50. DOI: https://doi.org/10.4082/kjfm.17.0093
https://doi.org/10.4082/kjfm.17.0093... ,¹⁸18 Kim KM, Jeon H, Lee JH. Having a physician rather than a place as a usual source of care would be better - from 2012 Korea health panel data. J Korean Med Sci. 2017;32(1):4-12. DOI: https://doi.org/10.3346/jkms.2017.32.1.4
https://doi.org/10.3346/jkms.2017.32.1.4... ,⁴²42 An AR, Kim K, Lee JH, et al. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey. BMC Fam Pract. 2016;17(1):167. DOI: https://doi.org/10.1186/s12875-016-0555-3
https://doi.org/10.1186/s12875-016-0555-...}, a presença de doença crônica^{⁵5 Stransky ML. Two-year stability and change in access to and reasons for lacking a usual source of care among working-age US adults. Public Health Rep. 2017;132(6):660-8. DOI: https://doi.org/10.1177/0033354917735322
https://doi.org/10.1177/0033354917735322... ,⁸8 Rohrer JE, Kruse G, Zhang Y. Hispanic ethnicity, rural residence, and regular source of care. J Community Health. 2004;29(1):1-13. DOI: https://doi.org/10.1023/b:johe.0000007441.84668.ac
https://doi.org/10.1023/b:johe.000000744... ,¹⁸18 Kim KM, Jeon H, Lee JH. Having a physician rather than a place as a usual source of care would be better - from 2012 Korea health panel data. J Korean Med Sci. 2017;32(1):4-12. DOI: https://doi.org/10.3346/jkms.2017.32.1.4
https://doi.org/10.3346/jkms.2017.32.1.4... ,⁴²42 An AR, Kim K, Lee JH, et al. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey. BMC Fam Pract. 2016;17(1):167. DOI: https://doi.org/10.1186/s12875-016-0555-3
https://doi.org/10.1186/s12875-016-0555-... ,⁴⁶46 Kim D, Kim S, Park HK, et al. Effect of having a usual source of care on medical expenses - using the korea health panel data. J Korean Med Sci. 2019;34(35):e229. DOI: https://doi.org/10.3346/jkms.2019.34.e229
https://doi.org/10.3346/jkms.2019.34.e22...}, física e mental^{²2 Tsai J, Shi L, Yu WL, et al. Usual source of care and the quality of medical care experiences: a cross-sectional survey of patients from a Taiwanese Community. Med Care. 2010;48(7):628-34. DOI: https://doi.org/10.1097/MLR.0b013e3181dbdf76
https://doi.org/10.1097/MLR.0b013e3181db...}, e não ter o hábito de fumar^{⁴¹41 Jerant A, Bertakis KD, Fenton JJ, et al. Gender of physician as the usual source of care and patient health care utilization and mortality. J Am Board Fam Med. 2013;26(2):138-48. DOI: https://doi.org/10.3122/jabfm.2013.02.120198
https://doi.org/10.3122/jabfm.2013.02.12...}.

As desigualdades demográficas e socioeconômicas que influenciam no reconhecimento de uma FUC estão relacionadas com as características individuais, que afetam a busca por serviços de saúde por cada sujeito, e estão associadas também às características e às formas de organização do sistema de saúde. Além disso, esses determinantes podem aumentar ou mitigar as desigualdades sociais no acesso aos serviços de saúde^{⁵⁶56 Travassos C, Viacava F, Fernandes C, et al. Desigualdades geográficas e sociais na utilização de serviços de saúde no Brasil. Ciênc saúde coletiva. 2000;5(1):133-49. DOI: https://doi.org/10.1590/S1413-81232000000100012
https://doi.org/10.1590/S1413-8123200000...

57 Travassos C, Castro M. Determinantes e desigualdades sociais no acesso e na utilização de serviços de saúde. In: Giovanella L, Escorel S, Lobato LVC, et al., editores. Políticas e sistema de saúde no Brasil. Rio de Janeiro (RJ): Fiocruz; 2008. p. 215-46.-⁵⁸58 Almeida APSC, Nunes BP, Duro SMS, et al. Determinantes socioeconômicos do acesso a serviços de saúde em idosos: revisão sistemática. Rev Saude Publica. 2017;51(50):1-15. DOI: https://doi.org/10.1590/S1518-8787.2017051006661
https://doi.org/10.1590/S1518-8787.20170...}.

Na análise dos determinantes conforme tipo de FUC, os estudos demonstram algumas divergências entre os grupos etários. Quando observados os fatores que favorecem o reconhecimento da APS como FUC, a única semelhança é ser do sexo feminino^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-... ,²⁸28 Klein JD, Wilson KM, Mcnulty M, et al. Access to medical care for adolescents: results from the 1997 commonwealth fund survey of the health of adolescent girls. J Adolesc Health. 1999;25(2):120-30. DOI: https://doi.org/10.1016/s1054-139x(98)00146-3
https://doi.org/10.1016/s1054-139x(98)00...}. Entretanto, a população de adultos e idosos demonstrou outros fatores que facilitam o reconhecimento da FUC de APS, como idade mais avançada^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-...}, estado civil solteiro^{³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025
https://doi.org/10.1016/j.ajog.2015.04.0...}, raça branca^{³⁶36 Arnett MJ, Thorpe Jr RJ, Gaskin DJ, et al. Race, medical mistrust, and segregation in primary care as usual source of care: findings from the exploring health disparities in integrated communities study. J Urban Health. 2016;93(3):456-67. DOI: https://doi.org/10.1007/s11524-016-0054-9
https://doi.org/10.1007/s11524-016-0054-... ,³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025
https://doi.org/10.1016/j.ajog.2015.04.0...}; enquanto outros estudos destacam raça/cor parda e indígenas^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-... ,³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025
https://doi.org/10.1016/j.ajog.2015.04.0...}, menor nível de escolaridade^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-...}, residir na zona rural^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-... ,³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025
https://doi.org/10.1016/j.ajog.2015.04.0...} e ter seguro saúde^{⁴⁸48 Davis MA, Guo C, Titler MG, et al. Advanced practice clinicians as a usual source of care for adults in the United States. Nursing Outlook. 2017;65(1):41-9. DOI: https://doi.org/10.1016/j.outlook.2016.07.006
https://doi.org/10.1016/j.outlook.2016.0...}. Já na FUC de emergência, as semelhanças foram observadas para a raça afro-americana^{⁷7 Berk ML, Bernstein AB. Regular source of care and the minority aged. J Am Geriatr Soc. 1982;30(4):251-4. DOI: https://doi.org/10.1111/j.1532-5415.1982.tb07096.x
https://doi.org/10.1111/j.1532-5415.1982...} e a relação de desconfiança entre usuário e profissional^{³⁶36 Arnett MJ, Thorpe Jr RJ, Gaskin DJ, et al. Race, medical mistrust, and segregation in primary care as usual source of care: findings from the exploring health disparities in integrated communities study. J Urban Health. 2016;93(3):456-67. DOI: https://doi.org/10.1007/s11524-016-0054-9
https://doi.org/10.1007/s11524-016-0054-...}. Na FUC de emergência, para as crianças e adolescentes, observaram-se ainda ser do sexo masculino^{²⁸28 Klein JD, Wilson KM, Mcnulty M, et al. Access to medical care for adolescents: results from the 1997 commonwealth fund survey of the health of adolescent girls. J Adolesc Health. 1999;25(2):120-30. DOI: https://doi.org/10.1016/s1054-139x(98)00146-3
https://doi.org/10.1016/s1054-139x(98)00...}, menor nível de escolaridade dos pais, não ter seguro e residir na área rural^{²⁹29 Wilson KM, Klein JD. Adolescents who use the emergency department as their usual source of care. Arch Pediatr Adolesc Med. 2000;154(4):361-5. DOI: https://doi.org/10.1001/archpedi.154.4.361
https://doi.org/10.1001/archpedi.154.4.3...}. Por fim, a FUC consultório com especialista foi identificada apenas nos estudos conduzidos com populações de adultos e idosos, tendo os seguintes determinantes associados: ser da faixa etária jovem^{³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025
https://doi.org/10.1016/j.ajog.2015.04.0...}, do sexo feminino^{³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025
https://doi.org/10.1016/j.ajog.2015.04.0...}, raça/cor branca^{³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025
https://doi.org/10.1016/j.ajog.2015.04.0... ,³⁶36 Arnett MJ, Thorpe Jr RJ, Gaskin DJ, et al. Race, medical mistrust, and segregation in primary care as usual source of care: findings from the exploring health disparities in integrated communities study. J Urban Health. 2016;93(3):456-67. DOI: https://doi.org/10.1007/s11524-016-0054-9
https://doi.org/10.1007/s11524-016-0054-...}, boas condições de renda e disponibilidade de seguro privado de saúde^{³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025
https://doi.org/10.1016/j.ajog.2015.04.0...}.

Esta revisão apontou o quanto os contrastes sociais e econômicos^{¹1 Stewart KA, Ristvedt S, Brown KM, et al. Giving voice to black men: guidance for increasing the likelihood of having a usual source of care. Am J Mens Health. 2019;13(3):1557988319856738. DOI: https://doi.org/10.1177/1557988319856738
https://doi.org/10.1177/1557988319856738... ,²⁷27 Moy E, Bartman BA, Clancy CM, et al. Changes in usual sources of medical care between 1987 and 1992. J Health Care Poor Underserved. 1998;9(2):126-39. DOI: https://doi.org/10.1353/hpu.2010.0305
https://doi.org/10.1353/hpu.2010.0305...} são barreiras determinantes para o reconhecimento de uma FUC e, consequentemente, para o acesso a cuidados adequados de saúde. Um estudo conduzido nos EUA destaca as dificuldades de os americanos acessarem um serviço de cuidados primários de qualidade, especialmente as pessoas em condições de vulnerabilidade, como as minorias étnicos/raciais e os não segurados^{³⁴34 Shi LY, Lebrun-Harris LA, Daly CA, et al. ngo-metzger, q. Reducing Disparities in Access to Primary Care and Patient Satisfaction with Care: The Role of Health Centers. J Health Care Poor Underserved. 2013;24(1):56-66. DOI: https://doi.org/10.1353/hpu.2013.0022
https://doi.org/10.1353/hpu.2013.0022...}. Os estudos selecionados demonstraram diferentes formas de financiamento dos sistemas de saúde (sistema universal público, seguro - saúde: público ou privado) - essa conformação do sistema de saúde pode favorecer um maior acesso para o indivíduo capaz de custear o uso dos serviços ou dispor de plano de saúde, o que pode aumentar as iniquidades na utilização dos serviços de saúde^{⁵⁸58 Almeida APSC, Nunes BP, Duro SMS, et al. Determinantes socioeconômicos do acesso a serviços de saúde em idosos: revisão sistemática. Rev Saude Publica. 2017;51(50):1-15. DOI: https://doi.org/10.1590/S1518-8787.2017051006661
https://doi.org/10.1590/S1518-8787.20170...}.

Conforme os determinantes observados, a literatura destaca que os indivíduos com melhores condições de renda e residentes na área urbana estavam associados ao aumento da utilização de serviços de saúde^{⁵⁹59 Travassos C, Viacava F, Pinheiro R, et al. Utilização dos serviços de saúde no Brasil: gênero, características familiares e condição social. Rev Panam Salud Publica. 2002;11(5/6):365-73.,⁶⁰60 Szwarcwald CL, Souza-júnior PR, Damacena GN. Socioeconomic inequities in the use of outpatient services in Brazil according to healthcare need: evidence from the World Health Survey. BMC Health Serv Res. 2010;10:217. DOI: https://doi.org/10.1186/1472-6963-10-217.
https://doi.org/10.1186/1472-6963-10-217...}. Em termos operacionais, a FUC tem sido utilizada muitas vezes para a mensuração de acesso aos serviços de saúde^{⁸8 Rohrer JE, Kruse G, Zhang Y. Hispanic ethnicity, rural residence, and regular source of care. J Community Health. 2004;29(1):1-13. DOI: https://doi.org/10.1023/b:johe.0000007441.84668.ac
https://doi.org/10.1023/b:johe.000000744... ,³¹31 Martin BC, Shi L, Ward RD. Race, gender, and language concordance in the primary care setting. Int J Health Care Qual Assur. 2009;22(4):340-52. DOI: https://doi.org/10.1108/09526860910964816
https://doi.org/10.1108/0952686091096481... ,³⁴34 Shi LY, Lebrun-Harris LA, Daly CA, et al. ngo-metzger, q. Reducing Disparities in Access to Primary Care and Patient Satisfaction with Care: The Role of Health Centers. J Health Care Poor Underserved. 2013;24(1):56-66. DOI: https://doi.org/10.1353/hpu.2013.0022
https://doi.org/10.1353/hpu.2013.0022... ,⁵²52 Cunningham PJ. Many medicaid beneficiaries receive care consistent with attributes of patient-centered medical homes. Health Aff (Millwood). 2015;34(7):1105-12. DOI: https://doi.org/10.1377/hlthaff.2015.0141
https://doi.org/10.1377/hlthaff.2015.014... ,⁵³53 Cross S, Kelly P. Access to care based on state nurse practitioner practice regulation: secondary data analysis results in the medicare population. J Am Assoc Nurse Pract. 2015;27(1):21-30. DOI: https://doi.org/10.1002/2327-6924.12191
https://doi.org/10.1002/2327-6924.12191...}. Além disso, um estudo ressaltou que a associação entre a FUC e o acesso já era bem estabelecida em diferentes populações etárias^{⁵¹51 Choi S. Longitudinal changes in access to health care by immigrant status among older adults: The importance of health insurance as a mediator. Gerontologist. 2011;51(2):156-69. DOI: https://doi.org/10.1542/peds.2008-3141
https://doi.org/10.1542/peds.2008-3141...}.

A disponibilidade de uma FUC favorece aos indivíduos o acesso aos cuidados de saúde^{⁴³43 Khan A, Thapa JR, Zhang D. Preventive dental checkups and their association with access to usual source of care among rural and urban adult residents. J Rural Health. 2017;33(4):419-26. DOI: https://doi.org/10.1111/jrh.12271.
https://doi.org/10.1111/jrh.12271...}, a avaliação da qualidade do atendimento^{²2 Tsai J, Shi L, Yu WL, et al. Usual source of care and the quality of medical care experiences: a cross-sectional survey of patients from a Taiwanese Community. Med Care. 2010;48(7):628-34. DOI: https://doi.org/10.1097/MLR.0b013e3181dbdf76
https://doi.org/10.1097/MLR.0b013e3181db... ,³3 Du Z, Liao Y, Chen CC, et al. Usual source of care and the quality of primary care: a survey of patients in Guangdong province, China. Int J Equity Health. 2015;14:60. DOI: https://doi.org/10.1186/s12939-015-0189-4
https://doi.org/10.1186/s12939-015-0189-... ,⁴³43 Khan A, Thapa JR, Zhang D. Preventive dental checkups and their association with access to usual source of care among rural and urban adult residents. J Rural Health. 2017;33(4):419-26. DOI: https://doi.org/10.1111/jrh.12271.
https://doi.org/10.1111/jrh.12271...}, o agendamento de consultas e o recebimento de exames de rotina^{⁵⁴54 Hammond WP, Matthews D, Smith GC. Psychosocial factors associated with routine health examination scheduling and receipt among African American men. J Natl Med Assoc. 2010;102(4):276-89. DOI: https://doi.org/10.1016/s0027-9684(15)30600-3
https://doi.org/10.1016/s0027-9684(15)30...}, o aumento do uso dos serviços preventivos, a diminuição dos serviços de emergência e menor tempo de internação hospitalar^{¹⁷17 Devoe JE, Petering R, Krois L. A usual source of care: Supplement or substitute for health insurance among low-income children? Med Care. 2008;46(10):1041-8. DOI: https://doi.org/10.1097/MLR.0b013e3181866443
https://doi.org/10.1097/MLR.0b013e318186... ,⁵⁰50 Devoe JE, Saultz JW, Krois L, et al. A medical home versus temporary housing: The importance of a stable usual source of care. Pediatrics. 2009;124(5):1363-71. DOI: https://doi.org/10.1542/peds.2008-3141
https://doi.org/10.1542/peds.2008-3141...}.

As disparidades no acesso e uso de serviços de APS atingem, especialmente, os indivíduos das minorias raciais/étnicas, bem como dos desfavorecidos economicamente^{¹⁰10 Devoe JE, Tillotson CJ, Wallace LS, et al. Parent and child usual source of care and children’s receipt of health care services. Ann Fam Med. 2011;9(6):504-13. DOI: https://doi.org/10.1370/afm.1300
https://doi.org/10.1370/afm.1300... ,²⁷27 Moy E, Bartman BA, Clancy CM, et al. Changes in usual sources of medical care between 1987 and 1992. J Health Care Poor Underserved. 1998;9(2):126-39. DOI: https://doi.org/10.1353/hpu.2010.0305
https://doi.org/10.1353/hpu.2010.0305... ,²⁹29 Wilson KM, Klein JD. Adolescents who use the emergency department as their usual source of care. Arch Pediatr Adolesc Med. 2000;154(4):361-5. DOI: https://doi.org/10.1001/archpedi.154.4.361
https://doi.org/10.1001/archpedi.154.4.3... ,⁴¹41 Jerant A, Bertakis KD, Fenton JJ, et al. Gender of physician as the usual source of care and patient health care utilization and mortality. J Am Board Fam Med. 2013;26(2):138-48. DOI: https://doi.org/10.3122/jabfm.2013.02.120198
https://doi.org/10.3122/jabfm.2013.02.12...}. Desse modo, uma das estratégias para promover cuidados de saúde apropriado e oportuno seria por meio do estabelecimento de uma FUC que promova cuidados de saúde coordenados e centrados no paciente para atender às suas necessidades^{¹1 Stewart KA, Ristvedt S, Brown KM, et al. Giving voice to black men: guidance for increasing the likelihood of having a usual source of care. Am J Mens Health. 2019;13(3):1557988319856738. DOI: https://doi.org/10.1177/1557988319856738
https://doi.org/10.1177/1557988319856738...}.

No Brasil, os indivíduos desfavorecidos economicamente referem ter um serviço de APS como sua FUC^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-...}. Diante dos diferentes contextos analisados, faz-se necessário o fortalecimento dos serviços de APS, por intermédio da expansão e da consolidação da Estratégia Saúde da família (ESF)^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-... ,³³33 Macinko J, Lima-Costa MF. Horizontal equity in health care utilization in Brazil, 1998-2008. Int J Equity Health. 2012;11:33. DOI: https://doi.org/10.1186%2F1475-9276-11-33
https://doi.org/10.1186%2F1475-9276-11-3...}. A Pesquisa Nacional de Saúde (PNS) buscou avaliar a disponibilidade de uma FUC e identificou que a procura regular é maior entre os indivíduos cadastrados na ESF, com redução significativa para os não cadastrados^{⁶¹61 Giovanella L, Bousquat A, Schenkman S, et al. Cobertura da Estratégia Saúde da Família no Brasil: o que nos mostram as Pesquisas Nacionais de Saúde 2013 e 2019. Ciênc saúde coletiva. 2021;26(supl1):2543-56. DOI: https://doi.org/10.1590/1413-81232021266.1.43952020
https://doi.org/10.1590/1413-81232021266...}.

Ter uma FUC de APS está associado a um maior acesso às ações de educação em saúde, maior uso de serviços preventivos, redução no uso de cuidados de emergência, melhora do estado de saúde e maior satisfação com os cuidados recebidos^{⁶6 Sung NJ, Lee JH. Association between types of usual source of care and user perception of overall health care service quality in Korea. Korean. J Fam Med. 2019;40(3):143-50. DOI: https://doi.org/10.4082/kjfm.17.0093
https://doi.org/10.4082/kjfm.17.0093...}. A existência de uma FUC pode não apenas melhorar a qualidade do cuidado ofertado pela APS, mas também possibilitar aos gestores o monitoramento em saúde, o planejamento e a implementação de intervenções de políticas de saúde, especialmente, para alguns grupos populacionais, como os pacientes com doenças crônicas^{³3 Du Z, Liao Y, Chen CC, et al. Usual source of care and the quality of primary care: a survey of patients in Guangdong province, China. Int J Equity Health. 2015;14:60. DOI: https://doi.org/10.1186/s12939-015-0189-4
https://doi.org/10.1186/s12939-015-0189-... ,¹¹11 Mendes EV. As redes de atenção à saúde. Brasília, DF: Organização Pan-Americana da Saúde; 2011. 549 p.}.

A fim de mitigar os problemas de acesso a cuidados de saúde, e de que os usuários recebam um cuidado oportuno, contínuo e resolutivo, faz-se necessário políticas públicas que disponibilizem e fortaleçam os serviços de APS^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-... ,⁶6 Sung NJ, Lee JH. Association between types of usual source of care and user perception of overall health care service quality in Korea. Korean. J Fam Med. 2019;40(3):143-50. DOI: https://doi.org/10.4082/kjfm.17.0093
https://doi.org/10.4082/kjfm.17.0093... ,³³33 Macinko J, Lima-Costa MF. Horizontal equity in health care utilization in Brazil, 1998-2008. Int J Equity Health. 2012;11:33. DOI: https://doi.org/10.1186%2F1475-9276-11-33
https://doi.org/10.1186%2F1475-9276-11-3... ,⁴²42 An AR, Kim K, Lee JH, et al. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey. BMC Fam Pract. 2016;17(1):167. DOI: https://doi.org/10.1186/s12875-016-0555-3
https://doi.org/10.1186/s12875-016-0555-...}. Nesse sentido, um estudo conduzido no Brasil destacou que a ESF consolidada foi associada ao reconhecimento da APS como FUC e ao menor uso de serviços de emergência^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-...}. Esses são achados que indicam não apenas a importância da APS em relação à ESF no Brasil, mas também a necessidade de consolidação desse tipo de serviços saúde em todo o País^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-...}.

A redução das iniquidades no acesso aos serviços de saúde está relacionada com o aumento da oferta de serviços de APS. No Brasil, a expansão da ESF, a partir dos anos 2000, resultou no aumento de utilização/acesso desses serviços pelos indivíduos mais pobres^{³³33 Macinko J, Lima-Costa MF. Horizontal equity in health care utilization in Brazil, 1998-2008. Int J Equity Health. 2012;11:33. DOI: https://doi.org/10.1186%2F1475-9276-11-33
https://doi.org/10.1186%2F1475-9276-11-3...}. Estudo que analisou a PNS no País identificou que as famílias cobertas pela ESF apresentaram maior probabilidade de ter uma FUC quando comparadas a outros grupos, exceto os moradores urbanos mais ricos com planos de saúde privados. O desempenho da ESF como FUC pode aumentar tanto a equidade como tornar-se cada vez mais universal^{⁶²62 Macinko J, Harris MJ, Rocha MG. Brazil’s National Program for Improving Primary Care Access and Quality (PMAQ): Fulfilling the Potential of the World’s Largest Payment for Performance System in Primary Care. J Ambul Care Manage. 2017;40(2supl):S4-11. DOI: https://doi.org/10.1097/JAC.0000000000000189.
https://doi.org/10.1097/JAC.000000000000...}.

Desse modo, vale ressaltar a importância de sistemas de acesso universal de saúde. Estudo conduzido na Coreia ressalta que um sistema universal de saúde é capaz de favorecer ao usuário a escolha de uma FUC de atenção à saúde^{⁶6 Sung NJ, Lee JH. Association between types of usual source of care and user perception of overall health care service quality in Korea. Korean. J Fam Med. 2019;40(3):143-50. DOI: https://doi.org/10.4082/kjfm.17.0093
https://doi.org/10.4082/kjfm.17.0093...}. Esse mesmo estudo destaca a fragilidade do sistema de saúde local da Coreia diante dos serviços de APS, o que demonstra a necessidade do fortalecimento deste sistema devido à alta prevalência do setor privado, que acaba negligenciando políticas desse nível de atenção^{⁶6 Sung NJ, Lee JH. Association between types of usual source of care and user perception of overall health care service quality in Korea. Korean. J Fam Med. 2019;40(3):143-50. DOI: https://doi.org/10.4082/kjfm.17.0093
https://doi.org/10.4082/kjfm.17.0093...}. Além dos problemas de cobertura dos serviços de saúde do referido país, outros países apresentam especificidades, a exemplo dos EUA, em que parcela significativa de indivíduos indicam os serviços hospitalares com sua FUC^{⁴⁹49 Rew L, Resnick M, Beuhring T. Usual sources, patterns of utilization, and foregone health care among Hispanic adolescents. J Adolesc Health. 1999;25(6):407-13. DOI: https://doi.org/10.1016/s1054-139x(98)00159-1
https://doi.org/10.1016/s1054-139x(98)00...}.

Diante da organização do sistema de saúde dos EUA, baseado em seguros de saúde, muitos americanos sem condições econômicas para o custeio de cuidados ficam à margem de um atendimento adequado de saúde, sendo restrito à avaliação de forma adequada à disponibilidade de uma FUC^{⁶6 Sung NJ, Lee JH. Association between types of usual source of care and user perception of overall health care service quality in Korea. Korean. J Fam Med. 2019;40(3):143-50. DOI: https://doi.org/10.4082/kjfm.17.0093
https://doi.org/10.4082/kjfm.17.0093... ,³⁴34 Shi LY, Lebrun-Harris LA, Daly CA, et al. ngo-metzger, q. Reducing Disparities in Access to Primary Care and Patient Satisfaction with Care: The Role of Health Centers. J Health Care Poor Underserved. 2013;24(1):56-66. DOI: https://doi.org/10.1353/hpu.2013.0022
https://doi.org/10.1353/hpu.2013.0022...}. Desse modo, o país disponibiliza serviços por meio dos centros de saúde que apresentam as seguintes características: localização ou prestação de serviços de saúde para comunidades de elevada necessidade de cuidados de saúde e que têm sérios problemas de acesso a cuidados médicos; sendo ofertados serviços de APS e que facilitam o acesso a atendimento mediante serviços de apoio; e que provêm serviços com taxas baseadas na capacidade de pagamento^{³⁴34 Shi LY, Lebrun-Harris LA, Daly CA, et al. ngo-metzger, q. Reducing Disparities in Access to Primary Care and Patient Satisfaction with Care: The Role of Health Centers. J Health Care Poor Underserved. 2013;24(1):56-66. DOI: https://doi.org/10.1353/hpu.2013.0022
https://doi.org/10.1353/hpu.2013.0022...}.

No estabelecimento de uma FUC, a confiança pode ser um meio de superação de barreiras de acesso a cuidados de saúde^{¹1 Stewart KA, Ristvedt S, Brown KM, et al. Giving voice to black men: guidance for increasing the likelihood of having a usual source of care. Am J Mens Health. 2019;13(3):1557988319856738. DOI: https://doi.org/10.1177/1557988319856738
https://doi.org/10.1177/1557988319856738...} para a melhor adesão dos pacientes ao plano de cuidados e, obviamente, sucesso do tratamento^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-...}. No entanto, essa relação de confiança estabelecida entre paciente e prestador de cuidados/profissional necessita de um tempo para se desenvolver^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-...}.

Estudo destaca que, independentemente de a FUC ser uma instalação/serviço ou um profissional de saúde, se ela consegue cumprir atributos essenciais da APS, como atenção de primeiro contato, continuidade do cuidado, abrangência e coordenação da atenção, além de reduzir custos, melhora a saúde da população, a experiência do atendimento, bem como permite uma continuidade de cuidados com provedores individuais^{⁴⁴44 Liaw W, Jetty A, Petterson S, et al. Trends in the types of usual sources of care: a shift from people to places or nothing at all. Health Serv Res. 2018;53(4):2346-67. DOI: https://doi.org/10.1111/1475-6773.12753.
https://doi.org/10.1111/1475-6773.12753...}. No Brasil, a maioria dos cuidados primários do serviço público é fornecida por uma equipe multiprofissional de saúde, o que favorece a resolubilidade da APS, o aumento do escopo das práticas profissionais, além de possíveis estratégias para alcance de melhor coordenação do cuidado^{⁶³63 Almeida PF, Medina MG, Fausto MCR, et al. Coordenação do cuidado e Atenção Primária à Saúde no Sistema Único de Saúde. Saúde debate. 2018;42(esp1):244-60. DOI: https://doi.org/10.1590/0103-11042018S116.
https://doi.org/10.1590/0103-11042018S11...}.

Ainda com relação aos atributos da APS, estudo conduzido na Coreia destaca a necessidade de as pessoas receberem atendimento abrangente e coordenado pelo médico de primeiro contato em sua própria comunidade, destacando a evidência de que, no referido país, melhorar a APS é fundamental para garantir a qualidade da atenção^{⁴²42 An AR, Kim K, Lee JH, et al. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey. BMC Fam Pract. 2016;17(1):167. DOI: https://doi.org/10.1186/s12875-016-0555-3
https://doi.org/10.1186/s12875-016-0555-...}. Devido à desarticulação do sistema de saúde para os serviços de APS na Coreia, os pacientes com doenças crônicas apresentam uma baixa coordenação do cuidado, ameaçando, assim, a qualidade e a eficiência do sistema, levando a custos desnecessários^{⁴²42 An AR, Kim K, Lee JH, et al. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey. BMC Fam Pract. 2016;17(1):167. DOI: https://doi.org/10.1186/s12875-016-0555-3
https://doi.org/10.1186/s12875-016-0555-...}.

Desse modo, para que a APS cumpra seu propósito, fazem-se necessários a disponibilidade ou o reconhecimento de uma FUC, a fim de fornecer continuidade, coordenar os serviços e ser responsável pelos resultados do cuidado^{²⁷27 Moy E, Bartman BA, Clancy CM, et al. Changes in usual sources of medical care between 1987 and 1992. J Health Care Poor Underserved. 1998;9(2):126-39. DOI: https://doi.org/10.1353/hpu.2010.0305
https://doi.org/10.1353/hpu.2010.0305...}. Ainda assim, é importante que faça parte de um sistema de referência integrado com uma equipe multiprofissional da APS que atua como FUC, o que pode ajudar na redução de despesas, bem como melhorar a qualidade das experiências dos cuidados médicos^{²2 Tsai J, Shi L, Yu WL, et al. Usual source of care and the quality of medical care experiences: a cross-sectional survey of patients from a Taiwanese Community. Med Care. 2010;48(7):628-34. DOI: https://doi.org/10.1097/MLR.0b013e3181dbdf76
https://doi.org/10.1097/MLR.0b013e3181db...}.

Quando analisadas pela ótica dos modelos de atenção à saúde, a expansão e a consolidação de cuidados primários podem aumentar o acesso a uma FUC com prestadores de APS, assegurando aos usuários um melhor acompanhamento, monitoramento das condições crônicas e atendimento às necessidades gerais de saúde do paciente^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-...}.

Os resultados desta revisão reiteram a importância da APS na equidade do acesso, reduzindo as diferenças socioeconômicas no acesso aos serviços de saúde, especialmente, para os indicadores entendidos como proxy de vulnerabilidade social, além de favorecer a longitudinalidade e continuidade do cuidado^{⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7
https://doi.org/10.1186/s12939-016-0440-... ,⁶¹61 Giovanella L, Bousquat A, Schenkman S, et al. Cobertura da Estratégia Saúde da Família no Brasil: o que nos mostram as Pesquisas Nacionais de Saúde 2013 e 2019. Ciênc saúde coletiva. 2021;26(supl1):2543-56. DOI: https://doi.org/10.1590/1413-81232021266.1.43952020
https://doi.org/10.1590/1413-81232021266...}.

Os estudos analisados podem ter sofrido algum viés de informação, uma vez que a grande maioria se baseou em autorrelato, podendo superestimar os valores reais de uma FUC. Outra questão que pode ser uma limitação é o desenho de estudo, visto que a maioria dos artigos teve desenhos metodológicos transversais, o que os impede de determinar as relações causais nas associações observadas entre a variável exposição e o desfecho.

Com base nesta revisão, é possível indicar a importância do desenvolvimento de políticas públicas que encorajem os indivíduos a terem uma FUC, especialmente, em nível de prevenção primária, a fim de reduzir despesas médicas e promover a utilização desejável de uma atenção à saúde^{⁴⁶46 Kim D, Kim S, Park HK, et al. Effect of having a usual source of care on medical expenses - using the korea health panel data. J Korean Med Sci. 2019;34(35):e229. DOI: https://doi.org/10.3346/jkms.2019.34.e229
https://doi.org/10.3346/jkms.2019.34.e22...}, além de melhoraria na qualidade da APS e aplicação de recursos de saúde^{³3 Du Z, Liao Y, Chen CC, et al. Usual source of care and the quality of primary care: a survey of patients in Guangdong province, China. Int J Equity Health. 2015;14:60. DOI: https://doi.org/10.1186/s12939-015-0189-4
https://doi.org/10.1186/s12939-015-0189-...}. Vale ressaltar, ainda, a importância de análise do indicador de FUC no contexto brasileiro, uma vez que estão sendo investigados por grandes pesquisas nacionais, como a Pesquisa Nacional de Saúde do Escolar (Pense)^{⁶⁴64 Brasil. Pesquisa nacional de saúde do escolar: 2015. Rio de Janeiro: IBGE; 2016. 132 p.} e a PNS^{⁶⁵65 Instituto Brasileiro de Geografia a e Estatística. Pesquisa Nacional de Saúde 2013: acesso e utilização dos serviços de saúde, acidentes e violências: Brasil, Grandes Regiões e Unidades da Federação. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2015.}.

Considerações finais

Ao ter em conta as especificidades contextuais e os sistemas de saúde de cada país, convém considerar limites para a generalização dos resultados. Novos estudos com desenhos de revisão sistemática podem ser mais adequados para extrapolar as especificidades das informações acerca do problema de pesquisa, tratados aqui de forma abrangente pelos propósitos da revisão de escopo.

Este trabalho colabora para o entendimento dos determinantes que mais influenciam no reconhecimento de uma FUC, bem como dos desafios para efetivação do atributo da longitudinalidade do cuidado, sendo de extrema relevância a consolidação e a expansão da APS de forma homogênea nos territórios. Os resultados sugerem que o reconhecimento de uma FUC pode ser explicado com base na diversidade dos cenários de condução dos estudos, assim como pelas diferenças organizacionais dos sistemas de saúde. Esses fatores explicam, além da determinação social individual, os determinantes estruturais que influenciam no reconhecimento ou na disponibilidade de uma FUC, por exemplo, condições de renda, disponibilidade de seguro saúde, nível de escolaridade, local de moradia etc. Vale ressaltar que, entre estes determinantes, os países com sistemas universais favorecem o reconhecimento da FUC para indivíduos oriundos de contextos sociais e econômicos desfavoráveis, implicando a possibilidade de maior equidade nos cuidados em saúde.

Ainda assim, a revisão permitiu traçar um panorama bastante amplo de desafios para a avaliação da disponibilidade ou reconhecimento de uma FUC, especialmente da APS. Essa compreensão abrangente sobre a temática FUC expressa a diversidade de contextos organizacionais dos sistemas de saúde, a qual evidencia que os sistemas universais de saúde são favoráveis para o reconhecimento de uma FUC, em contraponto a países como os EUA, em que a disponibilidade de uma FUC depende da condição financeira do indivíduo capaz de assegurar o custeio de um seguro saúde. Além disso, os resultados deste estudo têm implicações importantes para o modelo de atenção à saúde no Brasil e em outros países, especialmente para aqueles que baseiam fortemente seus sistemas de saúde em serviços na APS.

Suporte financeiro:
não houve

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Travassos C, Castro M. Determinantes e desigualdades sociais no acesso e na utilização de serviços de saúde. In: Giovanella L, Escorel S, Lobato LVC, et al., editores. Políticas e sistema de saúde no Brasil. Rio de Janeiro (RJ): Fiocruz; 2008. p. 215-46.
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Almeida APSC, Nunes BP, Duro SMS, et al. Determinantes socioeconômicos do acesso a serviços de saúde em idosos: revisão sistemática. Rev Saude Publica. 2017;51(50):1-15. DOI: https://doi.org/10.1590/S1518-8787.2017051006661
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Travassos C, Viacava F, Pinheiro R, et al. Utilização dos serviços de saúde no Brasil: gênero, características familiares e condição social. Rev Panam Salud Publica. 2002;11(5/6):365-73.
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Szwarcwald CL, Souza-júnior PR, Damacena GN. Socioeconomic inequities in the use of outpatient services in Brazil according to healthcare need: evidence from the World Health Survey. BMC Health Serv Res. 2010;10:217. DOI: https://doi.org/10.1186/1472-6963-10-217
» https://doi.org/10.1186/1472-6963-10-217
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Giovanella L, Bousquat A, Schenkman S, et al. Cobertura da Estratégia Saúde da Família no Brasil: o que nos mostram as Pesquisas Nacionais de Saúde 2013 e 2019. Ciênc saúde coletiva. 2021;26(supl1):2543-56. DOI: https://doi.org/10.1590/1413-81232021266.1.43952020
» https://doi.org/10.1590/1413-81232021266.1.43952020
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Macinko J, Harris MJ, Rocha MG. Brazil’s National Program for Improving Primary Care Access and Quality (PMAQ): Fulfilling the Potential of the World’s Largest Payment for Performance System in Primary Care. J Ambul Care Manage. 2017;40(2supl):S4-11. DOI: https://doi.org/10.1097/JAC.0000000000000189
» https://doi.org/10.1097/JAC.0000000000000189
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Almeida PF, Medina MG, Fausto MCR, et al. Coordenação do cuidado e Atenção Primária à Saúde no Sistema Único de Saúde. Saúde debate. 2018;42(esp1):244-60. DOI: https://doi.org/10.1590/0103-11042018S116
» https://doi.org/10.1590/0103-11042018S116
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Brasil. Pesquisa nacional de saúde do escolar: 2015. Rio de Janeiro: IBGE; 2016. 132 p.
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Instituto Brasileiro de Geografia a e Estatística. Pesquisa Nacional de Saúde 2013: acesso e utilização dos serviços de saúde, acidentes e violências: Brasil, Grandes Regiões e Unidades da Federação. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2015.

Datas de Publicação

Publicação nesta coleção
09 Dez 2024
Data do Fascículo
2024

Histórico

Recebido
21 Jul 2023
Aceito
09 Ago 2024

Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribution, que permite uso, distribuição e reprodução em qualquer meio, sem restrições desde que o trabalho original seja corretamente citado.

Características dos estudos	N	%
Local do estudo (países)
Estados Unidos da América	33	80.5
Coreia do Sul	4	9.8
China	2	4.9
Brasil	2	4.9
Período de Publicação dos Estudos
Década de 1980	1	2.4
Década de 1990	4	9.8
Década de 2000	7	17.1
Década de 2010	29	70.7
Tipo de Estudo
Transversais	34	82.9
Longitudinais	6	14.6
Qualiquantitativo	1	2.4
População de estudo
Crianças	8	19.5
Adolescentes	4	9.8
Adultos jovens	1	2.4
População adulta	24	58.5
Idosos	4	9.8
Tipo da variável FUC
Dependente	26	63.4
Independente principal	12	29.3
Covariável	3	7.3

Referência	Conceito	Nº de artigos	Referência	Formas de operacionalização	Nº de artigos
Newacheck et al., 1998²⁶26 Newacheck PW, Stoddard JJ, Hughes DC, et al. Health insurance and access to primary care for children. N Engl J Med. 1998;338(8):513-9. DOI: https://doi.org/10.1056/nejm199802193380806 https://doi.org/10.1056/nejm199802193380... ; Moy et al, 1998²⁷27 Moy E, Bartman BA, Clancy CM, et al. Changes in usual sources of medical care between 1987 and 1992. J Health Care Poor Underserved. 1998;9(2):126-39. DOI: https://doi.org/10.1353/hpu.2010.0305 https://doi.org/10.1353/hpu.2010.0305... ; Klein et al., 1999²⁸28 Klein JD, Wilson KM, Mcnulty M, et al. Access to medical care for adolescents: results from the 1997 commonwealth fund survey of the health of adolescent girls. J Adolesc Health. 1999;25(2):120-30. DOI: https://doi.org/10.1016/s1054-139x(98)00146-3 https://doi.org/10.1016/s1054-139x(98)00... ; Wilson; Klein, 2000²⁹29 Wilson KM, Klein JD. Adolescents who use the emergency department as their usual source of care. Arch Pediatr Adolesc Med. 2000;154(4):361-5. DOI: https://doi.org/10.1001/archpedi.154.4.361 https://doi.org/10.1001/archpedi.154.4.3... ; Mckee; Fletcher, 2006³⁰30 Mckee MD, Fletcher J. Primary care for urban adolescent girls from ethnically diverse populations: foregone care and access to confidential care. J Health Care Poor Underserved. 2006;17(4):759-74. DOI: https://doi.org/10.1353/hpu.2006.0131 https://doi.org/10.1353/hpu.2006.0131... ; Martin; Shi; Ward, 2009³¹31 Martin BC, Shi L, Ward RD. Race, gender, and language concordance in the primary care setting. Int J Health Care Qual Assur. 2009;22(4):340-52. DOI: https://doi.org/10.1108/09526860910964816 https://doi.org/10.1108/0952686091096481... ; Devoe et al., 2011¹⁰10 Devoe JE, Tillotson CJ, Wallace LS, et al. Parent and child usual source of care and children’s receipt of health care services. Ann Fam Med. 2011;9(6):504-13. DOI: https://doi.org/10.1370/afm.1300 https://doi.org/10.1370/afm.1300... ; Devoe et al., 2012³²32 Devoe JE, Tillotson CJ, Wallace LS, et al. Is health insurance enough? A usual source of care may be more important to ensure a child receives preventive health counseling. Matern Child Health J. 2012;16(2):306-15. DOI: https://doi.org/10.1007%2Fs10995-011-0762-4 https://doi.org/10.1007%2Fs10995-011-076... ; Macinko; Lima-Costa, 2012³³33 Macinko J, Lima-Costa MF. Horizontal equity in health care utilization in Brazil, 1998-2008. Int J Equity Health. 2012;11:33. DOI: https://doi.org/10.1186%2F1475-9276-11-33 https://doi.org/10.1186%2F1475-9276-11-3... ; Shi et al., 2013³⁴34 Shi LY, Lebrun-Harris LA, Daly CA, et al. ngo-metzger, q. Reducing Disparities in Access to Primary Care and Patient Satisfaction with Care: The Role of Health Centers. J Health Care Poor Underserved. 2013;24(1):56-66. DOI: https://doi.org/10.1353/hpu.2013.0022 https://doi.org/10.1353/hpu.2013.0022... ; Hall et al., 2015³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025 https://doi.org/10.1016/j.ajog.2015.04.0... ; Arnett et al., 2016³⁶36 Arnett MJ, Thorpe Jr RJ, Gaskin DJ, et al. Race, medical mistrust, and segregation in primary care as usual source of care: findings from the exploring health disparities in integrated communities study. J Urban Health. 2016;93(3):456-67. DOI: https://doi.org/10.1007/s11524-016-0054-9 https://doi.org/10.1007/s11524-016-0054-... ; Nothelle et al., 2018³⁷37 Nothelle SK, Boyd C, Sheehan O, et al. Factors associated with loss of usual source of care among older adults. Ann Fam Med. 2018;16(6):538-45. DOI: https://doi.org/10.1370/afm.2283 https://doi.org/10.1370/afm.2283... ; Chaiyachati et al., 2019³⁸38 Chaiyachati KH, Hom JK, Wong C, et al. Access to Primary and Dental Care Among Adults Newly Enrolled in Medicaid. Am J Manag Care. 2019;25(3):135-9..	Não apresenta conceito de FUC.	14	Newacheck et al., 1998²⁶26 Newacheck PW, Stoddard JJ, Hughes DC, et al. Health insurance and access to primary care for children. N Engl J Med. 1998;338(8):513-9. DOI: https://doi.org/10.1056/nejm199802193380806 https://doi.org/10.1056/nejm199802193380... .	A criança teve contato com médico, e qual o número de contatos no último ano?	1
			Moy et al., 1998²⁷27 Moy E, Bartman BA, Clancy CM, et al. Changes in usual sources of medical care between 1987 and 1992. J Health Care Poor Underserved. 1998;9(2):126-39. DOI: https://doi.org/10.1353/hpu.2010.0305 https://doi.org/10.1353/hpu.2010.0305... ; Wilson; Klein, 2000²⁹29 Wilson KM, Klein JD. Adolescents who use the emergency department as their usual source of care. Arch Pediatr Adolesc Med. 2000;154(4):361-5. DOI: https://doi.org/10.1001/archpedi.154.4.361 https://doi.org/10.1001/archpedi.154.4.3... ; Mckee; Fletcher, 2006³⁰30 Mckee MD, Fletcher J. Primary care for urban adolescent girls from ethnically diverse populations: foregone care and access to confidential care. J Health Care Poor Underserved. 2006;17(4):759-74. DOI: https://doi.org/10.1353/hpu.2006.0131 https://doi.org/10.1353/hpu.2006.0131... ; Devoe et al., 2012³²32 Devoe JE, Tillotson CJ, Wallace LS, et al. Is health insurance enough? A usual source of care may be more important to ensure a child receives preventive health counseling. Matern Child Health J. 2012;16(2):306-15. DOI: https://doi.org/10.1007%2Fs10995-011-0762-4 https://doi.org/10.1007%2Fs10995-011-076... ; Arnett et al., 2016³⁶36 Arnett MJ, Thorpe Jr RJ, Gaskin DJ, et al. Race, medical mistrust, and segregation in primary care as usual source of care: findings from the exploring health disparities in integrated communities study. J Urban Health. 2016;93(3):456-67. DOI: https://doi.org/10.1007/s11524-016-0054-9 https://doi.org/10.1007/s11524-016-0054-... ; Chaiyachati et al., 2019³⁸38 Chaiyachati KH, Hom JK, Wong C, et al. Access to Primary and Dental Care Among Adults Newly Enrolled in Medicaid. Am J Manag Care. 2019;25(3):135-9..	Há algum consultório médico, clínica, centro de saúde ou outro lugar que você geralmente vai se estiver doente ou precisando de aconselhamento sobre sua saúde?	6
			Martin; Shi; Ward, 2009³¹31 Martin BC, Shi L, Ward RD. Race, gender, and language concordance in the primary care setting. Int J Health Care Qual Assur. 2009;22(4):340-52. DOI: https://doi.org/10.1108/09526860910964816 https://doi.org/10.1108/0952686091096481... .	Você tem FUC?	1
			Devoe et al., 2011¹⁰10 Devoe JE, Tillotson CJ, Wallace LS, et al. Parent and child usual source of care and children’s receipt of health care services. Ann Fam Med. 2011;9(6):504-13. DOI: https://doi.org/10.1370/afm.1300 https://doi.org/10.1370/afm.1300... .	A criança e/ou ambos os pais têm uma FUC? A criança tem uma FUC e/ou ambos os pais não têm FUC? A criança não tem FUC e/ou ambos os pais têm FUC, e nem o filho nem os pais têm uma FUC?	1
			Macinko; Lima-Costa, 2012³³33 Macinko J, Lima-Costa MF. Horizontal equity in health care utilization in Brazil, 1998-2008. Int J Equity Health. 2012;11:33. DOI: https://doi.org/10.1186%2F1475-9276-11-33 https://doi.org/10.1186%2F1475-9276-11-3... .	Você tende a procurar os serviços de saúde no mesmo local?	1
			Hall et al., 2015³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025 https://doi.org/10.1016/j.ajog.2015.04.0... .	Com que frequência, em média, vocês (mulheres) haviam consultado um profissional de saúde nos últimos cinco anos e que tipo de estabelecimento de saúde haviam visitado com mais frequência?	1
			Klein et al., 1999²⁸28 Klein JD, Wilson KM, Mcnulty M, et al. Access to medical care for adolescents: results from the 1997 commonwealth fund survey of the health of adolescent girls. J Adolesc Health. 1999;25(2):120-30. DOI: https://doi.org/10.1016/s1054-139x(98)00146-3 https://doi.org/10.1016/s1054-139x(98)00... ; Nothelle et al., 2018³⁷37 Nothelle SK, Boyd C, Sheehan O, et al. Factors associated with loss of usual source of care among older adults. Ann Fam Med. 2018;16(6):538-45. DOI: https://doi.org/10.1370/afm.2283 https://doi.org/10.1370/afm.2283... .	Há algum médico que você considera seu médico regular, isto é, um médico que você costuma consultar quando está doente e precisa de aconselhamento sobre sua saúde?	2
			Shi et al., 2013³⁴34 Shi LY, Lebrun-Harris LA, Daly CA, et al. ngo-metzger, q. Reducing Disparities in Access to Primary Care and Patient Satisfaction with Care: The Role of Health Centers. J Health Care Poor Underserved. 2013;24(1):56-66. DOI: https://doi.org/10.1353/hpu.2013.0022 https://doi.org/10.1353/hpu.2013.0022... .	O questionamento não foi definido.	1
Guendelman; Wyn; Tsai, 2000³⁹39 Guendelman S, Wyn R, Tsai YW. Children of working low-income families in California: does parental work benefit children’s insurance status, access, and utilization of primary health care? Health Serv Res. 2000;35(2);417-41.; Devoe et al., 2012⁴⁰40 Devoe JE, Tillotson CJ, Wallace LS, et al. The Effects of health insurance and a usual source of care on a child’s receipt of health care. J Pediatr Health Care. 2012;26(5):e25-e35. DOI: https://doi.org/10.1016/j.pedhc.2011.01.003 https://doi.org/10.1016/j.pedhc.2011.01.... ; Jerant et al., 2013⁴¹41 Jerant A, Bertakis KD, Fenton JJ, et al. Gender of physician as the usual source of care and patient health care utilization and mortality. J Am Board Fam Med. 2013;26(2):138-48. DOI: https://doi.org/10.3122/jabfm.2013.02.120198 https://doi.org/10.3122/jabfm.2013.02.12... ; An et al., 2016⁴²42 An AR, Kim K, Lee JH, et al. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey. BMC Fam Pract. 2016;17(1):167. DOI: https://doi.org/10.1186/s12875-016-0555-3 https://doi.org/10.1186/s12875-016-0555-... ; Khan; Thapa; Zhang, 2017⁴³43 Khan A, Thapa JR, Zhang D. Preventive dental checkups and their association with access to usual source of care among rural and urban adult residents. J Rural Health. 2017;33(4):419-26. DOI: https://doi.org/10.1111/jrh.12271. https://doi.org/10.1111/jrh.12271... ; Kim; Jeon; Lee, 2017¹⁸18 Kim KM, Jeon H, Lee JH. Having a physician rather than a place as a usual source of care would be better - from 2012 Korea health panel data. J Korean Med Sci. 2017;32(1):4-12. DOI: https://doi.org/10.3346/jkms.2017.32.1.4 https://doi.org/10.3346/jkms.2017.32.1.4... ; Liaw et al., 2018⁴⁴44 Liaw W, Jetty A, Petterson S, et al. Trends in the types of usual sources of care: a shift from people to places or nothing at all. Health Serv Res. 2018;53(4):2346-67. DOI: https://doi.org/10.1111/1475-6773.12753. https://doi.org/10.1111/1475-6773.12753... ; Chaiyachati et al., 2017⁴⁵45 Chaiyachati KH, Hom JK, Hubbard RA, et al. Evaluating the association between the built environment and primary care access for new medicaid enrollees in an urban environment using walk and transit scores. Prev Med Rep. 2017;9:24-8. DOI: https://doi.org/10.1016/j.pmedr.2017.12.001. https://doi.org/10.1016/j.pmedr.2017.12.... ; Kim et al., 2019⁴⁶46 Kim D, Kim S, Park HK, et al. Effect of having a usual source of care on medical expenses - using the korea health panel data. J Korean Med Sci. 2019;34(35):e229. DOI: https://doi.org/10.3346/jkms.2019.34.e229 https://doi.org/10.3346/jkms.2019.34.e22... ; Dourado; Medina; Aquino, 2016⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7 https://doi.org/10.1186/s12939-016-0440-... ; Stransky, 2017⁵5 Stransky ML. Two-year stability and change in access to and reasons for lacking a usual source of care among working-age US adults. Public Health Rep. 2017;132(6):660-8. DOI: https://doi.org/10.1177/0033354917735322 https://doi.org/10.1177/0033354917735322... ; Sung; Lee, 2019⁶6 Sung NJ, Lee JH. Association between types of usual source of care and user perception of overall health care service quality in Korea. Korean. J Fam Med. 2019;40(3):143-50. DOI: https://doi.org/10.4082/kjfm.17.0093 https://doi.org/10.4082/kjfm.17.0093... ; Stewart et al., 2019¹1 Stewart KA, Ristvedt S, Brown KM, et al. Giving voice to black men: guidance for increasing the likelihood of having a usual source of care. Am J Mens Health. 2019;13(3):1557988319856738. DOI: https://doi.org/10.1177/1557988319856738 https://doi.org/10.1177/1557988319856738... .	Um provedor ou lugar em particular quando o indivíduo geralmente vai quando está doente, precisando de conselhos sobre saúde ou precisa de cuidados médicos.	13	Guendelman; Wyn; Tsai, 2000³⁹39 Guendelman S, Wyn R, Tsai YW. Children of working low-income families in California: does parental work benefit children’s insurance status, access, and utilization of primary health care? Health Serv Res. 2000;35(2);417-41..	A criança tem uma pessoa ou lugar em particular que geralmente vai quando está doente, precisando de conselhos sobre saúde ou precisando de cuidados médicos de prevenção e de rotina?	1
			Devoe et al., 2012⁴⁰40 Devoe JE, Tillotson CJ, Wallace LS, et al. The Effects of health insurance and a usual source of care on a child’s receipt of health care. J Pediatr Health Care. 2012;26(5):e25-e35. DOI: https://doi.org/10.1016/j.pedhc.2011.01.003 https://doi.org/10.1016/j.pedhc.2011.01.... .	A criança tinha cobertura de seguro saúde e/ou FUC no mesmo período durante o ano?	1
			Jerant et al., 2013⁴¹41 Jerant A, Bertakis KD, Fenton JJ, et al. Gender of physician as the usual source of care and patient health care utilization and mortality. J Am Board Fam Med. 2013;26(2):138-48. DOI: https://doi.org/10.3122/jabfm.2013.02.120198 https://doi.org/10.3122/jabfm.2013.02.12... ; Dourado; Medina; Aquino, 2016⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7 https://doi.org/10.1186/s12939-016-0440-... ; Khan; Thapa; Zhang, 2017⁴³43 Khan A, Thapa JR, Zhang D. Preventive dental checkups and their association with access to usual source of care among rural and urban adult residents. J Rural Health. 2017;33(4):419-26. DOI: https://doi.org/10.1111/jrh.12271. https://doi.org/10.1111/jrh.12271... ; Sung; Lee, 2019⁶6 Sung NJ, Lee JH. Association between types of usual source of care and user perception of overall health care service quality in Korea. Korean. J Fam Med. 2019;40(3):143-50. DOI: https://doi.org/10.4082/kjfm.17.0093 https://doi.org/10.4082/kjfm.17.0093... .	Você costuma ir ao mesmo lugar, ao mesmo médico ou serviço de saúde quando precisa de cuidados de saúde?	4
			Stewart et al., 2019.	Você sabe onde seu tio vai ao médico?	1
Rohrer; Kruse; Zhang, 2004⁸8 Rohrer JE, Kruse G, Zhang Y. Hispanic ethnicity, rural residence, and regular source of care. J Community Health. 2004;29(1):1-13. DOI: https://doi.org/10.1023/b:johe.0000007441.84668.ac https://doi.org/10.1023/b:johe.000000744... ; Devoe; Petering; Krois, 2008¹⁷17 Devoe JE, Petering R, Krois L. A usual source of care: Supplement or substitute for health insurance among low-income children? Med Care. 2008;46(10):1041-8. DOI: https://doi.org/10.1097/MLR.0b013e3181866443 https://doi.org/10.1097/MLR.0b013e318186... ; Devoe et al., 2009⁵⁰50 Devoe JE, Saultz JW, Krois L, et al. A medical home versus temporary housing: The importance of a stable usual source of care. Pediatrics. 2009;124(5):1363-71. DOI: https://doi.org/10.1542/peds.2008-3141 https://doi.org/10.1542/peds.2008-3141... ; Choi, 2011⁵¹51 Choi S. Longitudinal changes in access to health care by immigrant status among older adults: The importance of health insurance as a mediator. Gerontologist. 2011;51(2):156-69. DOI: https://doi.org/10.1542/peds.2008-3141 https://doi.org/10.1542/peds.2008-3141... ; Cunningham, 2015⁵²52 Cunningham PJ. Many medicaid beneficiaries receive care consistent with attributes of patient-centered medical homes. Health Aff (Millwood). 2015;34(7):1105-12. DOI: https://doi.org/10.1377/hlthaff.2015.0141 https://doi.org/10.1377/hlthaff.2015.014... ; Cross; Kelly, 2015⁵³53 Cross S, Kelly P. Access to care based on state nurse practitioner practice regulation: secondary data analysis results in the medicare population. J Am Assoc Nurse Pract. 2015;27(1):21-30. DOI: https://doi.org/10.1002/2327-6924.12191 https://doi.org/10.1002/2327-6924.12191... .	Refere-se a um indicador que avalia acesso, sendo que o acesso foi definido como a capacidade de um indivíduo obter serviços de saúde quando necessário.	6	Rohrer; Kruse; Zhang, 200⁴⁸48 Davis MA, Guo C, Titler MG, et al. Advanced practice clinicians as a usual source of care for adults in the United States. Nursing Outlook. 2017;65(1):41-9. DOI: https://doi.org/10.1016/j.outlook.2016.07.006 https://doi.org/10.1016/j.outlook.2016.0... .	Você tem um local de atendimento usual, e um médico pessoal ou enfermeira?	1
			Devoe; Petering; Krois, 2008¹⁷17 Devoe JE, Petering R, Krois L. A usual source of care: Supplement or substitute for health insurance among low-income children? Med Care. 2008;46(10):1041-8. DOI: https://doi.org/10.1097/MLR.0b013e3181866443 https://doi.org/10.1097/MLR.0b013e318186... ; Devoe et al., 2009⁵⁰50 Devoe JE, Saultz JW, Krois L, et al. A medical home versus temporary housing: The importance of a stable usual source of care. Pediatrics. 2009;124(5):1363-71. DOI: https://doi.org/10.1542/peds.2008-3141 https://doi.org/10.1542/peds.2008-3141... .	Onde costumam ir ou leva seus filhos quando estão doentes ou precisam de cuidados de saúde?	2
			Choi, 2011⁵¹51 Choi S. Longitudinal changes in access to health care by immigrant status among older adults: The importance of health insurance as a mediator. Gerontologist. 2011;51(2):156-69. DOI: https://doi.org/10.1542/peds.2008-3141 https://doi.org/10.1542/peds.2008-3141... .	Você tem FUC?	1
			Cross; Kelly, 2015⁵³53 Cross S, Kelly P. Access to care based on state nurse practitioner practice regulation: secondary data analysis results in the medicare population. J Am Assoc Nurse Pract. 2015;27(1):21-30. DOI: https://doi.org/10.1002/2327-6924.12191 https://doi.org/10.1002/2327-6924.12191... .	Há algum médico ou clínica particular que você costuma ir quando está doente ou para obter conselhos sobre sua saúde?	1
			Cunningham, 2015⁵²52 Cunningham PJ. Many medicaid beneficiaries receive care consistent with attributes of patient-centered medical homes. Health Aff (Millwood). 2015;34(7):1105-12. DOI: https://doi.org/10.1377/hlthaff.2015.0141 https://doi.org/10.1377/hlthaff.2015.014... .	Há um determinado provedor de cuidados de saúde (diferente de um hospital de emergência) a quem geralmente procura quando está doente ou precisando de aconselhamentos sobre saúde?	1
Stockwell et al., 2010⁴⁷47 Stockwell MS, Findley SE, Irigoyen M, et al. Change in parental reasons for use of an urban pediatric emergency department in the past decade. Pediatr Emerg Care. 2010;26(3):181-5. DOI: https://doi.org/10.1097/pec.0b013e3181d1dfc7 https://doi.org/10.1097/pec.0b013e3181d1... ; Davis et al., 2017⁴⁸48 Davis MA, Guo C, Titler MG, et al. Advanced practice clinicians as a usual source of care for adults in the United States. Nursing Outlook. 2017;65(1):41-9. DOI: https://doi.org/10.1016/j.outlook.2016.07.006 https://doi.org/10.1016/j.outlook.2016.0... ; Berk; Bernstein, 1982⁷7 Berk ML, Bernstein AB. Regular source of care and the minority aged. J Am Geriatr Soc. 1982;30(4):251-4. DOI: https://doi.org/10.1111/j.1532-5415.1982.tb07096.x https://doi.org/10.1111/j.1532-5415.1982... ; Rew; Resnick; Beuhring, 1999⁴⁹49 Rew L, Resnick M, Beuhring T. Usual sources, patterns of utilization, and foregone health care among Hispanic adolescents. J Adolesc Health. 1999;25(6):407-13. DOI: https://doi.org/10.1016/s1054-139x(98)00159-1 https://doi.org/10.1016/s1054-139x(98)00... ; Tsai et al., 2010²2 Tsai J, Shi L, Yu WL, et al. Usual source of care and the quality of medical care experiences: a cross-sectional survey of patients from a Taiwanese Community. Med Care. 2010;48(7):628-34. DOI: https://doi.org/10.1097/MLR.0b013e3181dbdf76 https://doi.org/10.1097/MLR.0b013e3181db... ; Du et al., 2015³3 Du Z, Liao Y, Chen CC, et al. Usual source of care and the quality of primary care: a survey of patients in Guangdong province, China. Int J Equity Health. 2015;14:60. DOI: https://doi.org/10.1186/s12939-015-0189-4 https://doi.org/10.1186/s12939-015-0189-... .	Consultório médico específico, clínica, centro de saúde ou outro lugar para onde o indivíduo costuma ir quando está doente, precisando de conselhos de saúde ou de cuidados primários.	6	Stockwell et al., 2010⁴⁷47 Stockwell MS, Findley SE, Irigoyen M, et al. Change in parental reasons for use of an urban pediatric emergency department in the past decade. Pediatr Emerg Care. 2010;26(3):181-5. DOI: https://doi.org/10.1097/pec.0b013e3181d1dfc7 https://doi.org/10.1097/pec.0b013e3181d1... .	Por que hoje você não levou seu filho para o seu médico regular? O que fez você hoje vir para a sala de emergência em vez de ir para o médico de cuidados primários da criança?	1
			Davis et al., 2017⁴⁸48 Davis MA, Guo C, Titler MG, et al. Advanced practice clinicians as a usual source of care for adults in the United States. Nursing Outlook. 2017;65(1):41-9. DOI: https://doi.org/10.1016/j.outlook.2016.07.006 https://doi.org/10.1016/j.outlook.2016.0... .	Há algum consultório médico, clínica, centro de saúde ou outro lugar que você geralmente vai se estiver doente ou precisar de aconselhamento sobre sua saúde ou precisando fazer um check-up?	1
			Tsai et al., 2010²2 Tsai J, Shi L, Yu WL, et al. Usual source of care and the quality of medical care experiences: a cross-sectional survey of patients from a Taiwanese Community. Med Care. 2010;48(7):628-34. DOI: https://doi.org/10.1097/MLR.0b013e3181dbdf76 https://doi.org/10.1097/MLR.0b013e3181db... .	Existe um médico ou lugar que você costuma ir se estiver doente ou precisar conselhos sobre sua saúde? Existe um médico ou lugar que conhece você melhor como pessoa? Há um médico ou lugar que é o mais responsável pelos seus cuidados de saúde?	1
			Berk; Bernstein, 1982⁷7 Berk ML, Bernstein AB. Regular source of care and the minority aged. J Am Geriatr Soc. 1982;30(4):251-4. DOI: https://doi.org/10.1111/j.1532-5415.1982.tb07096.x https://doi.org/10.1111/j.1532-5415.1982... ; Rew; Resnick; Beuhring, 1999⁴⁹49 Rew L, Resnick M, Beuhring T. Usual sources, patterns of utilization, and foregone health care among Hispanic adolescents. J Adolesc Health. 1999;25(6):407-13. DOI: https://doi.org/10.1016/s1054-139x(98)00159-1 https://doi.org/10.1016/s1054-139x(98)00... .	Onde costumam ir ou leva seus filhos quando estão doentes ou precisando de cuidados de saúde?	2
			Du et al., 2015³3 Du Z, Liao Y, Chen CC, et al. Usual source of care and the quality of primary care: a survey of patients in Guangdong province, China. Int J Equity Health. 2015;14:60. DOI: https://doi.org/10.1186/s12939-015-0189-4 https://doi.org/10.1186/s12939-015-0189-... .	Tem um médico ou outro profissional de saúde que você costuma ir quando está doente?	1
Hammond; Matthews; Smith, 2010⁵⁴54 Hammond WP, Matthews D, Smith GC. Psychosocial factors associated with routine health examination scheduling and receipt among African American men. J Natl Med Assoc. 2010;102(4):276-89. DOI: https://doi.org/10.1016/s0027-9684(15)30600-3 https://doi.org/10.1016/s0027-9684(15)30... .	Constitui um facilitador significativo de agendamento e recebimento de exames de saúde de rotina.	1	Hammond; Matthews; Smith, 2010⁵⁴54 Hammond WP, Matthews D, Smith GC. Psychosocial factors associated with routine health examination scheduling and receipt among African American men. J Natl Med Assoc. 2010;102(4):276-89. DOI: https://doi.org/10.1016/s0027-9684(15)30600-3 https://doi.org/10.1016/s0027-9684(15)30... .	No ano passado, você marcou alguma consulta com um médico ou outro provedor de saúde para cuidados de saúde de rotina ou regulares?	1
Lau et al., 2013⁵⁵55 Lau JS, Adams SH, Irwin Jr CE, et al. Receipt of preventive health services in young adults. J Adolesc Health. 2013;52(1):42-9. DOI: https://doi.org/10.1016/j.jadohealth.2012.04.017 https://doi.org/10.1016/j.jadohealth.201... .	É um componente do conceito de casa médica (Patient-centered Medical Home (PCMH), amplamente utilizado para melhorar a qualidade do atendimento para adolescentes em idade de transição.	1	Lau et al., 2013⁵⁵55 Lau JS, Adams SH, Irwin Jr CE, et al. Receipt of preventive health services in young adults. J Adolesc Health. 2013;52(1):42-9. DOI: https://doi.org/10.1016/j.jadohealth.2012.04.017 https://doi.org/10.1016/j.jadohealth.201... .	Há algum lugar que você costuma ir se estiver doente ou precisar de aconselhamento sobre sua saúde?	1

Reconhecimento de uma FUC				Tipo de FUC
Fatores determinantes	Categoria com maior chance de referir uma FUC	Nº de artigos	Referências	Categoria com maior chance de referir uma FUC segundo tipo		Nº de artigos	Referências
				APS	Emergência
Demográficos
Idade	Mais jovens	3	Klein et al., 1999²⁸28 Klein JD, Wilson KM, Mcnulty M, et al. Access to medical care for adolescents: results from the 1997 commonwealth fund survey of the health of adolescent girls. J Adolesc Health. 1999;25(2):120-30. DOI: https://doi.org/10.1016/s1054-139x(98)00146-3 https://doi.org/10.1016/s1054-139x(98)00... ; Devoe et al., 2009⁵⁰50 Devoe JE, Saultz JW, Krois L, et al. A medical home versus temporary housing: The importance of a stable usual source of care. Pediatrics. 2009;124(5):1363-71. DOI: https://doi.org/10.1542/peds.2008-3141 https://doi.org/10.1542/peds.2008-3141... ; Devoe et al., 2011¹⁰10 Devoe JE, Tillotson CJ, Wallace LS, et al. Parent and child usual source of care and children’s receipt of health care services. Ann Fam Med. 2011;9(6):504-13. DOI: https://doi.org/10.1370/afm.1300 https://doi.org/10.1370/afm.1300...
Sexo	Feminino	2	Rew; Resnick; Beuhring, 1999⁴⁹49 Rew L, Resnick M, Beuhring T. Usual sources, patterns of utilization, and foregone health care among Hispanic adolescents. J Adolesc Health. 1999;25(6):407-13. DOI: https://doi.org/10.1016/s1054-139x(98)00159-1 https://doi.org/10.1016/s1054-139x(98)00... ; Klein et al., 1999²⁸28 Klein JD, Wilson KM, Mcnulty M, et al. Access to medical care for adolescents: results from the 1997 commonwealth fund survey of the health of adolescent girls. J Adolesc Health. 1999;25(2):120-30. DOI: https://doi.org/10.1016/s1054-139x(98)00146-3 https://doi.org/10.1016/s1054-139x(98)00...	Feminino	Masculino	1	Klein et al., 1999²⁸28 Klein JD, Wilson KM, Mcnulty M, et al. Access to medical care for adolescents: results from the 1997 commonwealth fund survey of the health of adolescent girls. J Adolesc Health. 1999;25(2):120-30. DOI: https://doi.org/10.1016/s1054-139x(98)00146-3 https://doi.org/10.1016/s1054-139x(98)00...
Socioeconômicos
Raça/cor	Brancos	1	Klein et al., 1999²⁸28 Klein JD, Wilson KM, Mcnulty M, et al. Access to medical care for adolescents: results from the 1997 commonwealth fund survey of the health of adolescent girls. J Adolesc Health. 1999;25(2):120-30. DOI: https://doi.org/10.1016/s1054-139x(98)00146-3 https://doi.org/10.1016/s1054-139x(98)00...		Afro-americanos	1	Wilson; Klein, 2000²⁹29 Wilson KM, Klein JD. Adolescents who use the emergency department as their usual source of care. Arch Pediatr Adolesc Med. 2000;154(4):361-5. DOI: https://doi.org/10.1001/archpedi.154.4.361 https://doi.org/10.1001/archpedi.154.4.3...
	Não-hispânico	1	Devoe et al., 2009⁵⁰50 Devoe JE, Saultz JW, Krois L, et al. A medical home versus temporary housing: The importance of a stable usual source of care. Pediatrics. 2009;124(5):1363-71. DOI: https://doi.org/10.1542/peds.2008-3141 https://doi.org/10.1542/peds.2008-3141...
Escolaridade	Maior escolaridade	2	Devoe et al., 2011¹⁰10 Devoe JE, Tillotson CJ, Wallace LS, et al. Parent and child usual source of care and children’s receipt of health care services. Ann Fam Med. 2011;9(6):504-13. DOI: https://doi.org/10.1370/afm.1300 https://doi.org/10.1370/afm.1300... ; Devoe et al., 2012³²32 Devoe JE, Tillotson CJ, Wallace LS, et al. Is health insurance enough? A usual source of care may be more important to ensure a child receives preventive health counseling. Matern Child Health J. 2012;16(2):306-15. DOI: https://doi.org/10.1007%2Fs10995-011-0762-4 https://doi.org/10.1007%2Fs10995-011-076...		Menor escolaridade dos pais	1	Wilson; Klein, 2000²⁹29 Wilson KM, Klein JD. Adolescents who use the emergency department as their usual source of care. Arch Pediatr Adolesc Med. 2000;154(4):361-5. DOI: https://doi.org/10.1001/archpedi.154.4.361 https://doi.org/10.1001/archpedi.154.4.3...
Ocupação	Pai empregado	1	Guendelman; Wyn; Tsai, 2000³⁹39 Guendelman S, Wyn R, Tsai YW. Children of working low-income families in California: does parental work benefit children’s insurance status, access, and utilization of primary health care? Health Serv Res. 2000;35(2);417-41.
Condições financeiras	Boas condições de renda	3	Devoe et al., 2011¹⁰10 Devoe JE, Tillotson CJ, Wallace LS, et al. Parent and child usual source of care and children’s receipt of health care services. Ann Fam Med. 2011;9(6):504-13. DOI: https://doi.org/10.1370/afm.1300 https://doi.org/10.1370/afm.1300... ; Devoe et al., 2012³²32 Devoe JE, Tillotson CJ, Wallace LS, et al. Is health insurance enough? A usual source of care may be more important to ensure a child receives preventive health counseling. Matern Child Health J. 2012;16(2):306-15. DOI: https://doi.org/10.1007%2Fs10995-011-0762-4 https://doi.org/10.1007%2Fs10995-011-076... ; Devoe et al., 2012⁴⁰40 Devoe JE, Tillotson CJ, Wallace LS, et al. The Effects of health insurance and a usual source of care on a child’s receipt of health care. J Pediatr Health Care. 2012;26(5):e25-e35. DOI: https://doi.org/10.1016/j.pedhc.2011.01.003 https://doi.org/10.1016/j.pedhc.2011.01....
Local de residência					Residir na zona rural	1	Wilson; Klein, 2000²⁹29 Wilson KM, Klein JD. Adolescents who use the emergency department as their usual source of care. Arch Pediatr Adolesc Med. 2000;154(4):361-5. DOI: https://doi.org/10.1001/archpedi.154.4.361 https://doi.org/10.1001/archpedi.154.4.3...
Seguro saúde	Seguro (privado ou público)	2	Devoe et al., 2012³²32 Devoe JE, Tillotson CJ, Wallace LS, et al. Is health insurance enough? A usual source of care may be more important to ensure a child receives preventive health counseling. Matern Child Health J. 2012;16(2):306-15. DOI: https://doi.org/10.1007%2Fs10995-011-0762-4 https://doi.org/10.1007%2Fs10995-011-076... ; Devoe et al., 2012⁴⁰40 Devoe JE, Tillotson CJ, Wallace LS, et al. The Effects of health insurance and a usual source of care on a child’s receipt of health care. J Pediatr Health Care. 2012;26(5):e25-e35. DOI: https://doi.org/10.1016/j.pedhc.2011.01.003 https://doi.org/10.1016/j.pedhc.2011.01....
	Seguro privado	2	Newacheck et al., 1998²⁶26 Newacheck PW, Stoddard JJ, Hughes DC, et al. Health insurance and access to primary care for children. N Engl J Med. 1998;338(8):513-9. DOI: https://doi.org/10.1056/nejm199802193380806 https://doi.org/10.1056/nejm199802193380... ; Guendelman; Wyn; Tsai, 2000³⁹39 Guendelman S, Wyn R, Tsai YW. Children of working low-income families in California: does parental work benefit children’s insurance status, access, and utilization of primary health care? Health Serv Res. 2000;35(2);417-41.
	Seguro público	2	Devoe; Petering; Krois, 2008¹⁷17 Devoe JE, Petering R, Krois L. A usual source of care: Supplement or substitute for health insurance among low-income children? Med Care. 2008;46(10):1041-8. DOI: https://doi.org/10.1097/MLR.0b013e3181866443 https://doi.org/10.1097/MLR.0b013e318186... ; Devoe et al., 2009⁵⁰50 Devoe JE, Saultz JW, Krois L, et al. A medical home versus temporary housing: The importance of a stable usual source of care. Pediatrics. 2009;124(5):1363-71. DOI: https://doi.org/10.1542/peds.2008-3141 https://doi.org/10.1542/peds.2008-3141...		Falta de seguro Saúde	1	Wilson; Klein, 2000²⁹29 Wilson KM, Klein JD. Adolescents who use the emergency department as their usual source of care. Arch Pediatr Adolesc Med. 2000;154(4):361-5. DOI: https://doi.org/10.1001/archpedi.154.4.361 https://doi.org/10.1001/archpedi.154.4.3...
Estado de saúde, hábitos e comportamentos
Comportamentos de vida	Atividade sexual ativa	1	Mckee; Fletcher, 2006³⁰30 Mckee MD, Fletcher J. Primary care for urban adolescent girls from ethnically diverse populations: foregone care and access to confidential care. J Health Care Poor Underserved. 2006;17(4):759-74. DOI: https://doi.org/10.1353/hpu.2006.0131 https://doi.org/10.1353/hpu.2006.0131...
Estado de saúde	Bom ou excelente	1	Klein et al., 1999²⁸28 Klein JD, Wilson KM, Mcnulty M, et al. Access to medical care for adolescents: results from the 1997 commonwealth fund survey of the health of adolescent girls. J Adolesc Health. 1999;25(2):120-30. DOI: https://doi.org/10.1016/s1054-139x(98)00146-3 https://doi.org/10.1016/s1054-139x(98)00...
Serviço de saúde
Vínculo profisisonal e paciente	Confiança no profissional de saúde	1	Mckee; Fletcher, 2006³⁰30 Mckee MD, Fletcher J. Primary care for urban adolescent girls from ethnically diverse populations: foregone care and access to confidential care. J Health Care Poor Underserved. 2006;17(4):759-74. DOI: https://doi.org/10.1353/hpu.2006.0131 https://doi.org/10.1353/hpu.2006.0131...		Confiança no pediatra da emergência	1	Stockwell et al., 2010⁴⁷47 Stockwell MS, Findley SE, Irigoyen M, et al. Change in parental reasons for use of an urban pediatric emergency department in the past decade. Pediatr Emerg Care. 2010;26(3):181-5. DOI: https://doi.org/10.1097/pec.0b013e3181d1dfc7 https://doi.org/10.1097/pec.0b013e3181d1...
Ações ofertadas	Acesso a ações preventivas	1	Devoe et al., 2011¹⁰10 Devoe JE, Tillotson CJ, Wallace LS, et al. Parent and child usual source of care and children’s receipt of health care services. Ann Fam Med. 2011;9(6):504-13. DOI: https://doi.org/10.1370/afm.1300 https://doi.org/10.1370/afm.1300...
Satisfação do usuário	Necessidades atendidas	1	Devoe et al., 2011¹⁰10 Devoe JE, Tillotson CJ, Wallace LS, et al. Parent and child usual source of care and children’s receipt of health care services. Ann Fam Med. 2011;9(6):504-13. DOI: https://doi.org/10.1370/afm.1300 https://doi.org/10.1370/afm.1300...

Reconhecimento de uma FUC				Tipo de FUC
Fatores determinantes	Categoria com maior chance de referir uma FUC	Nº artigos	Referências	Categoria com maior chance de referir uma FUC segundo tipo			Nº artigos	Referências
				APS	Emergência/ hospital	Especialista
Demográficos
Idade	Mais Jovens	3	Jerant et al., 2013⁴¹41 Jerant A, Bertakis KD, Fenton JJ, et al. Gender of physician as the usual source of care and patient health care utilization and mortality. J Am Board Fam Med. 2013;26(2):138-48. DOI: https://doi.org/10.3122/jabfm.2013.02.120198 https://doi.org/10.3122/jabfm.2013.02.12... ; Cunningham, 2015⁵²52 Cunningham PJ. Many medicaid beneficiaries receive care consistent with attributes of patient-centered medical homes. Health Aff (Millwood). 2015;34(7):1105-12. DOI: https://doi.org/10.1377/hlthaff.2015.0141 https://doi.org/10.1377/hlthaff.2015.014... ; Davis et al., 2017⁴⁸48 Davis MA, Guo C, Titler MG, et al. Advanced practice clinicians as a usual source of care for adults in the United States. Nursing Outlook. 2017;65(1):41-9. DOI: https://doi.org/10.1016/j.outlook.2016.07.006 https://doi.org/10.1016/j.outlook.2016.0...			Mais jovens	1	Hall et al., 2015³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025 https://doi.org/10.1016/j.ajog.2015.04.0...
	Mais velhas (acima de 60 anos	7	Berk; Bernstein, 1982⁷7 Berk ML, Bernstein AB. Regular source of care and the minority aged. J Am Geriatr Soc. 1982;30(4):251-4. DOI: https://doi.org/10.1111/j.1532-5415.1982.tb07096.x https://doi.org/10.1111/j.1532-5415.1982... ; Rohrer; Kruse; Zhang, 2004⁸8 Rohrer JE, Kruse G, Zhang Y. Hispanic ethnicity, rural residence, and regular source of care. J Community Health. 2004;29(1):1-13. DOI: https://doi.org/10.1023/b:johe.0000007441.84668.ac https://doi.org/10.1023/b:johe.000000744... ; An et al., 2016⁴²42 An AR, Kim K, Lee JH, et al. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey. BMC Fam Pract. 2016;17(1):167. DOI: https://doi.org/10.1186/s12875-016-0555-3 https://doi.org/10.1186/s12875-016-0555-... ; Dourado; Medina; Aquino, 2016⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7 https://doi.org/10.1186/s12939-016-0440-... ; Kim; Jeon; Lee, 2017¹⁸18 Kim KM, Jeon H, Lee JH. Having a physician rather than a place as a usual source of care would be better - from 2012 Korea health panel data. J Korean Med Sci. 2017;32(1):4-12. DOI: https://doi.org/10.3346/jkms.2017.32.1.4 https://doi.org/10.3346/jkms.2017.32.1.4... ; Kim et al., 2019⁴⁶46 Kim D, Kim S, Park HK, et al. Effect of having a usual source of care on medical expenses - using the korea health panel data. J Korean Med Sci. 2019;34(35):e229. DOI: https://doi.org/10.3346/jkms.2019.34.e229 https://doi.org/10.3346/jkms.2019.34.e22... ; Sung; Lee, 2019⁶6 Sung NJ, Lee JH. Association between types of usual source of care and user perception of overall health care service quality in Korea. Korean. J Fam Med. 2019;40(3):143-50. DOI: https://doi.org/10.4082/kjfm.17.0093 https://doi.org/10.4082/kjfm.17.0093...	45 anos ou mais			1	Dourado; Medina; Aquino, 2016⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7 https://doi.org/10.1186/s12939-016-0440-...
Sexo	Feminino	8	Rohrer; Kruse; Zhang, 2004⁸8 Rohrer JE, Kruse G, Zhang Y. Hispanic ethnicity, rural residence, and regular source of care. J Community Health. 2004;29(1):1-13. DOI: https://doi.org/10.1023/b:johe.0000007441.84668.ac https://doi.org/10.1023/b:johe.000000744... ; Tsai et al., 2010²2 Tsai J, Shi L, Yu WL, et al. Usual source of care and the quality of medical care experiences: a cross-sectional survey of patients from a Taiwanese Community. Med Care. 2010;48(7):628-34. DOI: https://doi.org/10.1097/MLR.0b013e3181dbdf76 https://doi.org/10.1097/MLR.0b013e3181db... ; Jerant et al., 2013⁴¹41 Jerant A, Bertakis KD, Fenton JJ, et al. Gender of physician as the usual source of care and patient health care utilization and mortality. J Am Board Fam Med. 2013;26(2):138-48. DOI: https://doi.org/10.3122/jabfm.2013.02.120198 https://doi.org/10.3122/jabfm.2013.02.12... ; An et al., 2016⁴²42 An AR, Kim K, Lee JH, et al. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey. BMC Fam Pract. 2016;17(1):167. DOI: https://doi.org/10.1186/s12875-016-0555-3 https://doi.org/10.1186/s12875-016-0555-... ; Dourado; Medina; Aquino, 2016⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7 https://doi.org/10.1186/s12939-016-0440-... ; Davis et al., 2017⁴⁸48 Davis MA, Guo C, Titler MG, et al. Advanced practice clinicians as a usual source of care for adults in the United States. Nursing Outlook. 2017;65(1):41-9. DOI: https://doi.org/10.1016/j.outlook.2016.07.006 https://doi.org/10.1016/j.outlook.2016.0... ; Kim; Jeon; Lee, 2017¹⁸18 Kim KM, Jeon H, Lee JH. Having a physician rather than a place as a usual source of care would be better - from 2012 Korea health panel data. J Korean Med Sci. 2017;32(1):4-12. DOI: https://doi.org/10.3346/jkms.2017.32.1.4 https://doi.org/10.3346/jkms.2017.32.1.4... ; Sung; Lee, 2019⁶6 Sung NJ, Lee JH. Association between types of usual source of care and user perception of overall health care service quality in Korea. Korean. J Fam Med. 2019;40(3):143-50. DOI: https://doi.org/10.4082/kjfm.17.0093 https://doi.org/10.4082/kjfm.17.0093...	Feminino		Feminino	2	Hall et al., 2015³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025 https://doi.org/10.1016/j.ajog.2015.04.0... ; Dourado; Medina; Aquino, 2016⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7 https://doi.org/10.1186/s12939-016-0440-...
	Masculino	3	Hammond; Matthews; Smith, 2010⁵⁴54 Hammond WP, Matthews D, Smith GC. Psychosocial factors associated with routine health examination scheduling and receipt among African American men. J Natl Med Assoc. 2010;102(4):276-89. DOI: https://doi.org/10.1016/s0027-9684(15)30600-3 https://doi.org/10.1016/s0027-9684(15)30... ; Kim et al., 2019⁴⁶46 Kim D, Kim S, Park HK, et al. Effect of having a usual source of care on medical expenses - using the korea health panel data. J Korean Med Sci. 2019;34(35):e229. DOI: https://doi.org/10.3346/jkms.2019.34.e229 https://doi.org/10.3346/jkms.2019.34.e22...
Estado civil	Casado	1	Rohrer; Kruse; Zhang, 2004⁸8 Rohrer JE, Kruse G, Zhang Y. Hispanic ethnicity, rural residence, and regular source of care. J Community Health. 2004;29(1):1-13. DOI: https://doi.org/10.1023/b:johe.0000007441.84668.ac https://doi.org/10.1023/b:johe.000000744...	Solteiro			1	Hall et al., 2015³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025 https://doi.org/10.1016/j.ajog.2015.04.0...
	Divorciado/separado/viúvo	3	An et al., 2016⁴²42 An AR, Kim K, Lee JH, et al. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey. BMC Fam Pract. 2016;17(1):167. DOI: https://doi.org/10.1186/s12875-016-0555-3 https://doi.org/10.1186/s12875-016-0555-... ; Kim; Jeon; Lee, 2017¹⁸18 Kim KM, Jeon H, Lee JH. Having a physician rather than a place as a usual source of care would be better - from 2012 Korea health panel data. J Korean Med Sci. 2017;32(1):4-12. DOI: https://doi.org/10.3346/jkms.2017.32.1.4 https://doi.org/10.3346/jkms.2017.32.1.4... ; Sung; Lee, 2019⁶6 Sung NJ, Lee JH. Association between types of usual source of care and user perception of overall health care service quality in Korea. Korean. J Fam Med. 2019;40(3):143-50. DOI: https://doi.org/10.4082/kjfm.17.0093 https://doi.org/10.4082/kjfm.17.0093...
Socioeconômicos
Raça/cor	Não - hispânico	3	Moy et al., 1998²⁷27 Moy E, Bartman BA, Clancy CM, et al. Changes in usual sources of medical care between 1987 and 1992. J Health Care Poor Underserved. 1998;9(2):126-39. DOI: https://doi.org/10.1353/hpu.2010.0305 https://doi.org/10.1353/hpu.2010.0305... ; Jerant et al., 2013⁴¹41 Jerant A, Bertakis KD, Fenton JJ, et al. Gender of physician as the usual source of care and patient health care utilization and mortality. J Am Board Fam Med. 2013;26(2):138-48. DOI: https://doi.org/10.3122/jabfm.2013.02.120198 https://doi.org/10.3122/jabfm.2013.02.12... ; Liaw et al., 2018⁴⁴44 Liaw W, Jetty A, Petterson S, et al. Trends in the types of usual sources of care: a shift from people to places or nothing at all. Health Serv Res. 2018;53(4):2346-67. DOI: https://doi.org/10.1111/1475-6773.12753. https://doi.org/10.1111/1475-6773.12753...	Mesma raça do usuário e profissional			1	Martin; Shi; Ward, 2009³¹31 Martin BC, Shi L, Ward RD. Race, gender, and language concordance in the primary care setting. Int J Health Care Qual Assur. 2009;22(4):340-52. DOI: https://doi.org/10.1108/09526860910964816 https://doi.org/10.1108/0952686091096481...
	Branco	4	Berk; Bernstein, 1982⁷7 Berk ML, Bernstein AB. Regular source of care and the minority aged. J Am Geriatr Soc. 1982;30(4):251-4. DOI: https://doi.org/10.1111/j.1532-5415.1982.tb07096.x https://doi.org/10.1111/j.1532-5415.1982... ; Rohrer; Kruse; Zhang, 2004⁸8 Rohrer JE, Kruse G, Zhang Y. Hispanic ethnicity, rural residence, and regular source of care. J Community Health. 2004;29(1):1-13. DOI: https://doi.org/10.1023/b:johe.0000007441.84668.ac https://doi.org/10.1023/b:johe.000000744... ; Dourado; Medina; Aquino, 2016⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7 https://doi.org/10.1186/s12939-016-0440-... ; Davis et al., 2017⁴⁸48 Davis MA, Guo C, Titler MG, et al. Advanced practice clinicians as a usual source of care for adults in the United States. Nursing Outlook. 2017;65(1):41-9. DOI: https://doi.org/10.1016/j.outlook.2016.07.006 https://doi.org/10.1016/j.outlook.2016.0...	Branca		Branca	2	Arnett et al., 2016³⁶36 Arnett MJ, Thorpe Jr RJ, Gaskin DJ, et al. Race, medical mistrust, and segregation in primary care as usual source of care: findings from the exploring health disparities in integrated communities study. J Urban Health. 2016;93(3):456-67. DOI: https://doi.org/10.1007/s11524-016-0054-9 https://doi.org/10.1007/s11524-016-0054-... ; Hall et al., 2015³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025 https://doi.org/10.1016/j.ajog.2015.04.0...
	Negros	1	Jerant et al., 2013⁴¹41 Jerant A, Bertakis KD, Fenton JJ, et al. Gender of physician as the usual source of care and patient health care utilization and mortality. J Am Board Fam Med. 2013;26(2):138-48. DOI: https://doi.org/10.3122/jabfm.2013.02.120198 https://doi.org/10.3122/jabfm.2013.02.12...	pardos ou indigenas	Afro-americanos/ não brancos		3	Berk; Bernstein, 1982⁷7 Berk ML, Bernstein AB. Regular source of care and the minority aged. J Am Geriatr Soc. 1982;30(4):251-4. DOI: https://doi.org/10.1111/j.1532-5415.1982.tb07096.x https://doi.org/10.1111/j.1532-5415.1982... ; Arnett et al., 2016³⁶36 Arnett MJ, Thorpe Jr RJ, Gaskin DJ, et al. Race, medical mistrust, and segregation in primary care as usual source of care: findings from the exploring health disparities in integrated communities study. J Urban Health. 2016;93(3):456-67. DOI: https://doi.org/10.1007/s11524-016-0054-9 https://doi.org/10.1007/s11524-016-0054-... ; Dourado; Medina; Aquino, 2016⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7 https://doi.org/10.1186/s12939-016-0440-... ;
	Grupos não minorias raciais	1	Cunningham, 2015⁵²52 Cunningham PJ. Many medicaid beneficiaries receive care consistent with attributes of patient-centered medical homes. Health Aff (Millwood). 2015;34(7):1105-12. DOI: https://doi.org/10.1377/hlthaff.2015.0141 https://doi.org/10.1377/hlthaff.2015.014...				1	Hall et al., 2015³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025 https://doi.org/10.1016/j.ajog.2015.04.0...
Escolaridade	Maior escolaridade	4	Moy et al., 1998²⁷27 Moy E, Bartman BA, Clancy CM, et al. Changes in usual sources of medical care between 1987 and 1992. J Health Care Poor Underserved. 1998;9(2):126-39. DOI: https://doi.org/10.1353/hpu.2010.0305 https://doi.org/10.1353/hpu.2010.0305... ; Macinko; Lima-Costa, 2012³³33 Macinko J, Lima-Costa MF. Horizontal equity in health care utilization in Brazil, 1998-2008. Int J Equity Health. 2012;11:33. DOI: https://doi.org/10.1186%2F1475-9276-11-33 https://doi.org/10.1186%2F1475-9276-11-3... ; Jerant et al., 2013⁴¹41 Jerant A, Bertakis KD, Fenton JJ, et al. Gender of physician as the usual source of care and patient health care utilization and mortality. J Am Board Fam Med. 2013;26(2):138-48. DOI: https://doi.org/10.3122/jabfm.2013.02.120198 https://doi.org/10.3122/jabfm.2013.02.12... ; Dourado; Medina; Aquino, 2016⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7 https://doi.org/10.1186/s12939-016-0440-...
	Baixo nível de escolaridade	4	An et al., 2016⁴²42 An AR, Kim K, Lee JH, et al. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey. BMC Fam Pract. 2016;17(1):167. DOI: https://doi.org/10.1186/s12875-016-0555-3 https://doi.org/10.1186/s12875-016-0555-... ; Dourado; Medina; Aquino, 2016⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7 https://doi.org/10.1186/s12939-016-0440-... ; Kim; Jeon; Lee, 2017¹⁸18 Kim KM, Jeon H, Lee JH. Having a physician rather than a place as a usual source of care would be better - from 2012 Korea health panel data. J Korean Med Sci. 2017;32(1):4-12. DOI: https://doi.org/10.3346/jkms.2017.32.1.4 https://doi.org/10.3346/jkms.2017.32.1.4... ; Sung; Lee, 2019⁶6 Sung NJ, Lee JH. Association between types of usual source of care and user perception of overall health care service quality in Korea. Korean. J Fam Med. 2019;40(3):143-50. DOI: https://doi.org/10.4082/kjfm.17.0093 https://doi.org/10.4082/kjfm.17.0093...	Menor escolaridade			1	Dourado; Medina; Aquino, 2016⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7 https://doi.org/10.1186/s12939-016-0440-...
Ocupação				Desempregada			1	Hall et al., 2015³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025 https://doi.org/10.1016/j.ajog.2015.04.0...
Condições financeiras	Boas condições de renda	5	An et al., 2016⁴²42 An AR, Kim K, Lee JH, et al. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey. BMC Fam Pract. 2016;17(1):167. DOI: https://doi.org/10.1186/s12875-016-0555-3 https://doi.org/10.1186/s12875-016-0555-... ; Dourado; Medina; Aquino, 2016⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7 https://doi.org/10.1186/s12939-016-0440-... ; Kim; Jeon; Lee, 2017¹⁸18 Kim KM, Jeon H, Lee JH. Having a physician rather than a place as a usual source of care would be better - from 2012 Korea health panel data. J Korean Med Sci. 2017;32(1):4-12. DOI: https://doi.org/10.3346/jkms.2017.32.1.4 https://doi.org/10.3346/jkms.2017.32.1.4... ; Sung; Lee, 2019⁶6 Sung NJ, Lee JH. Association between types of usual source of care and user perception of overall health care service quality in Korea. Korean. J Fam Med. 2019;40(3):143-50. DOI: https://doi.org/10.4082/kjfm.17.0093 https://doi.org/10.4082/kjfm.17.0093...	Pró-pobre	Pró-rico	Boas condições de Renda	2	Macinko; Lima-Costa, 2012³³33 Macinko J, Lima-Costa MF. Horizontal equity in health care utilization in Brazil, 1998-2008. Int J Equity Health. 2012;11:33. DOI: https://doi.org/10.1186%2F1475-9276-11-33 https://doi.org/10.1186%2F1475-9276-11-3... ; Hall et al., 2015³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025 https://doi.org/10.1016/j.ajog.2015.04.0...
	Baixo nível de renda	2	An et al., 2016⁴²42 An AR, Kim K, Lee JH, et al. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey. BMC Fam Pract. 2016;17(1):167. DOI: https://doi.org/10.1186/s12875-016-0555-3 https://doi.org/10.1186/s12875-016-0555-... ; Kim; Jeon; Lee, 2017¹⁸18 Kim KM, Jeon H, Lee JH. Having a physician rather than a place as a usual source of care would be better - from 2012 Korea health panel data. J Korean Med Sci. 2017;32(1):4-12. DOI: https://doi.org/10.3346/jkms.2017.32.1.4 https://doi.org/10.3346/jkms.2017.32.1.4...				1	Hall et al., 2015³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025 https://doi.org/10.1016/j.ajog.2015.04.0...
Local de Residência	área urbana	4	Moy et al., 1998²⁷27 Moy E, Bartman BA, Clancy CM, et al. Changes in usual sources of medical care between 1987 and 1992. J Health Care Poor Underserved. 1998;9(2):126-39. DOI: https://doi.org/10.1353/hpu.2010.0305 https://doi.org/10.1353/hpu.2010.0305... ; Macinko; Lima-Costa, 2012³³33 Macinko J, Lima-Costa MF. Horizontal equity in health care utilization in Brazil, 1998-2008. Int J Equity Health. 2012;11:33. DOI: https://doi.org/10.1186%2F1475-9276-11-33 https://doi.org/10.1186%2F1475-9276-11-3... ; Jerant et al., 2013⁴¹41 Jerant A, Bertakis KD, Fenton JJ, et al. Gender of physician as the usual source of care and patient health care utilization and mortality. J Am Board Fam Med. 2013;26(2):138-48. DOI: https://doi.org/10.3122/jabfm.2013.02.120198 https://doi.org/10.3122/jabfm.2013.02.12... ; Dourado; Medina; Aquino, 2016⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7 https://doi.org/10.1186/s12939-016-0440-...	Zona Rural			2	Hall et al., 2015³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025 https://doi.org/10.1016/j.ajog.2015.04.0... ; Dourado; Medina; Aquino, 2016⁴4 Dourado I, Medina MG, Aquino R. The effect of the Family Health Strategy on usual source of care in Brazil: data from the 2013 National Health Survey (PNS 2013). Int J Equity Health. 2016;15(1):151. DOI: https://doi.org/10.1186/s12939-016-0440-7 https://doi.org/10.1186/s12939-016-0440-...
	área rural	1	Davis et al., 2017⁴⁸48 Davis MA, Guo C, Titler MG, et al. Advanced practice clinicians as a usual source of care for adults in the United States. Nursing Outlook. 2017;65(1):41-9. DOI: https://doi.org/10.1016/j.outlook.2016.07.006 https://doi.org/10.1016/j.outlook.2016.0...
Seguro saúde	Seguro (privado ou público)	5	Choi, 2011⁵¹51 Choi S. Longitudinal changes in access to health care by immigrant status among older adults: The importance of health insurance as a mediator. Gerontologist. 2011;51(2):156-69. DOI: https://doi.org/10.1542/peds.2008-3141 https://doi.org/10.1542/peds.2008-3141... ; Shi et al., 2013³⁴34 Shi LY, Lebrun-Harris LA, Daly CA, et al. ngo-metzger, q. Reducing Disparities in Access to Primary Care and Patient Satisfaction with Care: The Role of Health Centers. J Health Care Poor Underserved. 2013;24(1):56-66. DOI: https://doi.org/10.1353/hpu.2013.0022 https://doi.org/10.1353/hpu.2013.0022... ; Kim; Jeon; Lee, 2017¹⁸18 Kim KM, Jeon H, Lee JH. Having a physician rather than a place as a usual source of care would be better - from 2012 Korea health panel data. J Korean Med Sci. 2017;32(1):4-12. DOI: https://doi.org/10.3346/jkms.2017.32.1.4 https://doi.org/10.3346/jkms.2017.32.1.4... ; Stransky, 2017⁵5 Stransky ML. Two-year stability and change in access to and reasons for lacking a usual source of care among working-age US adults. Public Health Rep. 2017;132(6):660-8. DOI: https://doi.org/10.1177/0033354917735322 https://doi.org/10.1177/0033354917735322... ; Liaw et al., 2018⁴⁴44 Liaw W, Jetty A, Petterson S, et al. Trends in the types of usual sources of care: a shift from people to places or nothing at all. Health Serv Res. 2018;53(4):2346-67. DOI: https://doi.org/10.1111/1475-6773.12753. https://doi.org/10.1111/1475-6773.12753...
	Seguro privado	2	Rohrer; Kruse; Zhang, 2004⁸8 Rohrer JE, Kruse G, Zhang Y. Hispanic ethnicity, rural residence, and regular source of care. J Community Health. 2004;29(1):1-13. DOI: https://doi.org/10.1023/b:johe.0000007441.84668.ac https://doi.org/10.1023/b:johe.000000744... ; Macinko; Lima-Costa, 2012³³33 Macinko J, Lima-Costa MF. Horizontal equity in health care utilization in Brazil, 1998-2008. Int J Equity Health. 2012;11:33. DOI: https://doi.org/10.1186%2F1475-9276-11-33 https://doi.org/10.1186%2F1475-9276-11-3...	Plano privado		Seguro privado	2	Hall et al., 2015³⁵35 Hall KS, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol. 2015;213(3):e351-2. DOI: https://doi.org/10.1016/j.ajog.2015.04.025 https://doi.org/10.1016/j.ajog.2015.04.0... ; Davis et al., 2017⁴⁸48 Davis MA, Guo C, Titler MG, et al. Advanced practice clinicians as a usual source of care for adults in the United States. Nursing Outlook. 2017;65(1):41-9. DOI: https://doi.org/10.1016/j.outlook.2016.07.006 https://doi.org/10.1016/j.outlook.2016.0...
Estado de saúde, hábitos e comportamentos
Hábitos de saúde	Não fumante	1	Jerant et al., 2013⁴¹41 Jerant A, Bertakis KD, Fenton JJ, et al. Gender of physician as the usual source of care and patient health care utilization and mortality. J Am Board Fam Med. 2013;26(2):138-48. DOI: https://doi.org/10.3122/jabfm.2013.02.120198 https://doi.org/10.3122/jabfm.2013.02.12...
Estado de saúde	Melhor estado de saúde	4	Moy et al., 1998²⁷27 Moy E, Bartman BA, Clancy CM, et al. Changes in usual sources of medical care between 1987 and 1992. J Health Care Poor Underserved. 1998;9(2):126-39. DOI: https://doi.org/10.1353/hpu.2010.0305 https://doi.org/10.1353/hpu.2010.0305... ; Cunningham, 2015⁵²52 Cunningham PJ. Many medicaid beneficiaries receive care consistent with attributes of patient-centered medical homes. Health Aff (Millwood). 2015;34(7):1105-12. DOI: https://doi.org/10.1377/hlthaff.2015.0141 https://doi.org/10.1377/hlthaff.2015.014... ; Kim et al., 2019⁴⁶46 Kim D, Kim S, Park HK, et al. Effect of having a usual source of care on medical expenses - using the korea health panel data. J Korean Med Sci. 2019;34(35):e229. DOI: https://doi.org/10.3346/jkms.2019.34.e229 https://doi.org/10.3346/jkms.2019.34.e22... ; Chaiyachati et al., 2019⁴⁵45 Chaiyachati KH, Hom JK, Hubbard RA, et al. Evaluating the association between the built environment and primary care access for new medicaid enrollees in an urban environment using walk and transit scores. Prev Med Rep. 2017;9:24-8. DOI: https://doi.org/10.1016/j.pmedr.2017.12.001. https://doi.org/10.1016/j.pmedr.2017.12....
	Estado de saúde ruim	1	Sung; Lee, 2019⁶6 Sung NJ, Lee JH. Association between types of usual source of care and user perception of overall health care service quality in Korea. Korean. J Fam Med. 2019;40(3):143-50. DOI: https://doi.org/10.4082/kjfm.17.0093 https://doi.org/10.4082/kjfm.17.0093...
Problema de saúde	Portador de doença física ou mental	1	Tsai et al., 2010²2 Tsai J, Shi L, Yu WL, et al. Usual source of care and the quality of medical care experiences: a cross-sectional survey of patients from a Taiwanese Community. Med Care. 2010;48(7):628-34. DOI: https://doi.org/10.1097/MLR.0b013e3181dbdf76 https://doi.org/10.1097/MLR.0b013e3181db...
	Portador de doenças crônicas	5	Rohrer; Kruse; Zhang, 200⁴⁸48 Davis MA, Guo C, Titler MG, et al. Advanced practice clinicians as a usual source of care for adults in the United States. Nursing Outlook. 2017;65(1):41-9. DOI: https://doi.org/10.1016/j.outlook.2016.07.006 https://doi.org/10.1016/j.outlook.2016.0... ; An et al., 2016⁴²42 An AR, Kim K, Lee JH, et al. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey. BMC Fam Pract. 2016;17(1):167. DOI: https://doi.org/10.1186/s12875-016-0555-3 https://doi.org/10.1186/s12875-016-0555-... ; Kim; Jeon; Lee, 2017¹⁸18 Kim KM, Jeon H, Lee JH. Having a physician rather than a place as a usual source of care would be better - from 2012 Korea health panel data. J Korean Med Sci. 2017;32(1):4-12. DOI: https://doi.org/10.3346/jkms.2017.32.1.4 https://doi.org/10.3346/jkms.2017.32.1.4... ; Stransky, 2017⁵5 Stransky ML. Two-year stability and change in access to and reasons for lacking a usual source of care among working-age US adults. Public Health Rep. 2017;132(6):660-8. DOI: https://doi.org/10.1177/0033354917735322 https://doi.org/10.1177/0033354917735322... ; Kim et al., 2019⁴⁶46 Kim D, Kim S, Park HK, et al. Effect of having a usual source of care on medical expenses - using the korea health panel data. J Korean Med Sci. 2019;34(35):e229. DOI: https://doi.org/10.3346/jkms.2019.34.e229 https://doi.org/10.3346/jkms.2019.34.e22...
Serviço de saúde
Organização dos serviços de saúde	Facilidade de agendamento	1	Hammond; Matthews; Smith, 2010⁵⁴54 Hammond WP, Matthews D, Smith GC. Psychosocial factors associated with routine health examination scheduling and receipt among African American men. J Natl Med Assoc. 2010;102(4):276-89. DOI: https://doi.org/10.1016/s0027-9684(15)30600-3 https://doi.org/10.1016/s0027-9684(15)30...	Baixa oferta de serviços			1	Chaiyachati et al., 2019⁴⁵45 Chaiyachati KH, Hom JK, Hubbard RA, et al. Evaluating the association between the built environment and primary care access for new medicaid enrollees in an urban environment using walk and transit scores. Prev Med Rep. 2017;9:24-8. DOI: https://doi.org/10.1016/j.pmedr.2017.12.001. https://doi.org/10.1016/j.pmedr.2017.12....
	Exames de rotina	1	Hammond; Matthews; Smith, 2010⁵⁴54 Hammond WP, Matthews D, Smith GC. Psychosocial factors associated with routine health examination scheduling and receipt among African American men. J Natl Med Assoc. 2010;102(4):276-89. DOI: https://doi.org/10.1016/s0027-9684(15)30600-3 https://doi.org/10.1016/s0027-9684(15)30...
	Alcançe dos atributos da APS	1	Du et al., 2015³3 Du Z, Liao Y, Chen CC, et al. Usual source of care and the quality of primary care: a survey of patients in Guangdong province, China. Int J Equity Health. 2015;14:60. DOI: https://doi.org/10.1186/s12939-015-0189-4 https://doi.org/10.1186/s12939-015-0189-...
Relação Usuário/profissional	Confiança	1	Stewart et al., 2019¹1 Stewart KA, Ristvedt S, Brown KM, et al. Giving voice to black men: guidance for increasing the likelihood of having a usual source of care. Am J Mens Health. 2019;13(3):1557988319856738. DOI: https://doi.org/10.1177/1557988319856738 https://doi.org/10.1177/1557988319856738...
					Desconfiança		1	Arnett et al., 2016³⁶36 Arnett MJ, Thorpe Jr RJ, Gaskin DJ, et al. Race, medical mistrust, and segregation in primary care as usual source of care: findings from the exploring health disparities in integrated communities study. J Urban Health. 2016;93(3):456-67. DOI: https://doi.org/10.1007/s11524-016-0054-9 https://doi.org/10.1007/s11524-016-0054-...

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Fonte Usual de Cuidados: conceitos, métodos e fatores determinantes na avaliação da atenção primária

Usual Source of Care: concepts, methods and determining factors in the assessment of primary care

RESUMO

ABSTRACT

Introdução

Metodologia

Resultados

Qual o conceito e operacionalização do termo Fonte Usual de Cuidados?

Os determinantes do reconhecimento de uma FUC

Discussão

Considerações finais

Suporte financeiro:

Referências

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