Brazil’s National Healthcare System, known as the Unified Health System—Sistema Único de Saúde (SUS)—is a universal system and free to all citizens. It is provided by both private and government institutions, and while health policy is dictated at the federal level, elements of care and its execution are overseen by the individual states.
Brazil was assessed across 12 policy indicators on how well it manages atopic dermatitis (AD), also known as eczema, a chronic skin disease that can have psychosocial effects on patients and caregivers.
The Economist Intelligence Unit created an 8-country Atopic Dermatitis Scorecard, which contains policy indicators of importance to the management of the disease, including the provision of care and support for patients and caregivers (see below for the full Brazilian scorecard results).
Overall, Brazil performs moderately well compared with the other analysed countries. Brazil receives top scores for the currency of its population prevalence data, which were updated in 2008.2 According to that epidemiological data, 14% of the Brazilian population will have AD at some point in their life, a mid-range finding compared with the other countries reviewed (eg, Israel 9% and Australia 32%).
Studies of adult AD patients in Brazil, much like in other nations, have demonstrated a link between the disease and poor quality of life, both due to the disease severity and mental/emotional distress.3 AD is also among the most common dermatological diseases in Brazilian children.4 Among these paediatric patients, AD has a negative quality of life impact on patient and families, marked by itching and scratching, mood changes, treatment costs and sleep disturbance.5
Provision of care
According to the Economist Intelligence Unit scorecard findings, the country has 6,718 dermatologists for a population of 208m, totalling nearly 3 dermatologists per 100,000 people.6 Among the studied countries, this is on the higher end on a per-head basis. However, around 59% of dermatologists in Brazil are located in the south-east of the country, skewing the balance of regional access to treatment.7,8
The nation’s greatest relative strengths are in the specific recommendations for the use of multidisciplinary care. Multidisciplinary care services provide patients and carers with access to a number of healthcare professionals that share tools to better manage AD and corresponding quality- of-life issues.9
The Economist Intelligence Unit’s scoring was based on regional Latin American guidelines, which recommend that multidisciplinary care be considered. And unlike any other guidelines analysed by The Economist Intelligence Unit, Latin America’s includes recommendations as to what the team make-up should include: dermatologists, paediatricians, allergists and psychologists.10 Brazil also has two joint position papers on the diagnosis and treatment of AD from the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics.11,12
Brazil also performs strongly in its recommendations around psychological and emotional support for patients and carers. Brazil is one of three analysed countries found to use guidelines that recommend one or more specific psychological interventions and a referral process for that care. Specifically, the Latin American guidelines used by Brazil recommend an annual assessment for psychology in all patients with severe symptoms.10
Patient groups are helping to fill the gaps. In one Brazilian study, paediatric AD patients and their families attended a support group and afterwards reported a better knowledge of the anxieties and social difficulties of AD patients, as well as the correct use of medication to help patients. The results were also used as guidance for professionals on more effective ways to counsel patients and families.13
Monitoring and measuring
When it comes to monitoring and measuring AD, Brazil has a top score for having validated severity measure (eg, mild or severe),10 however, it is limited in the fact that it does not use quality-of-life measures—for which we did not rank this indicator high.10 This is significant because beyond the physical impact of AD (dry, itchy skin) the disease’s most significant effects are a complex array of quality-of-life issues that range from social distancing, low self-esteem and depression, to possible loss of jobs and education opportunities.14,15,16,17,18,19
In addition, the guidelines do not mention a need to assess the wider impacts of AD on families and carers, which deal with the impacts on a day-to-day basis.20 They often experience anxiety, poor sleep, time off work, and a lower family quality of life.18,20,21 Yet many countries do not formally account for these issues in their assessment of AD impacts. In the Latin American guidelines, family are mentioned when it comes to integrated education and assessing family history, but not when regarding the impact.10
Full scorecard results for Brazil are available in the downloadable article
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