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This study examines how primary health care attributes and local strategies affect care continuity during the COVID-19 pandemic.

April 11, 2026Open Access

Primary care and care continuity in the context of a health crisis: lessons learned from the Brazilian reality

Key Points

This study examines how primary health care attributes and local strategies affect care continuity during the COVID-19 pandemic.
Quantitative cross-sectional study conducted with health managers in São Paulo
Survey applied in 259 municipalities, analyzing indicators of care continuity
Investigated local strategies like telecare and adaptations of PHC units
Used Pearson’s correlation and multiple linear regression for statistical analysis.
Care continuity in PHC correlated significantly with essential PHC attributes (r = 0.453, p = 0.000)
Increased telecare investment and transformation of units for COVID-19 care improved continuity
Convergence of essential attributes was identified as the most critical factor for maintaining care during the pandemic.

Abstract

Primary health care (PHC) is crucial for achieving universal health coverage, particularly in low- and middle-income countries, where it has been linked to reducing health inequalities and providing financial protection. It is distinguished from other care levels by its essential attributes: longitudinality, first-contact care, comprehensiveness, and care coordination across the network. PHCs played a crucial role during the COVID-19 pandemic, and providing continuous care while coordinating testing and contact tracing was challenging. It is necessary to adapt its operations to ensure care. This study explores the influence of essential PHC attributes and local organizational strategies on care continuity during the pandemic. A quantitative cross-sectional study was conducted with health managers from municipalities in the state of São Paulo in a sample stratified by population size. The survey was applied in 259 municipalities, and the weighted analysis considered 553 municipalities. We evaluated indicators related to care continuity in PHC, convergence with essential PHC attributes, local strategies such as telecare, and the adaptation of PHC units (UBSs) to an exclusive COVID-19 PHC service. Statistical analyses included Pearson’s correlation and multiple linear regression. Care continuity in PHC was significantly associated with convergence of essential PHC attributes (r = 0.453, p = 0.000), PHC coverage, investment in telecare, and the transformation of UBS to care exclusively for COVID-19 patients. The regression model revealed that these variables significantly influenced care maintenance during the pandemic, and convergence of essential PHC attributes was the most relevant factor. Convergence in the essential attributes of comprehensive PHC was crucial for care continuity during the pandemic. Owing to the essential attributes of comprehensive PHC, continued strengthening of PHC is necessary to ensure the resilience of health systems, and we recommend future studies on the implementation of the essential attributes of comprehensive PHC.

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