{
  "abstract": "Background: Whether patient-reported experiences in primary care modify the association between multimorbidity and emergency department (ED) visits and hospitalizations remains unclear. We examined these associations across public and private health system sectors among Brazilians aged ≥50 years.\n\nMethods: This cross-sectional study used nationally representative data from the 2019–2021 Brazilian Longitudinal Study of Aging. Multimorbidity was defined as the presence of ≥2 of 13 chronic conditions. A 12-item patient-reported primary care effectiveness index captured access, continuity, communication, and coordination with participants’ usual source of healthcare. Primary outcomes were ED visits and hospitalizations in the past 12 months. Poisson regression models estimated associations with the outcomes, and assessed interactions among multimorbidity, primary care effectiveness, and health system sectors.\n\nFindings: Among 9058 participants (mean age = 66.3 ± 9.9 years; females = 55.3%; White race/ethnicity = 46.4%), 38.0% had multimorbidity. Overall, 12.5% reported an ED visit and 6.0% ≥ 1 hospitalization in the past 12 months. Multimorbidity was associated with approximately twice the prevalence of ED visits and three times the prevalence of hospitalizations. Primary care effectiveness modified these associations across health system sectors (three-way interaction p = 0.04 for ED visits and p < 0.001 for hospitalization). In the public system, higher primary care effectiveness attenuated the association between multimorbidity and hospitalization (interaction prevalence ratio [PR] = 0.74, 95% confidence interval [CI] = 0.63–0.87). In contrast, in the private system, higher primary care effectiveness strengthened the associations of multimorbidity with ED visits (interaction PR = 1.40, 95% CI = 1.18–1.66) and hospitalization (interaction PR = 1.75, 95% CI = 1.22–2.50).\n\nInterpretation: Associations between multimorbidity and healthcare use varied according to patient-reported primary care experiences and health system sector.\n\nFunding: The Brazilian National Council for Scientific and Technological Development, the Alzheimer’s Association, and the National Institute on Aging.",
  "abstract_shown": true,
  "affiliations": [
    "Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil",
    "Department of Epidemiology and Health Information, Hospital Israelita Albert Einstein, São Paulo, Brazil",
    "Department of Health and Kinesiology, University of Illinois Urbana-Champaign, Urbana, IL, USA",
    "Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA",
    "Center for Studies in Public Health and Aging, Universidade Federal de Minas Gerais and Fundação Oswaldo Cruz, Belo Horizonte, Brazil",
    "Departamento de Medicina Preventiva e Social, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil",
    "Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA",
    "Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA",
    "Research Institute, Hospital Sirio-Libanes, Sao Paulo, Brazil",
    "School of Health Sciences, Amazonas State University (UEA), Amazonas, Brazil",
    "Faculty of Medicine, University of Brasilia, Brasília, DF, Brazil",
    "Faculty of Medicine, Federal University of Goiás, Goiânia, GO, Brazil"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 14,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Giulia Muniz de Oliveira"
    },
    {
      "affs": [
        2
      ],
      "name": "Bruno Pereira Nunes"
    },
    {
      "affs": [
        3
      ],
      "name": "Kenneth Lam"
    },
    {
      "affs": [
        4
      ],
      "name": "Maria Fernanda Lima-Costa"
    },
    {
      "affs": [
        4,
        5
      ],
      "name": "Juliana Lustosa Torres"
    },
    {
      "affs": [
        6
      ],
      "name": "James Macinko"
    },
    {
      "affs": [
        4
      ],
      "name": "Bruno de Souza Moreira"
    },
    {
      "affs": [
        0,
        7
      ],
      "name": "Thiago Junqueira Avelino-Silva"
    },
    {
      "affs": [
        0,
        8
      ],
      "name": "Virgílio Augusto Deodato Gonçalves"
    },
    {
      "affs": [
        9
      ],
      "name": "Sileno de Queiroz Fortes-Filho"
    },
    {
      "affs": [
        10
      ],
      "name": "Thiago Figueiredo de Castro"
    },
    {
      "affs": [
        10,
        11
      ],
      "name": "Sandro Rogério Rodrigues Batista"
    },
    {
      "affs": [
        0
      ],
      "name": "Eduardo Ferriolli"
    },
    {
      "affs": [
        0,
        7
      ],
      "name": "Márlon Juliano Romero Aliberti"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4t9rdy14ftsyv.bib",
  "cited_by": 0,
  "doi": "10.1016/j.lana.2026.101680",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13696340/",
  "id": "4t9rdy14ftsyv",
  "issns": [
    "2667-193X"
  ],
  "landing_url": "https://doi.org/10.1016/j.lana.2026.101680",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
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      "heading",
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      "2713|Chronic Disease Management Strategies"
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  "pdf_url": "https://europepmc.org/articles/PMC13696340?pdf=render",
  "pmcid": "PMC13696340",
  "pmid": "42935795",
  "published": "2026-10-17",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/4t9rdy14ftsyv.ris",
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    {
      "first_seen": "2026-10-30T12:17:42Z",
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Chronic Disease Management Strategies",
      "subfield": "epidemiology-public-health"
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  ],
  "title": "Primary care effectiveness, multimorbidity, and hospital use in public and private health-care systems in Brazil: a cross-sectional analysis of data from the 2019–2021 Brazilian longitudinal study of aging",
  "title_text": "Primary care effectiveness, multimorbidity, and hospital use in public and private health-care systems in Brazil: a cross-sectional analysis of data from the 2019–2021 Brazilian longitudinal study of aging",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:33:41Z",
  "url": "https://research.draconitic.com/paper/4t9rdy14ftsyv",
  "venue": "Lancet Regional Health - Americas",
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