Improving and sustaining adolescent access to primary care in a socioeconomically vulnerable urban community in Brazil: outcomes of a quality improvement initiative

BACKGROUND: Ensuring effective inclusion of adolescents in primary care remains a major challenge within health systems. Despite structural efforts, adolescents still face barriers like stigma, low health literacy and limited access to preventive care. AIM: To assess the implementation of an initiative aimed at strengthening adolescent access to and use of primary care services. METHODS: , São Paulo, Brazil). The initiative was divided into three phases: preintervention (October 2022-March 2023), intervention (April 2023-March 2024) and postintervention (April 2024-September 2024). The Model for Improvement was used to build capability in healthcare teams, providing them with evidence-based QI strategies to improve adolescent care, and complemented by principles of implementation science to enhance the adoption and sustainability of QI interventions. RESULTS: The percentage of adolescents accessing primary care increased by 29.8% during the intervention period (10.4%-13.5%), sustaining this improvement in the postintervention period (13.8%). Human papillomavirus vaccine administration steadily improved (from 52.0% to 64.4% to 72.4%). Consultations with physicians (from 3.4% to 5.7% to 8.1%), nurses (from 3.2% to 8.2% to 11.0%), multidisciplinary professionals (from 0.6% to 0.8% to 0.7%) and odontologists (from 1.5% to 4.4% to 4.3%) increased across all participating health centres. CONCLUSION: Applying systematic and structured QI methodologies and implementation science strategies can enhance adolescent engagement in primary healthcare in limited-resource urban settings in Brazil. Our initiative offers a scalable, evidence-based and sustainable approach to strengthening adolescent health access, aiming for equitable service delivery.