Structure and work process in primary care and hospitalizations for sensitive conditions

Abstract

OBJECTIVE The objective of this study is to investigate whether the characteristics of the structure of primary health units and the work process of primary care teams are associated with the number of hospitalizations for primary care sensitive conditions.METHODS In this ecological study, we have analyzed data of Brazilian municipalities related to sociodemographic characteristics, coverage of care programs, structure of primary health units, and work process of primary care teams. We have obtained the data from the first cycle of the Brazilian Program for Improving Access and Quality of the Primary Care, of the Department of Information Technology of the Brazilian Unified Health System, the Brazilian Institute of Geography and Statistics, and the United Nations Development Programme. The associations have been estimated using negative binomial regression coefficients (β) and respective 95% confidence intervals, with a hierarchical approach in three levels (alpha = 5%).RESULTS In the adjusted analysis for the outcome in 2013, in the distal level, the coverage of the Bolsa Família Program (β = -0.001) and private insurance (β = -0.01) had a negative association, and the human development index (β = 1.13), the proportion of older adults (β = 0.05) and children under the age of five (β = 0.05), and the coverage of the Community Health Agent Strategy (β = 0.002) showed positive association with hospitalizations for primary care sensitive conditions. In the intermediate level, minimum hours (β = -0.14) and availability of vaccines (β = -0.16) showed a negative association, and availability of medications showed a positive association (β = 0.16). In the proximal level, only the variable of matrix support (β = 0.10) showed a positive association. The variables in the adjusted analysis of the number of hospitalizations for primary care sensitive conditions in 2014 presented the same association as in 2013.CONCLUSIONS The characteristics of the structure of primary health units and the work process of the primary care teams impact the number of hospitalizations for primary care sensitive conditions in Brazilian municipalities.

Pay for performance in primary care: the contribution of the Programme for Improving Access and Quality of Primary Care (PMAQ) on avoidable hospitalisations in Brazil, 2009–2018

“…For example, home visits, support from other professionals and referral to specialised care when needed have been associated with lower rates of avoidable hospitalisations. 42 In the state of Paraná, workers engaged in PMAQ have reported improvements in health information registries (allowing better monitoring of target populations) and the indicators from the external evaluation provided a good overview of what should be improved at team level. 43 On the other hand, qualitative studies conducted in state of Goiás and São Paulo showed a low perception of the PMAQ impact on clinical practices and work process, 15 44 mainly due to a top-down approach adopted during the implementation of PMAQ, lack of knowledge about the programme and absence of feedback regarding the results of external evaluation.…”

Estrutura e processo de trabalho para as ações de alimentação e nutrição na Atenção Primária à Saúde no Brasil, 2014

“…14 A estrutura e o processo de trabalho na APS são objeto de diferentes estudos, enquanto fatores fundamentais para a qualidade da atenção e integralidade do cuidado, 15,16 por conseguinte associados à redução de taxas de internação por condições sensíveis à atenção primária (ICSAP). 17 No caso das ações de alimentação e nutrição, a baixa adequação de estrutura e processo de trabalho pode influenciar, negativamente, aspectos da vigilância alimentar e nutricional, com ênfase na precarização do acompanhamento do desenvolvimento infantil e investigação dos casos de desnutrição. 18,19 Entre os itens analisados para a estrutura, insumos como sulfato ferroso, ácido fólico e sais para reidratação oral não estavam disponíveis em aproximadamente 10% das UBS.…”

Hospitalizações infantis por condições sensíveis à atenção primária em cidade brasileira

“…Neste estudo, também foi observado um decréscimo de 71,88 %, o que reflete taxas consideravelmente menores, quando comparadas à média de internações do país (17). Tal fato pode ser explicado pelo aumento da cobertura da ESF em Teresina-PI, ao longo do período analisado, pois se sabe que ela contribui para a prevenção e tratamento de doenças que comumente geram internações (1,4,21). Em estudo realizado na Bahia, foi demonstrado o declínio das hospitalizações com a ampliação da cobertura da ESF, além de fazer menção a mudanças nos fatores demográficos e socioeconômicos que aconteceram em paralelo à queda das hospitalizações por CSAP e, provavelmente, exerceram influência positiva (5).…”