Characteristics of primary care and rates of pediatric hospitalizations in Brazil

Abstract

OBJECTIVE: To evaluate the association among characteristics of primary health care center (PHCC) with hospitalizations for primary care sensitive conditions (PCSC) in Brazil. METHOD: In this study, a cross-sectional ecological study was performed. This study analyzed the 27 capitals of Brazil’s federative units. Data were aggregated from the following open access databases: National Program for Access and Quality Improvement in Primary Care, the Hospital Information System of Brazilian Unified Health System and Annual Population Census conducted by the Brazilian Institute of Geography and Statistics. Associations were estimated among characteristics of primary care with the number of three PCSC as the leading causes of hospitalization in children under-5 population in Brazil: asthma, diarrhea, and pneumonia. RESULTS: In general, PHCC showed limited structural adequacy (37.3%) for pediatric care in Brazil. The capitals in South and Southeast regions had the best structure whereas the North and Northeast had the worst. Fewer PCSC hospitalizations were significantly associated with PHCC which presented appropriate equipment (RR: 0.98; 95%CI: 0.97–0.99), structural conditions (RR: 0.98; 95%CI: 0.97–0.99), and signage/identification of professionals and facilities (RR: 0.98; 95%CI: 0.97–0.99). Higher PCSC hospitalizations were significantly associated with PHCC with more physicians (RR: 1.23, 95%CI: 1.02–1.48), it forms (RR: 1.01, 95%CI: 1.01–1.02), and more medications (RR: 1.02, 95%CI: 1.01–1.03). CONCLUSION: Infrastructural adequacy of PHCC was associated with less PCSC hospitalizations, while availability medical professional and medications were associated with higher PCSC hospitalizations.

Fatores associados às internações infantis por condições sensíveis à atenção primária no Brasil: estudo ecológico

“…Entre os indicadores granulares, apenas o indicador estrutural “equipamentos, materiais e insumos” foi associado negativamente à taxa de ICSAP. A maior presença de itens necessários ao cuidado infantil foi associada à redução das internações, corroborando resultados de outro estudo com dados do PMAQ-AB ( 13 ).…”

“…Esse achado é surpreendente pois deficiências na infraestrutura são limitadoras para o cuidado integral da criança na APS ( 31 ). Em outro estudo ( 13 ) utilizando dados do PMAQ-AB, relatou-se uma associação protetora das condições estruturais quanto à hospitalização de crianças.…”

Qualidade da Atenção Primária à Saúde infantil em estados da região Nordeste

“…Estudo que comparou a atenção à saúde da criança em dois municípios da Paraíba, com classificação de pequeno e médio porte, identificou que as crianças eram mais medidas do que pesadas, mesmo com a presença de balança infantil e antropômetro nas UBS 12 . Um estudo com dados do 1 o ciclo do PMAQ-AB nas capitais brasileiras, identificou-se adequação da estrutura de UBS para o atendimento infantil em apenas em 35,8% das UBS 13 .…”

Resilience to dealing with COVID-19: university perspective in a low-income health Brazilian region

“…The system can no longer overlook the serious disparities that exist even when there are no direct financial barriers to access. These low levels of structural adequacy in PHC pose a fundamental challenge for population health and contribute to an increased burden of avoidable diseases and their complications (LISBOA et al, 2020). Even in a pandemic, patients with chronic conditions need ongoing care.…”