Programa Saúde da Família e condições sensíveis à atenção primária, Bagé (RS)

Abstract

OBJECTIVE: Ambulatory care-sensitive conditions (ACSC) are health problems managed by actions at the fi rst level of care. The need for hospitalization by these causes is avoidable through an effective and proper primary health care. The objective of the study was to estimate ACSC among patients hospitalized by the Sistema Único de Saúde (Brazilian Health System). METHODS:Hospital-based cross-sectional study involving 1,200 inhabitants of Bagé (Southern Brazil) who were inpatients between September/2006 and January/2007. The patients answered a questionnaire applied by interviewers and were classifi ed according to the model of attention utilized prior to hospitalization. ACSC were defi ned in a workshop promoted by the Ministry of Health. The variables analyzed included demographic and socioeconomic characteristics, health and health services utilized. Multivariate analysis was conducted by the Poisson model, according to a hierarchical conceptual framework, stratifi ed by sex and model of care. RESULTS:ACSC accounted for 42.6% of the hospitalizations. The probability that the main diagnosis for hospitalization is considered an ACSC is greater among women, children under fi ve years of age, individuals with less then fi ve years of schooling, hospitalization in the year prior to the interview, emergency room consultation, and being an inpatient at the university hospital. Among women, ACSC are associated with age, educational level, length of time the health center has been in existence, living in an area covered by the Programa Saúde da Família (Family Health Program), use of this service, emergency room consultation during the month prior to the interview and hospital to which patient was admitted. For men, it was associated with age, have undergone another hospitalization in the year prior to the interview and hospital to which patient was admitted. CONCLUSIONS:Analysis of ACSC allows identifying groups with inadequate access to primary health care. Although we could not infer an effect on the risk of hospital admission, analysis by sex and model of care suggests that Family Health Program is more equitable than "traditional" primary health care.

Internações hospitalares por causas sensíveis à atenção primária no Distrito Federal, 2008

“…In a study performed in Brazil, 1 this proportion was 28.5%, slightly higher than the data found for the DF. In Bagé, 9 however, the results contrast with those reported previously and indicate that 42.6% of hospitalizations were due to ACSC. Similarly to the DF, the most frequent cause of hospitalization due to ACSC in Brazil 1 was gastroenteritis, followed by heart failure and bacterial pneumonia.…”

“…5,8,9 Through a literature review on hospitalizations for ACSC and the exposure to at least one characteristic of primary health care (18 articles in the past 13 years) it has been found that most studies pointed to a protective association of variables of structure, process and performance of primary care services, in relation to the risk of hospitalizations due to ACSC. 8 Preventive consultations (sporadic or not), vaccines and ongoing child health care were associated, in various studies, with lower risk of hospitalization due to ACSC.…”

“…More favorable results, but with no statistical signifi cance, were observed in the trends and magnitudes of these rates of hospitalization in the municipalities with adequate primary care when compared to those classifi ed as inadequate. 5 A study carried out in Bagé, Southern Brazil, 9 showed a protective statistically signifi cant association between hospitalizations due to ACSC and residency in areas where there was "organization of the primary health care (according to the manager's assessment)", when there was a traditional primary care model. 9 However, the authors show divergent results to those previously described.…”

Modelagem hierárquica de determinantes associados a internações por condições sensíveis à atenção primária no Espírito Santo, Brasil

“…Além disso, a menor formação escolar diminui as chances de emprego, e os desempregados tendem a retardar a busca por cuidados de saúde. Essa associação entre baixa escolaridade e aumento das ICSAP também foi encontrada por outros autores 21,22 . O achado, neste estudo, de maior número de ICSAP associadas à maior urbanização pode sugerir que a residência em aglomerados urbanos, nos quais, em geral, estão localizados os hospitais, facilita o acesso a eles, e, conforme aponta o estudo de Márquez-Calderón et al 8 , o maior acesso aos serviços de urgência e de emergência hospitalares em detrimento da atenção básica colabora para o aumento das hospitalizações sensíveis, pois a atenção secundária e terciária passam a ser a porta de entrada do sistema de saúde.…”

Avaliação das ações em hipertensão arterial sistêmica na atenção básica

“…5,12 Among the ineffi cient municipalities, 387 hospitalizations were observed. To achieve effi ciency in results, it would be necessary that 250.6 potentially avoidable hospitalizations had not occurred, that is, 64.8% could have been prevented in these municipalities, in case they had adopted the benchmarks' practices.…”