Abstract
This study compared standardised rates of hospitalisations due to ambulatory care sensitive conditions (ACSCs) in Brazil's Federal District from 2009 to 2018, as compared with those for selected state capitals, age groups and admissions groups. This ecological study used secondary data drawn from Hospital Information System microdata for the study period, during which, in the Federal District, the proportion of such admissions among 50-59 and 60-69 year olds declined, while those among children and adolescents held stable. Meanwhile, rates did not decrease in the ≤ 20 year age groups, a priority population in PHC, which may suggest that this population encountered barriers to access. The results showed that the expected reduction in the proportion of such admissions has not occurred, because coverage by Family Health Teams has been expanded only recently.
Highlights
Stratification of hospitalisations due to ambulatory care sensitive conditions (HACSCs) by age group highlighted the large proportion of such admissions among children up to nine years of age, who represented around 20% of total admissions in the Federal District
On the one hand, percentage rates of HACSCs in the state capitals are stable at around 10 to 15% of total admissions, an examination of the groups that make up HACSCs reveals regional inequalities that may reflect the stage of health system organisation and Primary Health Care (PHC)’s centrality or otherwise to the system[23,24]
On examining the groups into which HACSCs can be subdivided (Table 2), municipal-based studies, mainly in the South and Southeast regions, of the under-20s, find that there has been a decrease in admissions connected with avoidable and immunisable conditions, nutritional deficiencies and anaemia, and those relating to the perinatal period and parasitic infectious diseases, such as gastroenteritis
Summary
Primary Health Care (PHC) is interpreted in various manners, which can be explained by the manner in which it originated and has evolved in practice in health systems, by the ambiguity of some of its formal definitions as established in international forums and by the indiscriminate use of the term by some schools of thought in public health[1].That said, there are basically three main interpretations: PHC as selective primary care, understood as a specific programme offering a set of simple, low-cost technologies destined for poor populations and regions; PHC as the primary level of the health care system; and PHC as a strategy for organising the health system[1].In Brazil, PHC has been considered synonymous with basic care since publication of the 2011 National Basic Care Policy (PNAB) and again in the 2017 PNAB2. It was conceived as the gateway to the health system and today plays a leading role in Health Care Networks as the centre of communication and, in setting up the networks, as the organiser and coordinator of care. For these purposes, it is structured by seven attributes: first contact, comprehensiveness, continuity, coordination, family-centred, family approach and community-oriented[3]. In Brazil, the Family Health Strategy (Estratégia de Saúde da Família, ESF) is considered a priority strategy for expanding, establishing and informing basic care, and is producing important results as shown in indicators of health, efficiency and equity[7,8,9,10]
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