Hospitalizations For Primary Care Sensitive Conditions Research Articles

Tuberculosis in Brazil: one country, multiple realities

ABSTRACTObjective:To identify the determinants of tuberculosis-related variables in the various regions of Brazil and evaluate trends in those variables over the ten-year period preceding the end of the timeframe defined for the United Nations Millennium Development Goals (MDGs). Methods:This was an ecological analytical study in which we utilized eight national public databases to investigate the 716,971 new tuberculosis cases reported between 2006 and 2015. Results:Over the study period, there were slight reductions in the prevalence, incidence, and mortality associated with tuberculosis. Brazil did not reach the MDG for tuberculosis-related mortality. Among the performance indicators of tuberculosis control, there were improvements only in those related to treatment and treatment abandonment. In terms of the magnitude of tuberculosis, substantial regional differences were observed. The tuberculosis incidence rate was highest in the northern region, as were the annual mean temperature and relative air humidity. That region also had the second lowest human development index, primary health care (PHC) coverage, and number of hospitalizations for tuberculosis. The northeastern region had the highest PHC coverage, number of hospitalizations for primary care-sensitive conditions, and tuberculosis-related mortality rate. The southern region showed the smallest reductions in epidemiological indicators, together with the greatest increases in the frequency of treatment abandonment and retreatment. The central-west region showed the lowest overall magnitude of tuberculosis and better monitoring indicators. Conclusions:The situation related to tuberculosis differs among the five regions of Brazil. Those differences can make it difficult to control the disease in the country and could explain the fact that Brazil failed to reach the MDG for tuberculosis-related mortality. Tuberculosis control measures should be adapted to account for regional differences.

Effect of the Family Health Strategy on hospitalizations for primary care sensitive conditions in infants in Bahia State, Brazil

This study aimed to assess the effect of the expansion of the Family Health Strategy (FHS) on hospitalizations for primary care sensitive conditions (PCSCs) in children under one year of age. This was a longitudinal ecological study with the use of panel data, for which the analytical units were the 417 municipalities (counties) in Bahia State, Brazil, from 2000 to 2012. Data were obtained from the official health information systems. The hospitalization rate for PCSCs was the outcome and FHS coverage was the principal exposure. The co-variables referred to demographic and socioeconomic characteristics and the local availability of pediatric beds. Bivariate and multivariate panel data analyses were performed, with negative binomial response and fixed effects models, using crude and adjusted relative risk (RR) as the measure of association, with the respective confidence intervals. To control for trend effect, the models were adjusted for time. From 2000 to 2012, 248,944 hospitalizations for PCSCs were recorded in children under one year, and the median municipal rate of hospitalizations for PCSCs decreased by 52.5% during the period, ranging from 96.9 to 46.0 avoidable hospitalizations per 1,000 live births. After adjusting the model, the reduction in avoidable hospitalizations was maintained at the different FHS coverage levels. This study demonstrated the effects of the consolidation of the FHS on hospitalizations for PCSCs in infants, which indicates the importance of strengthening primary care measures in order to offer case-resolving care during the first contact with the health system and avoid unnecessary hospitalizations.

Hospitalizations for primary care sensitive conditions: association with socioeconomic status and quality of family health teams in Belo Horizonte, Brazil.

Hospitalizations for primary care sensitive conditions (HPCSC) have been used as a measure of the effectiveness of primary care. Few studies, however, have measured the quality of primary health care (PHC) and how it impacts HPCSC trends. We employed previously calculated quality scores of PHC attributes (access, continuous/ongoing care, coordinated care and comprehensive care) assigned to health centres and investigated the correlation between these quality scores and HPCSC time trends in public hospitals in the city of Belo Horizonte, Brazil, adjusted by demographic and socioeconomic factors between 2010 and 2013. Socioeconomic risk was determined using the Health Vulnerability Index, a composite indicator including sanitation, habitation, education, income and health variables. Between 2010 and 2013, 447 500 hospitalizations, excluding births, were recorded in Belo Horizonte. Of these, 85 211 were HPCSC (19% of total admissions). Of 145 health centres, 133 were analysed in this study, with 75 059 HPCSC in the 4-year period. In the initial univariate model, only the PCH attribute 'access' and 'social vulnerability' had an effect on hospitalization rates. In the multilevel analysis, socioeconomic vulnerability became the only predictor of HPCSC rates. A 10% increase in high socioeconomic risk population meant an increase of 5 HPCSC/10 000 in women and 4/10 000 in men for each individual primary care unit, while a 10% increase in low-risk population meant a reduction in HPCSC of 6/10 000 in women and 5/10 000 in men. The results support the importance of using HPCSC as a measure of PHC effectiveness, considering individual, health service-related and socioeconomic characteristics; however, additional measures of effectiveness of care provided by family health teams seem necessary to assess PHC performance.

Physical therapy in avoidable hospitalizations for primary care-sensitive conditions

Abstract Avoidable hospitalizations for primary care-sensitive conditions have been used as indicators of access to timely and appropriate care because hospital admissions for many conditions could be prevented by interventions in primary care. Physical therapists play an important role in health promotion, disease prevention, and the pursuit of fairness and improvements in the effectiveness of health care services, which are the goals of the public policies proposed by the Brazilian unified health care system. We used MEDLINE and SciELO to search the literature for articles concerning the association between physical therapy and the reduction of avoidable hospitalizations for primary care-sensitive conditions. The literature on the topic is still in its infancy and confined to relatively few studies. Although the available literature associates access to quality primary care with reduced hospitalizations for primary care-sensitive conditions, there is a need for original studies investigating whether there is an association between physical therapy and decreased hospital admissions for primary care-sensitive conditions.

Internações por condições sensíveis à atenção primária em município do sudeste do Brasil

ObjectiveTo study the most frequent causes of hospitalizations for primary care-sensitive conditions (HPCSC) in the city of Juiz de Fora, MG, Brazil, by age group and gender, over the periods of 2002 to 2005 and of 2006 to 2009. MethodsThis was a descriptive study, with data collected from the Hospital Information System of the Unified Health System (Sistema de Informação Hospitalar do Sistema Único de Saúde – SIH-SUS) and from population projections by the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística – IBGE). HPCSC rates were calculated for 1,000 inhabitants, and the most frequent causes were studied by gender and age group, comparing both periods. ResultsHPCSP showed rates of 7.74/1,000 between 2002 and 2005 and 8.81/1,000 between 2006 and 2009. The main causes were heart failure, cerebrovascular diseases, angina pectoris, pulmonary diseases, and kidney and urinary tract infections, which together represented 4.9/1,000 in the first period and 5.6/1,000 in the second period. The evolution of the rates between both periods occurred differently by age group and gender. ConclusionThe study did not exhibit any remarkable differences in HPCSC rates between the periods. Regarding the most frequent causes, reduced hospitalization rates for gastroenteritis, asthma, high blood pressure, and cerebrovascular diseases were observed, as well as increased hospitalizations for heart failure, pulmonary diseases, epilepsies, and kidney and urinary tract infections; these hospitalizations occurred differently by gender and age group. The results showed that a deep reflection regarding the determinants of hospitalizations for avoidable causes is needed.

Hospitalizations for primary care-sensitive conditions in a Southern Brazilian municipality

ObjectiveTo study the most frequent causes of hospitalizations for primary care-sensitive conditions (HPCSC) in the city of Juiz de Fora, Brazil, by age group and gender, over the periods of 2002 to 2005 and of 2006 to 2009. MethodsThis was a descriptive study, with data collected from the Hospital Information System of the Unified Health System (Sistema de Informação Hospitalar do Sistema Único de Saúde - SIH-SUS) and from population projections by the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística – IBGE). HPCSC rates were calculated for 1,000 inhabitants, and the most frequent causes were studied by gender and age group, comparing both periods. ResultsHPCSP showed rates of 7.74/1,000 between 2002 and 2005 and 8.81/1,000 between 2006 and 2009. The main causes were heart failure, cerebrovascular diseases, angina pectoris, pulmonary diseases, and kidney and urinary tract infections, which together represented 4.9/1,000 in the first period and 5.6/1,000 in the second period. The evolution of the rates between both periods occurred differently by age group and gender. ConclusionThe study did not exhibit any remarkable differences in HPCSC rates between the periods. Regarding the most frequent causes, reduced hospitalization rates for gastroenteritis, asthma, high blood pressure, and cerebrovascular diseases were observed, as well as increased hospitalizations for heart failure, pulmonary diseases, epilepsies, and kidney and urinary tract infections; these hospitalizations occurred differently by gender and age group. The results showed that a deep reflection regarding the determinants of hospitalizations for avoidable causes is needed.

Estratégia Saúde da Família e internações hospitalares em menores de 5 anos no Piauí, Brasil

Hospitalizations for some health conditions can be reduced by timely primary care with appropriate quality, especially in children. This study analyzed the trend in hospitalizations in children under five years of age in Piauí State, Brazil, from 2000 to 2010, according to groups of causes (ICD-10) and hospital admissions in 2010, based on the Brazilian List of Hospitalizations for Primary Care-Sensitive Conditions. The objectives were to identify changes in the hospital morbidity profile and to discuss their relationship to expansion of the Family Health Strategy (FHS) in the State. Piauí showed the highest proportional expansion of the FHS in Brazil, reaching an estimated coverage of 97.2% in 2010. From 2000 to 2010, there was a reduction in the hospitalization frequency and rates in children under five years, but the proportion of hospitalizations in the leading groups of causes persisted or increased during the decade. In 2010, 60% of hospitalizations in children under five years were for causes that are sensitive to primary care, especially infectious gastroenteritis, respiratory infections, and asthma.