Primary Care Sensitive Conditions Research Articles

Spatial and Temporal Analysis of Hospitalizations Due to Primary Care-Sensitive Conditions Related to Diabetes Mellitus in a State in the Northeast of Brazil.

Hospitalizations due to primary care-sensitive conditions (PCSCs) can be considered a proxy for the effectiveness of primary healthcare (PHC), especially diabetes mellitus (DM). The aim of this study was to analyze the temporal, spatial, and space-time patterns of PCSCs associated with DM in a state in Northeast Brazil from 2008 to 2022. An ecological and time-series study that included all records related to PCSCs-DM from the 75 municipalities of Sergipe was conducted. Segmented linear regression, global (I) and local (LISA) Moran indices, spatial scanning, Spearman correlation tests, bivariate I, and LISA were used in our analysis to examine the temporal trends and clusters of high spatial risk. Overall, 14,390 PCSCs-DM were recorded between 2008 and 2022. There was a higher prevalence of PCSCs-DM among women (53.75%) and individuals over 70 years old (57.60%). Temporal trends in PCSCs-DM were increasing with regard to the overall rate (AAPC: 2.39); males (AAPC: 3.15); age groups ≤ 19 years (AAPC: 6.13), 20-39 years (AAPC: 4.50), and 40-59 years (AAPC: 2.56); and 3 out of the 7 health regions. There was a positive spatial correlation between per capita income (I = -0.23; p = 0.004) and diabetic foot examination being performed by a nurse in a PHC (I = -0.18; p = 0.019) setting. The heterogeneous spatial distribution of DM hospitalizations demonstrated that this condition is a persistent public health problem in Sergipe.

Increasing primary care capacity and referral efficiency: A case study of a telehealth centre eConsult service in Brazil.

eConsults are asynchronous digital communications for primary care professionals to seek timely specialist advice. Potential benefits include increased primary healthcare capacity and referral efficiency. Santa Catarina Telehealth Centre in Brazil has offered eConsults for an increasing number of specialties since 2008. This study described the characteristics of this service, including referral efficiency, sustainability, and satisfaction. Retrospective longitudinal analysis of eConsults activity data from 2015 to 2022 with three domains of the Model for Assessment of Telemedicine Applications used to structure the analysis. Characteristics of the application: The total number of eConsults performed in 2015 was 4764, reaching 41,178 in 2022. While 30.3% of eConsults were synchronous in 2015, only asynchronous communication remained from 2021. Clinical effectiveness: eConsults requested to refer patients to specialist care resulting in primary care management remaining above 30% of the total for all specialties from 2019 to 2022, with hematology having the highest percentage (>52%). Organizational aspects: Established workflows with local specialists responding to eConsults (cardiology, endocrinology, hematology and orthopaedics) kept a constant or increasing number of eConsults and maintained the proportion of primary care management from 2019 to 2022, once recovered from COVID-19 and funding restrictions-related reductions. Over 90% of primary care professionals are either satisfied or very satisfied with the eConsult service. Over 8 years, 223,734 consultations were conducted, with high satisfaction, demonstrating the substantial potential for increased primary care-sensitive conditions management. Hiring local specialists, fostering integrated care, and enabling sustainable workflows are key to eConsults' success.

Hospitalizations for conditions sensitive to primary care and sustainable development objectives

Hospitalizations for Primary Care Sensitive Conditions (ICSAP) are widely recognized as an indicator of health system performance. Considering that the evaluation of health practices is mandatory, monitoring these indicators becomes relevant, with a view to directing actions that can contribute to the Sustainable Development Goals. The objective of this study was to analyze the profile of ICSAP that occurred in the Federal District (DF) in the period from 2018 to 2022. This is an ecological time series study, using Hospital Admission Authorizations as a data source, via the Information System Hospital of the Unified Health System. Data collection was carried out in November 2022 and covered the period from 2018 to 2022. Descriptive statistical analysis was carried out. It was possible to identify the profile of ICSAP in DF. The elderly population and children aged 1 to 14 years were predominant, as well as diagnoses related to anemia, ear, nose and throat infections and asthma. The main causes of deaths and expenses were cerebrovascular diseases, heart failure and bacterial pneumonia.

Hospitalizations for primary care sensitive conditions: an approach to the elderly population in the interior of the brazilian Amazon

The aim of this study is to analyze Hospitalizations for Conditions Sensitive to Primary Health Care (HACSC) in the elderly population in a municipality in the interior of the Brazilian Amazon. This is an ecological, time-series study in which the Hospital Information System (SIH/SUS) was used for data collection, the unit of analysis being the municipality of Santarém from 2011 to 2020. The data was subjected to simple descriptive statistical analysis and presented in the form of tables and graphs. During the period under study, 7,567 HACSC notifications were identified. Diseases of the circulatory system stood out (43.54%), specifically stroke (23.54%), followed by diseases of the respiratory system (23.34%), most notably pneumonia (22.19%). There was a higher incidence among females (53.11%), and there was a worsening and aggravation of the conditions, since 95% of the cases were emergency cases. Therefore, discussions on HACSCs should involve the engagement of various actors in order to re-evaluate actions and strategies and identify possible limiting factors for effective preventive activities for these conditions.

Elderly Mortality due to Ambulatory Care Sensitive Conditions and Primary Health Care Coverage in the Federal District.

To describe the mortality coefficients of elderly due to primary care sensitive conditions, from 2008 to 2018, and determine its association with the coverage of the Primary Health Care (Family Health Strategy and Basic Care models) in the Federal District. Ecological time series of mortality in Federal District elderly, from 2008 to 2018. The Poisson regression model was applied, considering as significant those with p<0.05, with a CI of 95%. There were 70,503 deaths. There was a decrease in the risk of death of elders due to cardiovascular diseases and diabetes. Higher primary care coverage decreased the chance of death by sensitive conditions, both in Basic Care (OR: 0.994, CI: 0.990-0.998) and in the Family Health Strategy (OR: 0.997, CI: 0.995-0.999). Primary Care coverage was associated with a lower chance of death of the elderly due to Ambulatory Care Sensitive Conditions, especially in Basic Care.

Pediatric hospitalizations due to primary care sensitive conditions in northern Minas Gerais, Brazil: reassessment after 10 years

Resumo Introdução As internações por condições sensíveis à atenção primária (ICSAP) representam um importante indicador de saúde, que pode orientar sobre o acesso e a qualidade da assistência à saúde no âmbito da atenção primária. Objetivo Avaliar a prevalência e os fatores associados às ICSAP em crianças de zero a 10 anos incompletos, no norte de Minas Gerais, comparando o indicador com estudo similar realizado há dez anos. Métodos Estudo transversal com amostra aleatória de hospitalizações pediátricas selecionadas entre junho/2016 e agosto/2017. As variáveis associadas às ICSAP foram identificadas após análise múltipla, por meio da regressão de Poisson, com variância robusta. Resultados Foram analisadas 376 hospitalizações. A proporção de ICSAP foi de 29,0%, significativamente menor do que o estudo anterior, com proporção de 41,4%. As variáveis sexo masculino (RP = 0,91; IC95%:0,86-0,97), baixo peso de nascimento (PR = 0,91; IC 95%: 0,85-0,97) e escolaridade materna inferior a oito anos (RP = 0,93; IC 95%: 0,88-0,98) foram identificados como fatores protetores. Conclusão Registrou-se prevalência ainda elevada para as ICSAP, mas com importante redução em dez anos. Apenas variáveis sociodemográficas se mostraram associadas às ICSAP.

Evolução da estrutura e resultados da Atenção Primária à Saúde no Brasil entre 2008 e 2019

Abstract This paper describes the structure and results of Primary Health Care (PHC) in Brazil between 2008 and 2019. The medians of the following variables were calculated: PHC spending per inhabitant covered, PHC coverage, and rates of mortality and hospitalizations due to primary care sensitive conditions (PCSC), in 5,565 Brazilian municipalities stratified according to population size and quintile of the Brazilian Deprivation Index (IBP), and the median trend in the period was analyzed. There was a 12% increase in median PHC spending. PHC coverage expanded, with 3,168 municipalities presenting 100% coverage in 2019, compared to 2,632 in 2008. The median rates of PCSC mortality and hospitalizations increased 0.2% and decreased 44.9%, respectively. PHC spending was lower in municipalities with greater socioeconomic deprivation. The bigger the population and the better the socioeconomic conditions were in the municipalities, the lower the PHC coverage. The greater the socioeconomic deprivation was in the municipalities, the higher the median PCSC mortality rates. This study showed that the evolution of PHC was heterogeneous and is associated both with the population size and with the socioeconomic conditions of the municipalities.

Evolution of the structure and results of Primary Health Care in Brazil between 2008 and 2019.

This paper describes the structure and results of Primary Health Care (PHC) in Brazil between 2008 and 2019. The medians of the following variables were calculated: PHC spending per inhabitant covered, PHC coverage, and rates of mortality and hospitalizations due to primary care sensitive conditions (PCSC), in 5,565 Brazilian municipalities stratified according to population size and quintile of the Brazilian Deprivation Index (IBP), and the median trend in the period was analyzed. There was a 12% increase in median PHC spending. PHC coverage expanded, with 3,168 municipalities presenting 100% coverage in 2019, compared to 2,632 in 2008. The median rates of PCSC mortality and hospitalizations increased 0.2% and decreased 44.9%, respectively. PHC spending was lower in municipalities with greater socioeconomic deprivation. The bigger the population and the better the socioeconomic conditions were in the municipalities, the lower the PHC coverage. The greater the socioeconomic deprivation was in the municipalities, the higher the median PCSC mortality rates. This study showed that the evolution of PHC was heterogeneous and is associated both with the population size and with the socioeconomic conditions of the municipalities.

Comparative performance of public and private primary care service delivery in Malaysia: An analysis of findings from QUALICOPC

Primary care services are essential in achieving universal health coverage and Malaysia is looking into public-private partnership to overcome resource constraints. The study aims to compare the performance of primary care service delivery dimensions between public and private sector. This cross-sectional study used the data from the Malaysian International Quality and Costs of Primary Care (QUALICOPC) study conducted in 2015-2016. The relative performance of each sector in four dimensions was compared using multi-level linear regression by incorporating a dummy variable indicating public sector in the model. The public sector was shown to have higher performance in comprehensiveness and coordination, while the private sector was better in continuity. There was no significant difference in accessibility. The public primary care services were better in serving primary care sensitive conditions, better informational continuity, and with better skill-mix and inter- and intra- professional relationship. Meanwhile, the private sector was stronger in referral decision making process, specialist feedback and greater out of hours facilities access. The public and private sectors differ in their strengths, which the government may tap into to strengthen primary care services. Other areas for improvement include seamless care strategies that promote good referral, feedback, and information continuity.

Spatiotemporal analysis of hospital admissions for primary care-sensitive conditions in women and children in the first 1000 days of life.

ObjectiveTo analyze the spatiotemporal distribution of hospital admission rates for primary care-sensitive conditions (PCSC) in women and children in the first 1000 days of life in Brazil.MethodsEcological study, with spatiotemporal analyses, using secondary data from Brazilian municipalities. PCSC in women, related to prenatal care and childbirth, and in children under two years old, from 2008 to 2019 were used to characterize trends and formations of spatiotemporal clusters/outliers. Crude PCSC rates were calculated and adjusted by the local empirical Bayesian method, presented in choropleth maps. We also used Anselin Local Moran I type analyses to identify spatial clusters, and space-time cube with clustering by emerging hotspot, followed by time series clustering, for analysis of spatiotemporal trends (alpha = 5%).ResultsA total of 1,850,776 PCSC were registered in pregnant women, puerperae, and children under two years of age in Brazil, representing 1.7% of the total number of hospital admissions in the period. PCSC rates showed different behaviors when the groups of women and children were evaluated, with a predominant growing trend of 109% in admissions in the first group and a reduction of 34.4% in the second. The North, Northeast, and Midwest regions had larger high-risk clusters and more significant increasing trends in PCSC in the two subpopulations studied.ConclusionsHealth actions and services in primary care may be reducing hospital admissions for children, but they are not being effective in reducing hospital admissions for women for causes related to prenatal care and childbirth, especially in the North, Northeast, and Midwest of Brazil. Investments in the qualification of care over the thousand days are urgent in the country.

Sociodemographic and health profile of asylum-seekers in Rio de Janeiro, 2016-2017.

ABSTRACTOBJECTIVE To analyze the sociodemographic profile and self-reported health conditions of asylum-seekers in Rio de Janeiro.METHODS A cross-sectional study of secondary data, collected from asylum claims forms completed in 2016 and 2017, at Cáritas Arquidiocesana do Rio de Janeiro (Cáritas-RJ). Descriptive analyses were performed and absolute and relative frequencies and 95% confidence intervals were calculated.RESULTS Claims completed by 818 asylum-seekers from 49 different countries were identified, of whom 126 (20.3%) were stateless, 510 (62.7%) were male, 797 (97.4%) were adults, with a mean age of 30.5 years, 551 (73.5%) were single, 340 (44.1%) had higher education, and 27 (4.0%) were unemployed in their country of origin before coming to Brazil. Fear of persecution for political opinion, violation of human rights, and risk of torture stood out among the reasons stated for requesting asylum. To reach Brazil, 629 (80.5%) traveled only by plane. Regarding health conditions, 216 (29.0%) reported having some symptom, disease or health problem, the most frequent being pain, vision problems, infectious diseases (including HIV/AIDS), and hypertension. Only 15 individuals (2.2%) reported being in some medical or psychological treatment; 42 (6.0%) reported visual impairments, 14 (2.0%) reported physical impairments and 4 (0.6%) hearing impairments.CONCLUSIONS Unlike other countries, where forced migrants with a low level of education enter clandestinely by sea or land, asylum-seekers residing in Rio de Janeiro between 2016 and 2017 were mostly adults with higher education who migrated using air transport. They had primary care-sensitive health conditions that could be treated via access to public primary health care services.

Exploring social inequalities in healthcare trajectories following diagnosis of diabetes: a state sequence analysis of linked survey and administrative data

BackgroundSocial inequalities in complications associated with diabetes mellitus persist. As a primary care sensitive condition (PCSC), this association could be related to differential access to primary care. Our objectives are to establish a typology of care trajectories following a new diagnosis, and to explore social determinants of trajectories.MethodsWe used the TorSaDe (The Care Trajectories-Enriched Data) cohort, which links Canadian Community Health Survey respondents to health administrative data. Care trajectories were mapped over a two-year period following a new diagnosis and analysed using state sequence and clustering methods. Associations between individual and geographic characteristics with trajectory types were assessed with multinomial logistic regression.ResultsThree trajectories were identified: Regular Family Physician (FP) Predominant, Specialist Physician Predominant, and Few Services. With Regular FP as the reference, males had higher odds of experiencing the Few Services trajectory, higher education was associated with higher odds of both the Few Services and the Specialist trajectories, and immigrants had higher odds of the Specialist trajectory. Diagnoses in a physician’s office, as opposed to in hospital, were associated with higher odds of the Regular FP trajectory.ConclusionsThe Regular FP trajectory most closely aligns with the management principles of the PCSC approach. We did not find strong evidence of social status privileging access to this trajectory. However, the association with location of diagnosis suggests that efforts to ensure patients diagnosed in hospital are well linked to a regular family physician for follow up may help to reduce unnecessary specialist use and meet PCSC goals.

Number of health care teams and hospitalizations due to primary care sensitive conditions.

This study aimed to analyze the correlation between the number of health care teams of the Family Health Strategy (FHS) and the number of hospitalizations due to primary care sensitive conditions (HPCSC) taking into account rates, costs and hospital days in a large municipality of the state of Minas Gerais, Brazil, between 2010 and 2019. We performed an ecological time series correlation study on HPCSC of patients hospitalized by the public health system. Data were obtained from the Hospital Information System of the IT Department of the Public Health System (DATASUS) and from the Primary Care Information and Management System. The correlation analysis was performed based on the number, gross and standardized rates, percentages, costs and hospital days of HPCSC and health care coverage (average number of teams) using Spearman's correlation coefficient at a significance level of 5% (p < 0.05). No satisfactory correlation was found in the entire period between the increase in the number of health care teams and HPCSC (except for the standardized hospitalization rate). However, during the period in which the FHS coverage of the population was greater than 70%, all correlations were inversely proportional and statistically significant.

Número de equipes assistenciais e internações por condições sensíveis à atenção primária

Abstract This study aimed to analyze the correlation between the number of health care teams of the Family Health Strategy (FHS) and the number of hospitalizations due to primary care sensitive conditions (HPCSC) taking into account rates, costs and hospital days in a large municipality of the state of Minas Gerais, Brazil, between 2010 and 2019. We performed an ecological time series correlation study on HPCSC of patients hospitalized by the public health system. Data were obtained from the Hospital Information System of the IT Department of the Public Health System (DATASUS) and from the Primary Care Information and Management System. The correlation analysis was performed based on the number, gross and standardized rates, percentages, costs and hospital days of HPCSC and health care coverage (average number of teams) using Spearman’s correlation coefficient at a significance level of 5% (p &lt; 0.05). No satisfactory correlation was found in the entire period between the increase in the number of health care teams and HPCSC (except for the standardized hospitalization rate). However, during the period in which the FHS coverage of the population was greater than 70%, all correlations were inversely proportional and statistically significant.

Internações evitáveis de idosos no estado do Ceará: estudo ecológico descritivo

Studies that evaluate Hospitalizations due to Primary Care-sensitive Conditions (HPCSC) are relevant in the field of health, as they refer to indicators of hospital care that represent an indirect measurement of the effect of Primary Health Care (PHC), based on the premise that good quality PHC prevents/reduces hospitalizations among the elderly population. This article aimed to describe the behavior of HPCSC in elderly people aged 60 to 74 years old in the state of Ceará. This is a descriptive ecological study that analyzed the temporal evolution of annual rates of HPCSC in the elderly in the five health macro-regions of the state of Ceará, from 2008 to 2019. Secondary data regarding hospitalizations and the projection of the resident population for the calculation of rates were extracted, respectively, from the hospital information system and from the demographic database, both contained within the Tabnet of the Department of Informatics of the UHS. In the period from 2008 to 2019, there were 686,906 hospitalizations in the five health macro-regions of the state of Ceará, of which (298,002) were due to sensitive conditions. The highest rate of HPCSC (452.99) occurred in the Cariri macro-region. There was a predominance of elderly men (4,731) aged 70-74 years (5,893) and due to chronic conditions (2,195.3). There was a reduction in hospitalizations due to primary care-sensitive conditions in the period studied, except in the central Sertão region. The decrease in hospitalizations of the elderly in the state of Ceará may be related to a more resolute primary care in the care of the elderly.

Impact of COAP on access to primary care in Ceará and Mato Grosso do Sul through the analysis of interrupted time series.

ABSTRACTOBJECTIVE:To analyze the impact of implementing the Contrato Organizativo de Ação Pública (COAP – Public Action Organizational Contract) on the expansion of access to primary care in the states of Ceará and Mato Grosso do Sul.METHODS:We used the interrupted time series method to analyze the effect of COAP on primary care coverage (PCCov) and on avoidable hospitalization rates. To analyze the effects of increased PCCov on avoidable hospitalizations, we used non-segmented time series models.RESULTS:The results showed that implementing COAP had a positive impact on increased coverage in both cases, with did not happen in the control states. However, this impact was not reflected in the decrease in hospitalizations due to primary care sensitive conditions (HPCSC) or for acute preventable causes. When we analyzed the effects of the increase in PCCov on avoidable hospitalizations between 2009 and 2016, we observed that coverage had a positive impact on the decrease in the rate of HPCSC only in Ceará, although hospitalizations have a significant trend to decrease in time both in this state and in Mato Grosso do Sul, except for acute respiratory infections.CONCLUSIONS:The COAP continues to be the regulatory instrument of regionalization force, however, the results obtained by adhering to it in the expansion of primary care in Ceará and Mato Grosso do Sul makes us question whether the contractual model, as predicted, is the best instrument for advancing regionalization in the Brazilian Unified Health System.

Internações por Causas Sensíveis à Atenção Primária em Idosos da Região Centro-Sul do Estado do Paraná

Hospitalizations due to Primary Care-Sensitive Conditions (HPCSC) are caused by diseases whose care must be carried out at the first level of care and when not carried out lead to hospitalization, such as bacterial pneumonia, complications of diabetes mellitus, systemic arterial hypertension, asthma, among others. In order to analyze the main groups of diseases that cause HPCSC in elderly people in the South-Central region of the state of Paraná, a descriptive, exploratory, and ecological study of elderly people aged 60 to 74 years was carried out from 2008 to 2018 using the Hospital Information System of the Unified Health System (HIS/UHS), available on the website of the UHS Department of Informatics (DATASUS). In the analyzed period, there were 19,948 hospitalizations of elderly people aged 60 to 74 years due to PCSC. 10,007 (50.16%) cases were of men and 9,941 (49.84%) of women; the group of causes with the highest incidence of hospitalization were pulmonary diseases at 23.86%, followed by bacterial pneumonia at 20.47%, and heart failure at 12.59%; and these three groups accounted for more than 50% of all hospitalizations. The findings demonstrate a higher male incidence of HPCSC, with lung diseases, pneumonia, and heart failure being the main pathologies that affect the elderly population in the studied region. This reinforces the idea that promotion and prevention actions can help to reduce the number of hospitalizations and improved quality of life.

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.

Hospitalization for Primary Care-Sensitive Conditions in Adults and Its Impact on Hospital Care in São Paulo City, Brazil.

Identifying conditions among all cause hospitalizations that could be prevented at the primary care level would allow the development of strategies to reduce the range of diseases treated in hospital and promote a more efficient utilization of resources. We sought to evaluate hospitalizations for clinical conditions that are sensitive to primary care in adults. Cross-sectional study with data captured in hospital electronic health records using the diagnosis related groups classification system. Primary care-sensitive conditions were associated with longer duration of hospitalization, older age, higher prevalence of female patients, higher complexity at admission and during hospitalization, and a higher risk of mortality as compared with other conditions not sensitive to primary care. A significant proportion of hospitalizations are due to causes sensitive to primary care. Hospitalizations due to primary care-sensitive conditions are associated with longer hospital stay, greater complexity and severity, and a higher risk of mortality.

Impact of Brazil's More Doctors Program on hospitalizations for primary care sensitive cardiovascular conditions.

Globally, cardiovascular diseases are the leading cause of disease burden and death. Timely and appropriate provision of primary care may lead to sizeable reductions in hospitalizations for a range of chronic and acute health conditions. In this paper, we study the impact of Brazil's More Doctors Program (MDP) on hospitalizations due to cerebrovascular disease and hypertension. We exploit the geographic variation in the uptake of the MPD and combine coarsened exact matching and difference-in-difference methods to construct valid counterfactual estimates. We use data from the Hospital Information System in Unified Health System, the MDP administrative records, the Brazilian Regulatory Agency, the Ministry of Health, and the Brazilian Institute of Geography and Statistics, covering the years from 2009 to 2017. Our analysis resulted in estimated coefficients of −1.47 (95%CI: −4.04,1.10) for hospitalizations for cerebrovascular disease and −1.20 (95%CI: −5.50,3.11) for hypertension, suggesting an inverse relationship between the MDP and hospitalizations. For cerebrovascular disease, the estimated MDP coefficient was −0.50 (95%CI: −2.94,1.95) in the year of program introduction, −5.21 (95%CI: −9.43,-0.99) and −8.21 (95%CI: −13.68,-2.75) in its third and fourth year of implementation, respectively. Our results further suggest that the beneficial impact of MDP on hospitalizations due to cerebrovascular disease became discernable in urban municipalities starting from the fourth year of implementation. We found no evidence that the MDP led to reductions in hospitalizations due to hypertension. Our results highlight that increased investment in resources devoted to primary care led to improvements in hospitalizations for selected cardiovascular conditions. However, it took time for the beneficial effects of the MDP to become discernable and the Program did not guarantee declines in hospitalizations for all cardiovascular conditions, suggesting that further improvements may be needed to enhance the beneficial impact of the MDP on the level and distribution of population health in Brazil.