Internações por condições sensíveis e sua associação com a qualidade do cuidado na Atenção Primária à Saúde nos municípios brasileiros

Abstract

Introduction: Primary Health Care (PHC) is an important structure within health systems. Understanding its operation and studying what impacts on indicators is essential for directing policies and investments. Objective: The objective is to assess how the rates of Ambulatory Care Sensitive Conditions (ACSC) had varied from 2010 to 2019, and whether these rates are associated with the quality of PHC and other variables in Brazilian municipalities. Methodology: An ecological and historical series study was conducted in which trends in ACSC rates in Brazil and regions were analyzed, by age group, sex, and cause. Trends in rates were analyzed from 2010 to 2019 and by percentage change between 2010-2014 and 2015-2019. A correlation was also made between the rates of ICSAP in Brazilian municipalities, with the quality of PHC based on the cycles of the Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) and variables of socioeconomic characteristics and health systems. Correlation analysis over time was performed using the Generalized Equations Estimating (GEE) model. Results The ACSC rates standardized by Brazilian population or rates by age groups, had a statistically significant reduction in the period. The drop was greater from 2010 to 2014 than from 2015 to 2019, especially in the 0 to 4 and 5 to 19 age groups. About the causes of hospitalization, the three with the highest drops in females were: gastroenteritis (59.6%), asthma (58.7%) and hypertension (49.2%). There was an increase in some rates, such as cerebrovascular diseases (11.2%). These data were similar in males. In the multivariate analysis, it was observed that hospitalization rates dropped by 0.2% per year, with each increase of one point in the PHC quality score, keeping the other variables constant. Municipalities with greater deprivations also had higher rates. The increase of one unit in the number of beds per one thousand inhabitants resulted in an increase in rates of 7.84%. Conclusion: There was a decrease in the trend of decline rates from 2015 to 2019, especially in the range of children and adolescents, during a period of economic crisis and austerity policies. The quality of PHC in the country had an impact on the reduction of ACSC in the same municipality over time. The number of available beds seems to increase rates. ACSC rates can be useful to point out health outcomes, especially if they are analyzed in a historical series, they seem to be impacted by the quality of PHC and periods of economic crisis and austerity.