Médicos de Família e Comunidade como médicos ideais para as Equipes de Saúde da Família: evidências de um estudo ecológico longitudinal entre 2017 e 2021 no município de Belo Horizonte para informar políticas de saúde pública

Abstract

Introduction: Primary care sensitive conditions are conditions for which the provision of timely and qualified primary care can reduce the risks of hospitalization by preventing, treating or controlling a disease. For this reason, hospitalizations for primary care sensitive conditions have been commonly employed by health systems as an indicator of effectiveness for the primary level of care. The objective of the study was to evaluate whether the greater supply, in primary care services, of doctors with training in Family Medicine Residency is associated or not with the coefficients of general hospitalizations for hospitalizations for primary care sensitive conditions in the SUS network in the city of Belo Horizonte. Methodology: Longitudinal ecological design study, using the Generalized Linear Model (MLG) Gamma, with socioeconomic and health data from January 1, 2017 to December 31, 2021, aggregated in the unit of analysis at the level of Health Centers (HC). Results: After adjusting for age and sex by the direct method, and controlling for socioeconomic variables captured through the Health Vulnerability Index, the study observed a lower incidence of ICSAP significantly associated with a higher concentration of doctors with training in Family Medicine Residency (Reduction of the Relative Risk of 11,89% [7,30%; 16,30%] with p-value < 0.05). The interpretation is that by increasing the proportion of medical hours of Family physician by one unit over the total medical hours of Family Health teams, that is, turning 100% of doctors working in Family Health teams into Family physician, there is a potential reduction of about 11,89% of hospitalizations for primary care sensitive conditions. This reduction effect was not observed with the presence of general practitioners, without specialization in Family Medicine. Subgroup analyzes were performed to verify the effect on social vulnerability categories (Low, Medium, High and Very High), period categories (Pre-Pandemic and Pandemic) and hospitalizations for primary care sensitive conditions cause categories. Conclusion: The present study found associations between the availability of Family physician and lower rates of hospitalizations for primary care sensitive conditions. Such evidence can contribute to the writing of evidence-informed public policies.