Reinternações hospitalares por condições sensíveis à Atenção Primária em crianças menores de 5 anos no Sistema Único de Saúde

Abstract

Hospitalizations due to Ambulatory Care Sensitive Conditions (ACSC) comprise a group of conditions considered preventable if timely and high-quality Primary Health Care (PHC) services are provided. The occurrence of unplanned hospital readmissions is a promising indicator for assessing and monitoring ACSC and the capacity of PHC to effectively manage healthcare demands. Childhood is a developmental stage differentially affected by public health policies, especially primary care. This study aims to analyze readmissions due to ACSC in children under 5 years old in the Unified Health System (SUS) between the years 2009 and 2015, to identify the main cause groups and associated factors. This was a retrospective cohort study that used information from the National Health Database, an individual-centered database constructed from secondary data from the main information systems of SUS. The study population comprised children under 5 years old hospitalized within SUS from July 2009 to June 2014, with a primary diagnosis recorded in the Brazilian List of Primary Care Sensitive Conditions. Standardized readmission rates for ACSC were calculated by sex and age, and variables related to sociodemographic, clinical, hospitalization characteristics, and hospital services were analyzed. The factors associated with readmission occurrence were: age <1 year (OR=1.81; 95% CI 1.79-1.83), male gender (OR=1.05; 95% CI 1.04-1.06), hospitalization in a private institution (OR=1.16; 95% CI 1.15-1.18), or non-profit private institution in the first hospitalization (OR=1.11; 95% CI 1.10-1.12), residing in the same municipality as the hospital institution (OR=1.03; 95% CI 1.01-1.04), and the initial cause of hospitalization being pulmonary diseases (OR=1.25; 95% CI 1.23-1.27), bacterial pneumonia (OR=1.33; 95% CI 1.31-1.35), asthma (OR=1.47; 95% CI 1.45-1.50), and epilepsy (OR=1.85; 95% CI 1.80-1.90). Age was the factor with the greatest magnitude of association with readmission. Although it is not a modifiable characteristic, it allows healthcare services to identify and closely monitor, in conjunction with other factors, infants under one year old with these target conditions for the occurrence of preventable readmissions. It is believed that this study can contribute to understanding the health vulnerabilities of the pediatric population and to generating information on hospital readmissions due to ACSC in SUS.