Qualidade da Atenção Primária à Saúde e internações por condições sensíveis: um estudo a partir do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica

Abstract

This is an ecological study that used the database of the second cycle of the Program for Improving Access and Quality of Primary Care (PMAQ-AB) to assess the quality of Primary Health Care (PHC) in Brazilian municipalities and assess its relationship with the number of Admissions due to ambulatory care sensitive conditions (ACSC), in 2014. Municipalities with more than 80% adherence of the health teams to the PMAQ-AB were included in the study. The measure of association between the number of admissions due to ambulatory care sensitive conditions and the quality of the PHC was calculated by negative binomial regression with robust variance and the total population as offset, setting a significance of 20% in the univariate analysis, and 5% in the multivariate analysis. A hierarchical modeling with block input using the backward method was used. The mean number of ACSC in the period under study was 359.97 hospitalizations per municipality. In the adjusted analysis, in the distal block, municipalities with a higher proportion of elderly and high vulnerability showed a higher number of ACSC. The number of admissions presents an 8% growth for each 1% increase of the population above 60 years (CI: 1.071.10). The number of ACSC of municipalities with greater socioeconomic vulnerability is 1.53 times the number of ACSC of municipalities with low socioeconomic vulnerability (CI: 1.32-1.78). In the proximal block, with the exception of the coverage plans that did not remain in the final model, all variables assessed displayed a significant association with the outcome of the study. For each 1 unit increase in the number of beds per thousand inhabitants, the number of ACSC increases 3.8% (CI: 1.02-1.06). Municipalities with greater FHS coverage presented a higher number of ACSC. Municipalities with high coverage presented 1.71 times the number of admissions of municipalities with low coverage (CI: 1.51-1.93). The quality of the PHC showed a protective effect on the occurrence of ACSC. Better evaluated municipalities (quartile 4) presented 17.5% less ACSC than municipalities with worse quality (CI: 0.75-0.91). The results show that the country's PHC quality has an impact on the reduction of ACSC, even in contexts of social vulnerability.