Hospitalizations of older adults due to chronic conditions sensitive to primary care in a Ceará region

Abstract

Objective: to analyze the time evolution of chronic HPCSCs in older adults and its correlation with the FHS coverage and socioeconomic indicators of a health region. Method: a descriptive and ecological study, whose unit of analysis were the municipalities of the 11 Health Region of Ceará during the 2012-2017 period. The data were extracted from the Hospital Information System, e-Gestor Information System and Atlas of Human Development in Brazil, and analyzed in the STATA software. Results: a total of 7,245 HPCSCs were recorded, of which 4,650 (64.18%) belonged to the chronic condition groups. The highest frequency of hospitalizations was among male older adults, with 2,578 (55.4%), and aged from 70 to 74 years old, with 1,873 (35.87%). The most prevalent causes were the following: Heart Failure with 1,666 (35.83%), Cerebrovascular Diseases with 1,048 (22.54%), and Angina with 754 (16.22%). There was a tendency towards a reduction of chronic HPCSCs and expansion of the FHS coverage with a strong inverse correlation (r = -0.80, p-value = 0.0301), as well as with the Gini index (R = 0.80, p = 0.0291). The other socioeconomic indicators showed no correlation with the HPCSC rates. Conclusion: the expansion of the FHS coverage was strongly correlated with a reduction in the rates of chronic HPCSCs in older adults. Thus, it is appropriate to urge professionals and managers to develop strategies in the territory that favor effective care. Descriptors: Primary Health Care. Aged. Hospitalization. Chronic Disease. Social Conditions. RESUMO Objetivo: analisar a evolução temporal das ICSAP crônicas em idosos e sua correlação com a cobertura da ESF e indicadores socioeconômicos de uma região de saúde. Método: estudo ecológico descritivo, cuja unidade de análise foram os municípios da 11a Região de Saúde do Ceará no período de 2012 a 2017. Os dados foram extraídos do Sistema de Informação Hospitalar, Sistema de Informação e-Gestor e Atlas de Desenvolvimento Humano no Brasil e analisados no software STATA. Resultados: registradas 7.245 ICSAP, 4.650 (64,18%) pertencem aos grupos de condições crônicas. A maior frequência de internações foi entre os idosos do sexo masculino 2.578 (55,4%) e com idade de 70 a 74 anos com 1.873 (35,87%). As causas mais prevalentes foram: Insuficiência Cardíaca com 1.666 (35,83%), Doenças Cerebrovasculares com 1.048 (22,54%) e Angina com 754 (16,22%). Houve tendência de redução das ICSAP crônicas e expansão da cobertura da ESF com forte correlação inversa (r= -0,80, p-valor =0,0301) e com o índice de Gini (R = 0,80, p = 0,0291). Os demais indicadores socioeconômicos não apresentaram correlação com as taxas de ICSAP. Conclusão: a expansão da cobertura da ESF esteve fortemente correlacionada à redução das taxas de ICSAP crônicas em idosos. Assim, é oportuno exortar profissionais e gestores para desenvolver estratégias no território que favoreça um cuidado efetivo. Descritores: Atenção primária à Saúde. Idoso. Hospitalização. Doença crônica. Condições sociais. RESUMÉN Objetivo: analizar la evolución temporal de la HCSAP crónica en adultos mayores y su correlación con la cobertura de la ESF y los indicadores socioeconómicos de una región sanitaria. Método: estudio ecológico descriptivo, realizado en los municipios de la XI Región Sanitaria de Ceará, entre 2012 a 2017. Datos extraídos del Sistema de Informação Hospitalar, Sistema de Informação e-Gestor y Atlas de Desenvolvimento Humano no Brasil, analizados por el Software STATA. Resultados: registrados 7.245 HCSAP, 4.650 (64,18%) en grupos de enfermedades crónicas. La mayor frecuencia de hospitalizaciones se registró en hombres (2.578; 55,4%), de 70 a 74 años (1.873; 35,87%). Las causas más prevalentes fueron: Insuficiencia Cardíaca (1.666; 35,83%); Enfermedades Cerebrovasculares (1.048; 22,54%) y Angina (754; 16,22%). Hubo una tendencia a reducir el HCSAP crónico y la expansión de la cobertura ESF con una fuerte correlación inversa (r = 0,80, valor de p=0,0301) y con el índice de Gini (R = 0,80, p=0,0291). Otros indicadores socioeconómicos no se correlacionaron con las tasas de HCSAP. Conclusión: la expansión de la ESF se correlacionó fuertemente con la reducción de las tasas crónicas de HCSAP en personas mayores. Así, es oportuno estimular profesionales y gestores a desarrollar estrategias que favorezcan una atención eficaz. Descriptores: Atención Primaria a la Salud. Anciano. Hospitalización. Enfermedad Crónica. Condiciones Sociales. ISSN: 2238-7234 Azevedo SGV, et al. Hospitalizations of older adults.. 2 English Rev Enferm UFPI. 2021 10:e883. DOI: 10.26694/reufpi.v10i1.883 INTRODUCTION The indicator of Hospitalizations due to Primary Care Sensitive Conditions (HPCSCs) is widely used in several countries to verify the performance of Primary Health Care (PHC). Two studies contribute a well-established relationship between decreased rates of HPCSCs in older adults and improved access and resoluteness of the first-level health care services. The socioeconomic profile can also exert an influence on the HPCSC rates. According to Amorim et al., the social determinants of health can be considered as external influencers of the HPCSC rates, especially those related to education, income, and housing conditions. Therefore, the resolutive capacity of the first level of care and the socioeconomic profile directly impact on the quality of life of the aged population and on the maintenance of their functional capacity, affecting their health, disease, and need or not for hospitalizations. Older adults have a seven times higher risk of hospitalizations due to these conditions compared to the general population, which reflects the relevance of analyzing and monitoring this indicator in this population. In addition, the Brazilian Northeast region is marked by social characteristics that make its population vulnerable, although it is a pioneer in the development of programs to access the basic health network, which makes it relevant to explore the correlation between the Family Health Strategy (FHS) coverage, the socioeconomic indicators, and the HPCSC rates in this region. The objective of this study is to analyze the time evolution of chronic HPCSCs in older adults and its correlation with the Family Health Strategy (FHS) coverage and socioeconomic indicators in a health region of Ceará.