Veneza Berenice de Oliveira

Internações por condições sensíveis à atenção primária: a construção da lista brasileira como ferramenta para medir o desempenho do sistema de saúde (Projeto ICSAP - Brasil)

Ambulatory care sensitive hospitalizations are a set of conditions for which access to effective primary care can reduce the likelihood of hospitalization. These hospitalizations have been used as an indicator of primary care performance in several countries and in three Brazilian states, but there is little consensus on which conditions should be included in this indicator. This paper presents a description of the steps undertaken to construct and validate a list for Brazil. The final list includes 20 groups of diagnostic conditions that represented 28.3% of a total of 2.8 million hospitalizations in the National Unified Health System in 2006. Gastroenteritis and complications, congestive heart failure, and asthma represented 44.1% of all ambulatory care sensitive hospitalizations. From 2000 to 2006, ambulatory care sensitive hospitalizations decreased by 15.8%, and this reduction was more significant than that observed in all other hospitalizations. The article concludes with potential applications and limitations of the proposed Brazilian list.

Major Expansion Of Primary Care In Brazil Linked To Decline In Unnecessary Hospitalization

In 1994 Brazil launched what has since become the worlds largest community-based primary health care program. Under the Family Health Program, teams consisting of at least one physician, one nurse, a medical assistant, and four to six trained community health agents deliver most of their services at community-based clinics. They also make regular home visits and conduct neighborhood health promotion activities. This study finds that during 1999-2007, hospitalizations in Brazil for ambulatory care-sensitive chronic diseases, including cardiovascular disease, stroke, and asthma, fell at a rate that was statistically significant and almost twice the rate of decline in hospitalizations for all other causes. In municipalities with high Family Health Program enrollment, chronic disease hospitalization rates were 13 percent lower than in municipalities with low enrollment, when other factors were held constant. These results suggest that the Family Health Program has improved health system performance in Brazil by reducing the number of potentially avoidable hospitalizations.

The Influence of Primary Care and Hospital Supply on Ambulatory Care–Sensitive Hospitalizations Among Adults in Brazil, 1999–2007

OBJECTIVES We assessed the influence of changes in primary care and hospital supply on rates of ambulatory care-sensitive (ACS) hospitalizations among adults in Brazil. METHODS We aggregated data on nearly 60 million public sector hospitalizations between 1999 and 2007 to Brazils 558 microregions. We modeled adult ACS hospitalization rates as a function of area-level socioeconomic factors, health services supply, Family Health Program (FHP) availability, and health needs by using dynamic panel estimation techniques to control for endogenous explanatory variables. RESULTS The ACS hospitalization rates declined by more than 5% annually. When we controlled for other factors, FHP availability was associated with lower ACS hospitalization rates, whereas private or nonprofit hospital beds were associated with higher rates. Areas with highest predicted ACS hospitalization rates were those with the highest private or nonprofit hospital bed supply and with low (< 25%) FHP coverage. The lowest predicted rates were seen for areas with high (> 75%) FHP coverage and very few private or nonprofit hospital beds. CONCLUSIONS These results highlight the contribution of the FHP to improved health system performance and reflect the complexity of the health reform processes under way in Brazil.

Trends in primary health care-sensitive conditions in Brazil: the role of the Family Health Program (Project ICSAP-Brazil)

BackgroundThis study describes trends in hospital admission rates for primary healthcare-sensitive conditions (PHCSC) in Brazil. ObjectivesTo evaluate the impact of increased primary healthcare availability through the implementation of the Family Health Program (FHP) on PHCSC admissions rates at the national, regional, and state-levels between 1999 and 2007. Research DesignAn ecologic panel data study was used and a fixed effects multivariate negative binomial model was used to estimate the association of PHCSC admission rate and FHP controlling for other relevant covariates. ResultsIt was shown that, at the national level, PHCSC hospital admissions declined by 24%—over 2.5 times more rapidly than the decline in hospitalizations for all other (non-PHCSC) conditions. Greater reductions in the PHCSC admission rates when compared with the non-PHCSC admission rates were also observed when the data were divided by regions and states. Regression models showed that at the state level the greater the FHP coverage, the less was the PHCSC hospital admissions even when controlling for confounding variables. ConclusionsThe results of this study have important implications for the healthcare model in countries that base their national health systems on primary healthcare. This is the first study to evaluate the association between FHP coverage and PHCSC admissions rates in all the Brazilian states over a long and relevant period for the consolidation of FHP in the country.

O desafio da expansão do Programa de Saúde da Família nas grandes capitais brasileiras

O Programa de Saude da Familia (PSF) foi a estrategia escolhida pelo Ministerio da Saude para promover a substituicao do modelo assistencial brasileiro. Quase dez anos apos o seu inicio, constata-se uma heterogeneidade na sua implantacao: observa-se a ausencia de cobertura em municipios de grande porte, notadamente as capitais brasileiras, e tambem em municipios muito pequenos, nao habilitados nas modalidades de gestao municipal do Sistema Unico de Saude (SUS). A expansao do programa a esses dois espacos encontra restricoes especificas e, ao mesmo tempo, situacoes potencialmente vantajosas. Devido ao grande contingente populacional que se encontra nas capitais brasileiras, a cobertura das mesmas revela-se essencial para a consolidacao definitiva do modelo assistencial proposto, mas para tal devera vencer problemas advindos de suas relacoes com os atores dos novos espacos, bem como usufruir de vantagens oferecidas, como o emprego do meio academico em processos de capacitacao e educacao permanente.

INTERNAÇÕES POR CONDIÇÕES SENSÍVEIS À ATENÇÃO PRIMÁRIA EM MINAS GERAIS, ENTRE 1999 E 2007

The indicator Hospitalizations due to Primary Care Sensitive Conditions has been used in Brazil to assess the impact of the activities of the Family Health Strategy, allowing the identification of regional fragilities, so that they can be more effectively addressed by health managers. This study aimed to analyze the rates of hospitalizations due to primary care sensitive conditions in the health regions of Minas Gerais from 1999 to 2007. An ecological study was developed, with a correlation analysis between hospitalization rates and coverage of the Family Health Strategy. The numbers of hospitalizations were provided by the Informatics Department of the Unified Health System and the population, each year, was obtained based on the population estimates of the Brazilian Institute of Geography and Statistics. The results indicated that, in the period evaluated, hospitalizations due to Primary Care Sensitive Conditions decreased from 244.19 to 143.5/10,000 inhabitants, a reduction of 41.2% over the years. There was a reduction in all health regions, but heterogeneously, with worse results for the poorest regions. There was a negative and statistically significant correlation between the population coverage by the Family Health Strategy and the number of these hospitalizations. In conclusion, there was an improvement to the effectiveness of primary health care in Minas Gerais and a reduction in the rates and percentage of hospitalizations for conditions sensitive to primary care in the total of hospitalization between 1999 and 2007.

Hospitalizations for conditions susceptible to primary care among children and adolescents in Minas Gerais, Brazil, 1999-2007

Objectives: to describe the evolution of rates of Hospitalizations for Conditions Susceptible to Primary Care (HCSPCs) in children and adolescents in Minas Gerais, testing the correlation with population coverage of the Family Health Strategy (FHS). Methods: an ecological study analyzing the evolution over time and correlation with rates of coverage of the FHS between 1999 and 2007. Analyses were carried out for three age groups: 0 - 4 years, 5 - 9 years and 10 - 19 years. Pearsons correlation coefficient was used with a level of significance of 5%. Results: the rates of HCSPAs were found to decline during the period studied. In the population aged 0 - 4 years, a decrease of 19.1% was observed. For the 5 - 9 and 10 - 19 year age groups, the rates fell by 0.6% and 18.5% respectively. There was no significant correlation between the decline in rates and increased FHS coverage. The main causes of hospitalization for all age groups were infectious gastroenteritis, bacterial pneumonia and asthma. Conclusions: despite the decrease observed, the lack of correlation between coverage and rates of HCSPA draws attention to the need for improvement in access to and better professional qualification for child and adolescent healthcare.

Viver próximo à saúde em Belo Horizonte

A definicao de unidades espaciais como locus preferencial na prestacao do cuidado em saude e desafiadora quando se buscam modelos assistenciais que reduzam as iniquidades de acesso aos servicos de saude e os humanizem, integrando dados demograficos, socioeconomicos, culturais e ambientais, configurando localmente os determinantes sociais da saude. Este estudo introduz uma analise da localizacao das Unidades Basicas de Saude (UBS) nos distritos sanitarios de Belo Horizonte, comparando as divisoes administrativas adotadas com as obtidas pelo teste cartografico de influencia de acesso as UBS. Demonstra-se a potencialidade de investigacoes futuras sobre o territorio da cidade na busca de melhores localizacoes e acesso as UBS, acenando para o enriquecimento do debate sobre os rumos da saude urbana no Brasil.