Teses e Dissertações

• Teses
• Dissertações

 

ARTIGOS

 

1- Family Health Program and ambulatory-care sensitive conditions in Southern Brazil

 

ABSTRACT

 

OBJECTIVE: Ambulatory care-sensitive conditions (ACSC) are health problems managed by actions at the fi rst level of care. The need for hospitalization by these causes is avoidable through an effective and proper primary health care. The objective of the study was to estimate ACSC among patients hospitalized by the Sistema Único de Saúde (Brazilian Health System).

 

METHODS: Hospital-based cross-sectional study involving 1,200 inhabitants of Bagé (Southern Brazil) who were inpatients between September/2006 and January/2007. The patients answered a questionnaire applied by interviewers and were classifi ed according to the model of attention utilized prior to hospitalization. ACSC were defi ned in a workshop promoted by the Ministry of Health. The variables analyzed included demographic and socioeconomic characteristics, health and health services utilized. Multivariate analysis was conducted by the Poisson model, according to a hierarchical conceptual framework, stratifi ed by sex and model of care.

 

RESULTS: ACSC accounted for 42.6% of the hospitalizations. The probability that the main diagnosis for hospitalization is considered an ACSC is greater among women, children under fi ve years of age, individuals with less then five years of schooling, hospitalization in the year prior to the interview, emergency room consultation, and being an inpatient at the university hospital. Among women, ACSC are associated with age, educational level, length of time the health center has been in existence, living in an area covered by the Programa Saúde da Família (Family Health Program), use of this service, emergency room consultation during the month prior to the interview and

hospital to which patient was admitted. For men, it was associated with age, have undergone another hospitalization in the year prior to the interview and hospital to which patient was admitted.

 

CONCLUSIONS: Analysis of ACSC allows identifying groups with inadequate access to primary health care. Although we could not infer an effect on the risk of hospital admission, analysis by sex and model of care suggests that Family Health Program is more equitable than “traditional� primary health care.

 

DESCRIPTORS: Family Health Program. Primary Health Care. Health Services, utilization. Hospitalization. Socioeconomic Factors. Cross- Sectional Studies

 

 

2- Hospitalización por Condiciones Sensibles a la Atención Primaria en Rio

Grande do Sul, Brasil

 

Resumen

 

Objetivos: Describir las tasas de hospitalización por Condiciones Sensibles a la

Atención Primaria (CSAP) en un estado del sur de Brasil, y analizar su variabilidad

según la cobertura del Programa Salud de la Familia (PSF), variables socioeconómicas y del sistema de salud.

 

Métodos: registros de hospitalización de residentes de los 496 municipios de Rio

Grande do Sul en el año 2007, de las bases de datos del Sistema de Informações

Hospitalares do SUS; población residente, datos socioeconómicos, de estructura y

desempeño del sistema de salud, de diversas fuentes públicas, mayormente del próprio SUS. Las tasas fueron estandarizadas por el método indirecto, y la Razón de Morbilidad Esperada (RME) categorizada en terciles. El análisis multivariado incluyó apenas municipios con menos de 50 mil habitantes. Previo análisis de correspondencias múltiple, se utilizó de un modelo politómico, comparando paralelamente municipios em terciles inferior y superior de la RME con los del mediano. Se realizaron dos análisis, uno con todos municipios y otro con los con PSF instalado y variables propias del PSF.

 

Resultados: 30,5% de las 638.359 hospitalizaciones fueron por CSAP, tasa de 17,6/mil hab. En municipios con peores tasas, estas se asociaron directamente con la cobertura y tiempo de funcionamiento del PSF.

 

Conclusiones: Un alta cobertura del PSF no fue suficiente para evitar las hospitalizaciones por CSAP, sino que se asoció a mayores tasas. Si bien hay limitaciones de los datos, el estudio refleja la importancia y utilidad de evaluaciones de impacto en APS con datos secundarios de registro rutinario.

 

3- Características da atenção básica associadas ao risco de internar por

condições sensíveis à atenção primária: revisão bibliográfica

 

Resumo

 

As hospitalizações por Condições Sensíveis à Atenção Primária (CSAP) – pneumonias bacterianas, complicações da diabete e da hipertensão, entre outras – são um indicador indireto da efetividade do primeiro nível de atenção à saúde. Frente à utilidade do indicador para a avaliação da Atenção Básica no SUS, realizou-se uma revisão bibliográfica de estudos sobre características da atenção primária associadas ao risco de internação por CSAP, através de busca na MEDLINE e LILACS. A maioria dos estudos foi realizada nos Estados Unidos e

Espanha, utilizando análise transversal de dados secundários. Na Espanha, as taxas CSAP não se associaram ao tamanho da população adscrita ao médico ou enfermeiro. A continuidade da atenção se associou a menores taxas, nos Estados Unidos e Canadá. A continuidade da atenção, a equipe multidisciplinar e em menor destaque a população adscrita ao médico mostraram-se associadas em diferentes estudos a menor probabilidade de hospitalização por CSAP.

 

Palavras-chave: Atenção Primária à Saúde; Sistemas de Saúde; Política de Saúde; Indicadores Básicos de Saúde

 

4-Conceptual and methodological aspects in the study of hospitalizations for Ambulatory Care Sensitive Conditions

 

Abstract

 

Hospitalization rates for Ambulatory Care Sensitive Conditions have been used to

assess effectiveness of the first level of health care. From a critical analysis of related concepts, we discuss principles for selecting a list of codes and, taking the example of the Brazilian Family Health Program, propose a methodological pathway for identifying variables in order to inform statistical models of analysis. We argue that for the indicator to be comparable between regions, disease codes should be selected based on sensitivity  and specificity principles, not on observed disease frequency. Rates of hospitalization will be determined, at a distal level, by the socio-economic environment and their effect on the social and demographic structure. Timely and effective care depends on the organization of health services, their availability and access barriers, which depend on the ways health and related technology are conceptualised and on their adherence to the biomedical model or to the Primary Health Care (PHC) principles; performance indicators of the health system will be the proximal determinants. This indicator is potentially useful for primary care evaluation. The historical reconstruction of PHC improves the analysis of the indicator variability.

 

Keywords: Primary Health Care; Family Health Program; Outcome Assessment

(Health Care); Hospital Information Systems; Health Systems