Nedel Fúlvio Borges, Facchini Luiz Augusto, Martín-Mateo Miguel, Vieira Lúcia Azambuja Saraiva, Thumé Elaine
Departamento de Medicina Social, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, RS, Brasil.
Rev Saude Publica. 2008 Dec;42(6):1041-52. doi: 10.1590/s0034-89102008000600010.
Ambulatory care-sensitive conditions (ACSC) are health problems managed by actions at the first 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 Unico de Saúde (Brazilian Health System).
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 classified according to the model of attention utilized prior to hospitalization. ACSC were defined 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, stratified by sex and model of care.
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 five 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.
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.
门诊可避免性疾病（ACSC）是指通过一级医疗保健行动进行管理的健康问题。通过有效的初级卫生保健，这些病因导致的住院需求是可以避免的。本研究的目的是估计巴西统一卫生系统（Sistema Unico de Saúde）住院患者中的ACSC情况。
基于医院的横断面研究，涉及2006年9月至2007年1月期间在巴热（巴西南部）住院的1200名居民。患者回答了由访谈员发放的问卷，并根据住院前使用的护理模式进行分类。ACSC由卫生部组织的一次研讨会定义。分析的变量包括人口统计学和社会经济特征、健康状况以及所使用的卫生服务。根据分层概念框架，采用泊松模型进行多变量分析，并按性别和护理模式分层。
ACSC占住院病例的42.6%。住院主要诊断被认为是ACSC的概率在女性、五岁以下儿童、受教育年限不足五年者、访谈前一年住院、急诊室就诊以及大学医院住院患者中更高。在女性中，ACSC与年龄、教育水平、健康中心存在的时长、居住在家庭健康计划（Programa Saúde da Família）覆盖地区、使用该服务、访谈前一个月的急诊室就诊以及患者入住的医院有关。对于男性，它与年龄、访谈前一年曾再次住院以及患者入住的医院有关。
对ACSC的分析有助于识别获得初级卫生保健不足的群体。尽管我们无法推断其对住院风险的影响，但按性别和护理模式分析表明，家庭健康计划比“传统”初级卫生保健更为公平。
