Castro Dayanna Mary de, Oliveira Veneza Berenice de, Andrade Amanda Cristina de Souza, Cherchiglia Mariângela Leal, Santos Alaneir de Fátima Dos
Universidade Federal de Minas Gerais, Belo Horizonte, Brasil.
Universidade Federal de Mato Grosso, Cuiabá, Brasil.
Cad Saude Publica. 2020 Nov 23;36(11):e00209819. doi: 10.1590/0102-311X00209819. eCollection 2020.
This study aimed to analyze the association between quality of primary healthcare (PHC) in Brazilian municipalities (counties) and the number of hospitalizations due to primary healthcare-sensitive conditions. This was an ecological study with analysis of nationwide secondary data. The quality of the number of hospitalizations due to primary healthcare-sensitive conditions was based on assessment of the National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB). The analysis used a hierarchical explanatory model, with the number of the number of hospitalizations due to primary healthcare-sensitive conditions hospitalizations in the year 2014 as the dependent variable and sociodemographic and health system data as the independent variables. The measure of association between the number of hospitalizations and quality of PHC was calculated with negative binomial regression with robust variance and the total population as offset, with significance set at 20% in the univariate analysis and 5% in the multivariate analysis. The mean number of hospitalizations due to primary healthcare-sensitive conditions admissions during the target period was 359.97 hospitalizations per municipality. The quality of PHC showed a negative association with the number of hospitalizations due to primary healthcare-sensitive conditions admissions. Municipalities with lower quality of PHC (quartile 1) showed 21.2% more number of hospitalizations due to primary healthcare-sensitive conditions admissions than municipalities with higher quality (95%CI: 1.09-1.34). The results showed that quality of PHC in Brazil reduced hospitalizations due to primary healthcare-sensitive conditions, even in contexts of social vulnerability.
本研究旨在分析巴西各市（县）初级医疗保健（PHC）质量与初级医疗保健敏感疾病住院人数之间的关联。这是一项利用全国性二手数据进行分析的生态学研究。初级医疗保健敏感疾病住院人数的质量是基于对全国改善基本医疗服务可及性和质量计划（PMAQ-AB）的评估。该分析采用分层解释模型，将2014年初级医疗保健敏感疾病住院人数作为因变量，社会人口统计学和卫生系统数据作为自变量。住院人数与初级医疗保健质量之间的关联度通过稳健方差的负二项回归计算得出，并以总人口作为偏移量，单变量分析中的显著性设定为20%，多变量分析中的显著性设定为5%。目标期间内，各市因初级医疗保健敏感疾病入院的平均住院人数为359.97例。初级医疗保健质量与初级医疗保健敏感疾病入院住院人数呈负相关。初级医疗保健质量较低的市（第一四分位数）因初级医疗保健敏感疾病入院的住院人数比质量较高的市多21.2%（95%置信区间：1.09 - 1.34）。结果表明，巴西的初级医疗保健质量降低了因初级医疗保健敏感疾病导致的住院人数，即使在社会弱势群体的情况下也是如此。
