Universidade Federal de Minas Gerais . Faculdade de Medicina . Programa de Pós-graduação em Saúde Pública . Belo Horizonte , MG , Brasil.
Universidade Federal de Minas Gerais . Faculdade de Medicina . Núcleo de Educação em Saúde Coletiva . Belo Horizonte , MG , Brasil.
Rev Saude Publica. 2023 Nov 10;57:85. doi: 10.11606/s1518-8787.2023057004879. eCollection 2023.
To analyze the association between municipal rates of ambulatory care sensitive conditions (ACSC) hospitalization and the quality of primary health care (PHC), socioeconomic, and demographic variables and those related to local characteristics of the health system from 2010 to 2019.
Ecological time series study in Brazilian municipalities analyzing the correlation of ACSC hospitalization rates with PHC quality measured by the three cycles of the Primary Care Access and Program for improving primary care access and quality (PMAQ-AB). The study included municipalities whose teams participated in 80% or more of at least two PMAQ-AB cycles. The correlation between standardized ACSC hospitalization rates and PHC quality and other variables was analyzed. Spearman's test was used between the response variable and numerical explanatory variables. Generalized equations estimation was used as a multivariate model associating ACSC hospitalization rates with the other variables over the years.
A total of 3,500 municipalities were included in the models. The quality of PHC (PMAQ-AB score) showed an inverse association with the variation in ACSC hospitalization rates. Hospitalization rates fell by -2% per year every ten-point increase in the PMAQ-AB score, adjusted by the remaining variables. A one-unit increase in the beds per 1,000 inhabitants variable had an impact of approximately +6.4% on ACSC hospitalization rates. Regarding population size, larger municipalities had lower ACSC hospitalization rates. Increased PHC coverage and lower socioeconomic inequality were also associated with the reduction in hospitalizations.
The reduction in ACSC hospitalization rates over time was associated with an increase in the quality of PHC. It was also associated with a reduction in the number of hospital beds and municipalities with better socioeconomic indicators.
分析 2010 年至 2019 年期间，门诊医疗敏感条件（ACSC）住院率与初级卫生保健（PHC）质量、社会经济和人口统计学变量以及与卫生系统局部特征相关的变量之间的关联，这些变量与门诊医疗敏感条件（ACSC）住院率与初级卫生保健（PHC）质量之间的关联。
对巴西各市镇进行生态时间序列研究，分析 ACSC 住院率与初级保健准入和改善初级保健准入和质量方案（PMAQ-AB）三个周期测量的 PHC 质量之间的相关性。该研究包括其团队参加了至少两个 PMAQ-AB 周期 80%或以上的市镇。分析了标准化 ACSC 住院率与 PHC 质量和其他变量之间的相关性。在响应变量和数值解释变量之间使用了斯皮尔曼检验。使用广义方程估计作为一种多元模型，将 ACSC 住院率与多年来的其他变量相关联。
共有 3500 个市镇纳入了模型。PHC 质量（PMAQ-AB 评分）与 ACSC 住院率的变化呈负相关。调整其余变量后，PMAQ-AB 评分每增加 10 分，ACSC 住院率每年下降 2%。每 1000 居民床位增加一个单位，对 ACSC 住院率的影响约为+6.4%。就人口规模而言，较大的市镇 ACSC 住院率较低。增加 PHC 覆盖率和降低社会经济不平等也与住院人数减少有关。
随着时间的推移，ACSC 住院率的下降与 PHC 质量的提高有关。它还与医院床位数量的减少和社会经济指标较好的市镇有关。
