Trends in rates of hospitalizations for primary care sensitive conditions in a health system with universal coverage: Brazil, 2000 to 2006

Trends in rates of hospitalizations for primary care sensitive conditions in a health system with universal coverage: Brazil, 2000 to 2006

 Oliveira, V.B; Bonolo, P.F, Turci, M.A; Macinko, J.

 Background: The study of hospitalizations for primary care sensitive conditions (PCSH) has been proposed as an indicator of primary care system effectiveness, access, and quality.
Methods: Cross-sectional, ecologic study, of all population, between 2000 and 2006. Using hospital discharge data, PCSH (numerator) were selected from the list of 20 groups of conditions validated for Brazil (Immunization-preventable infectious diseases, Gastroenteritis, Anemia, Nutritional deficiencies, Diseases of the upper-lower respiratory tract, Pneumonia, Asthma, Hypertensive heart, Angina pectoris, Heart failure and Cerebrovascular diseases, Diabetes mellitus, Epilepsy, Urinary tract infections, Disease of the skin, Pelvic inflammatory diseases, Bleeding or perforated Ulcer, Diseases of prenatal and birth delivery).  The denominator was the entire population. Rates were standardized for age and sex. Sensitivity tests also employ denominators that exclude all individuals with private health insurance (about 20%).
Results: Of all the hospitalizations, 29.4% were for PCSH. Rates were 7.6% higher among women. Direct standardization analysis showed a 2.3% decrease in PCSH rates for the population without private insurance plan. In the South, Southeast and Northeast regions the decline was higher than in the North and Northeast (coefficient variation of 2.6). In 2006, 51.5% of PCSH was caused by Gastroenteritis, Heart failure, lower respiratory tract diseases, and Asthma. For those ≤ 20 years, Gastroenteritis was the most prevalent cause. Leading causes for those 20 to 59 years were Gastroenteritis, Heart failure disease and Urinary tract infections, while for those ≥ 60, Heart failure and lower respiratory tract Diseases were highest.
Conclusion: Overall, the decrease in PCSH observed over this period is consistent with the very large increase in primary care accessibility throughout Brazil. Nevertheless, geographic and population rate variations in PCSH were observed in spite of universal health coverage, pointing to the need to better target primary care interventions to areas with higher PCSH rates.