Admissions for conditions sensitive to primary health care, 2008-2015: an analysis of the impact of the expansion of the Family Health Strategy in the city of Rio de Janeiro

Abstract Background The municipality of Rio de Janeiro has presented an important expansion of Primary Health Care coverage through Family Health Strategy since 2009, and it is important to evaluate the impact of this agenda. Admissions Rate by Primary Care Sensitive Conditions is an indicator used in order to assess the effectiveness of PHC. Objective Evaluate the repercussion of the expansion of Family Health Strategy (FHS) on admission for conditions sensitive to primary health care (ICSAP) from 2008 to 2015. Method FHS and ICSAP coverage indicators were analyzed between 2008 and 2015 in the municipality of Rio de Janeiro. Correlation between the indicators was obtained using Spearman's coefficient and the rate ratio was calculated using as a parameter the year immediately preceding the expansion of coverage in the municipality (2008). Results Results identified a trend towards increased FHS coverage and reduced ICSAP indicators, inverse correlation between FHS coverage and the proportion of hospitalizations due to ICSAP (r = -0.888, p = 0.020), and between FHS coverage and ICSAP rate (r = -0.753, p = 0.031). Significant correlation was observed between the rate ratios of coverage indicators as of 2011 and the hospitalization rates as of 2013. Conclusion Expansion of PHC in the city of Rio de Janeiro had a positive impact on hospitalizations because of conditions that were sensitive to PHC. It is necessary to discuss the standardization of services for PHC units and the encouragement of the qualification of professionals in the area.背景 里约热内卢市自2009年起通过家庭健康策略（Family Health Strategy, FHS）大幅拓展了初级卫生保健（Primary Health Care, PHC）的覆盖范围，对该项议程的实施效果开展评估具有重要价值。初级卫生保健敏感病症住院率是用于评估初级卫生保健有效性的常用指标。 研究目的 评估2008年至2015年间，家庭健康策略（FHS）扩容对初级卫生保健敏感病症（conditions sensitive to primary health care, ICSAP）住院情况的影响。 研究方法 本研究分析了里约热内卢市2008至2015年间的FHS覆盖与ICSAP相关指标。采用斯皮尔曼相关系数计算两类指标间的相关性，并以该市覆盖扩容前的基准年（2008年）为参照计算率比。 研究结果 结果显示，FHS覆盖范围呈上升趋势，而ICSAP相关指标则呈下降趋势；FHS覆盖范围与ICSAP相关住院占比呈显著负相关（r=-0.888，p=0.020），与ICSAP住院率亦呈显著负相关（r=-0.753，p=0.031）。2011年起的覆盖指标率比与2013年的住院率之间存在显著相关性。 研究结论 里约热内卢市的初级卫生保健扩容对初级卫生保健敏感病症相关住院具有积极影响。后续需进一步探讨基层卫生保健机构的服务标准化路径，并推动该领域专业人员的资质提升工作。