Family Health Support Center: Impact on Ambulatory Care Sensitive Conditions

ABSTRACT The Family Health Strategy is the preferred admittance of the Brazilian Unified Health System (SUS) and relies on Family Health Support Centers (FHSC) to reduce referrals to secondary care, as it seeks to reduce Ambulatory Care Sensitive Conditions (ACSC). This study analyzed the growth of FHSC and its impact on the number of ACSC. This is an exploratory, descriptive and quantitative study, conducted between 1998 and 2016, based on the database of the Department of Primary Care of the Brazilian Unified Health System (SUS). An expansion of the family health teams all over Brazil was identified: 40,490 teams were established in 5,483 municipalities, covering 64.2% of the population. The number of FHSC at the Northeast and the population coverage was higher in relation to other regions. The highest decrease of ACSC occurred in the Midwest, which has a minor number of FHSC established. The Northeast had the highest number and coverage of FHSC; however, a proportional reduction of ACSC did not happen. The largest number or FHSC coverage has still not influenced the reduction rate of ACSC in the most vulnerable populations within the context of social determinants.摘要 家庭健康策略（Family Health Strategy）是巴西统一健康系统（SUS）的首选准入模式，依托家庭健康支持中心（Family Health Support Centers, FHSC）减少向二级医疗的转诊，旨在降低门诊医疗敏感病症（Ambulatory Care Sensitive Conditions, ACSC）的发生。本研究基于巴西统一健康系统基层医疗部门的数据库，针对1998年至2016年间的数据展开分析，属于探索性、描述性与定量研究，旨在探究家庭健康支持中心的发展态势及其对门诊医疗敏感病症数量的影响。研究发现，家庭医疗团队已在巴西全境实现扩张：在5483个市镇中累计组建40490支团队，覆盖全国64.2%的人口。东北部地区的家庭健康支持中心数量与人口覆盖率均高于其他区域。中西部地区的门诊医疗敏感病症降幅最大，但其家庭健康支持中心的设立数量相对较少。东北部地区的家庭健康支持中心总数与覆盖率均居全国首位，但并未实现门诊医疗敏感病症的同比下降。即便家庭健康支持中心的覆盖率与数量均处于最高水平，在社会决定因素的研究语境下，仍未对弱势人群的门诊医疗敏感病症降幅产生影响。