Socioeconomic conditions, physician supply, and ambulatory care sensitive hospitalization in large Brazilian cities

Abstract Ambulatory care sensitive hospitalizations have been used as an indicator of the effectiveness of primary health care. The research involved a descriptive analysis of the evolution of national indicators from 1998 to 2012 and a cross-sectional study of Brazilian municipalities with populations greater than 50,000, by region of the country, for the year 2012, using correlation and linear regression statistical techniques. There was a slight decline in the proportion of ambulatory care sensitive hospitalizations in Brazil. Socioeconomic and demographic factors and physician supply in the healthcare system are associated with the proportion of ambulatory care sensitive hospitalizations, differing by region of the country. Despite advances in the expansion of the Family Health Strategy, some challenges remain, including better distribution of physicians and other health professionals in the country and effective changes in the healthcare model.

摘要：门诊护理敏感住院病例（ambulatory care sensitive hospitalizations）常被用作评估初级卫生保健有效性的指标。本研究首先对1998年至2012年全国相关指标的演变趋势进行描述性分析，并于2012年针对巴西全国各区域人口规模超过5万的自治市，采用相关性分析与线性回归等统计技术开展横断面研究。巴西的门诊护理敏感住院病例占比呈现小幅下降趋势。社会经济与人口统计学因素，以及医疗系统内的医师供给情况，均与门诊护理敏感住院病例占比存在关联，且该关联存在显著的区域差异。尽管家庭健康策略（Family Health Strategy）的推广工作已取得进展，但巴西仍面临诸多挑战，包括优化国内医师与其他卫生专业人员的分布格局，以及对医疗服务模式进行切实有效的改革。