Characteristics of primary care and rates of pediatric hospitalizations in Brazil

ABSTRACT OBJECTIVE To evaluate the association among characteristics of primary health care center (PHCC) with hospitalizations for primary care sensitive conditions (PCSC) in Brazil. METHOD In this study, a cross-sectional ecological study was performed. This study analyzed the 27 capitals of Brazil’s federative units. Data were aggregated from the following open access databases: National Program for Access and Quality Improvement in Primary Care, the Hospital Information System of Brazilian Unified Health System and Annual Population Census conducted by the Brazilian Institute of Geography and Statistics. Associations were estimated among characteristics of primary care with the number of three PCSC as the leading causes of hospitalization in children under-5 population in Brazil: asthma, diarrhea, and pneumonia. RESULTS In general, PHCC showed limited structural adequacy (37.3%) for pediatric care in Brazil. The capitals in South and Southeast regions had the best structure whereas the North and Northeast had the worst. Fewer PCSC hospitalizations were significantly associated with PHCC which presented appropriate equipment (RR: 0.98; 95%CI: 0.97–0.99), structural conditions (RR: 0.98; 95%CI: 0.97–0.99), and signage/identification of professionals and facilities (RR: 0.98; 95%CI: 0.97–0.99). Higher PCSC hospitalizations were significantly associated with PHCC with more physicians (RR: 1.23, 95%CI: 1.02–1.48), it forms (RR: 1.01, 95%CI: 1.01–1.02), and more medications (RR: 1.02, 95%CI: 1.01–1.03) CONCLUSION Infrastructural adequacy of PHCC was associated with less PCSC hospitalizations, while availability medical professional and medications were associated with higher PCSC hospitalizations.

摘要
研究目的：评估巴西基层医疗卫生机构（Primary Health Care Center, PHCC）的特征与基层医疗敏感病症（Primary Care Sensitive Conditions, PCSC）住院情况之间的关联。
研究方法：本研究为横断面生态学研究，分析对象为巴西27个联邦单元的首府城市。研究数据整合自以下开放获取数据库：巴西基层医疗准入与质量改善国家计划、巴西统一健康系统医院信息系统，以及巴西地理与统计研究所开展的年度人口普查。本研究以巴西5岁以下儿童群体的三大主要住院病因——哮喘、腹泻与肺炎——这三类基层医疗敏感病症的住院人数为结局指标，分析基层医疗特征与该指标间的关联。
研究结果：总体而言，巴西基层医疗卫生机构的儿科服务结构达标率仅为37.3%。南部与东南部地区的首府机构结构配置最优，北部与东北部地区的机构结构则最差。基层医疗卫生机构若配备适宜设备（相对风险（Relative Risk, RR）：0.98；95%置信区间（Confidence Interval, CI）：0.97–0.99）、结构条件达标（RR：0.98；95%CI：0.97–0.99），且专业人员与设施标识清晰（RR：0.98；95%CI：0.97–0.99），则其对应的基层医疗敏感病症住院率显著更低。反之，基层医疗卫生机构若医师数量更多（RR：1.23，95%CI：1.02–1.48）、人员配置规模更大（RR：1.01，95%CI：1.01–1.02）、药物储备更充足（RR：1.02，95%CI：1.01–1.03），则其对应的基层医疗敏感病症住院率显著更高。
研究结论：基层医疗卫生机构的结构达标情况与更低的基层医疗敏感病症住院率相关，而医疗人员可及性与药物储备充足性则与更高的基层医疗敏感病症住院率相关。