Análise das internações por condições sensíveis à atenção primaria sob a perspectiva de taxa de cobertura de equipes da estratégia saúde da família e distribuição espacial no município de Montes Claros (MG) e do índice de desenvolvimento humano municipal das macrorregiões de saúde do estado de Minas Gerais

Abstract

Admissions for Sensitive Conditions to Primary Care (ACSC) are considered an important access and quality indicator of primary health care (PHC) services. However, the thesis defended here is that the ACSC indicator is not strictly related to the availability of health care access and/or quality, but it can reveal important weaknesses in the health care network and opportunities for health managers’ action. It is argued that there is no linear relationship between the population coverage rate and the number or costs of ACSC and that such hospitalizations, although they are potentially preventable, are closely associated with hospital access. Additionally, the indicator can point to possible inequities in health care, which can and should guide health managers’ actions. In this sense, the objective of this study was to analyze the ACSC served by the Unified Health System (SUS) from the coverage rate perspective of Family Health Strategy (FHS) teams and spatial distribution in the municipality of Montes Claros (MG) and the Municipal Human Development Index of health macro-regions in Minas Gerais (MG) state. The thesis consists of three scientific articles, all with an ecological approach based on secondary data from the Hospital Information System of the Department of Informatics of the Unified Health System (DATASUS) and the Primary Care Information and Management System. The first product aimed to analyze the existing correlation between the number of care teams and the number of hospitalizations for causes sensitive to primary care (ACSC), also considering fees, costs and daily hospital rates in Montes Claros (MG), between 2010 and 2019. The study carried out a correlation analysis based on the number, crude and standardized rates, percentages, costs and daily rates of ACSC and care coverage (average number of teams), using Spearman's correlation coefficient, assuming a significance level of 5% (p < 0.05). For the entire period, there was no satisfactory correlation for the increase in the number of teams on ACSC (except for the standardized rate of hospitalizations). When the period from which the municipality presented a population coverage greater than 70% for the FHS was exclusively evaluated, all correlations were inversely proportional and statistically significant. The second article analyzed the territorial origin, demographic and financial aspects and the frequency of occurrences of ACSC for the same municipality, for the period from 2017 to 2021. It was recorded that most (18%) hospitalizations originate in the city central region, with the most frequent diagnoses being “Heart failure” (17.38%), “Cerebrovascular diseases” (12.87%) and “Bacterial pneumonia” (11.52%). The average cost per ACSC was BRL1,781.23, with the highest cost being related to “Angina” (BRL4,859.04). The demographic internees profile highlights a slight majority of females (50.62%) and the largest age range was 60 to 79 years old (37.19%). As for skin color, 62.94% of admissions included hospitalized patients who declared themselves brown. The third article aimed to describe and analyze the behavior and costs of hospitalizations for all causes (HAC), of ACSC and hospitalizations due to Covid-19 that occurred in the public health system of Minas Gerais and to correlate them with the Municipal Human Development Index (MHDI) of the fourteen Health Macro-regions of the State of Minas Gerais in the period from 2017 to 2020. For the correlation analysis, the average MHDI of each of the macro regions was used, through Pearson's correlation, defining it as strong correlation values above 0.6, moderate correlation, values from 0.3 to 0.59 and weak correlation, values below 0.3. For all correlation analyses, a significance level of 5% (p<0.05) was assumed. Regarding the rates of hospitalizations for all causes, there is an inverse correlation, even though it is weak and not statistically significant. On the other hand, in relation to ACSC, an inverse correlation was observed, one of moderate intensity and statistically significant for the entire evaluated period, pointing to a tendency for the poorest regions to present higher rates of these hospitalizations. The behavior and costs of hospital admissions, especially ACSC, therefore point to a distribution of resources which is not equitable when disregarding each region’s particularities and the factors that interfere with the comprehensiveness and continuity of patient care at different levels of care. The results which were found in this work support the thesis that was developed here, expanding the dimension of the evaluated indicator, which proved to be associated with other PHC attributes, especiall y care coordination. Its use also reaches the attributes of the Unified Health System, pointing out possible inequities in health care. ACSC systematic analysis can guide health managers in implementing a more effective, efficient and equitable policy.