Internações por condições sensíveis à atenção primária e sua relação com custos e vulnerabilidade social

Abstract

Hospitalizations for Ambulatory Care Sensitive Conditions (ACSC) are indicators used to assess the effectiveness of primary healthcare services, guiding the planning and evaluation of policies and actions. This study analyzed ACSC considering costs and aspects related to social vulnerability from 2019 to 2023 in Montes Claros, Minas Gerais, Brazil. It is an observational, analytical, and quantitative study based on data from patients hospitalized through the Brazilian Unified Health System (SUS) in the municipality, extracted from the Hospital Admission System (SIH/SUS). ACSC rates were analyzed considering causes, diagnoses, admission and discharge dates, length of stay, age, sex, planning regions, and age groups. Social vulnerability indicators such as Urban Infrastructure (UI), Public Free Green Spaces (PFGS), Health (H), Education (E), Socioeconomic Status (SES), and Healthy Cities Index (HCI) were assessed by socio-political-administrative regions. Statistical analyses included frequencies, means, and association tests (Pearson‘s Chi-square and Fisher‘s Exact test). Associations were considered significant at a 5% level (p ≤ 0.05). During the study period, 99,854 total hospitalizations were recorded, of which 13,262 (13.3%) were due to avoidable causes. ACSC showed a balance between sexes, with a slight female predominance (50.6%), significant only in 2019 (p = 0.031) and 2023 (p = 0.006). The most affected age group was ≥65 years, accounting for 43.3% of hospitalizations, with statistically significant differences in all years (p ≤ 0.005). Areas with deficient urban infrastructure and limited access to health services recorded higher ACSC rates, whereas regions with better urban conditions showed fewer avoidable hospitalizations, demonstrating a significant association (p < 0.001) between more favorable socioeconomic conditions and reduced hospitalizations. In 2022, pneumonia and heart failure presented the longest average lengths of stay and costs, with significant differences in hospitalization rates (p = 0.000 to 0.001). The highest average cost per hospitalization occurred in 2022 (p = 0.000 to 0.001). Pneumonia, heart failure, and cerebrovascular diseases were the groups with the greatest financial impact (p = 0.000). ACSC were concentrated in levels 2 and 3 of the Healthy Cities Index (p = 0.000), representing areas with poorer urban conditions. Low coverage of Urban Infrastructure (UI), Public Free Green Spaces (PFGS), and lower income were associated with higher ACSC prevalence (all p = 0.000). An inverse association was observed between the Health indicator (H) and ACSC rates. In conclusion, ACSC showed sex balance with a slight female predominance. The most affected age group was elderly individuals aged 65 years or older. Pneumonia and heart failure stood out for having the longest average hospital stays, especially in 2022, the year with the highest average costs per hospitalization. ACSC were more prevalent among patients residing in areas with poorer urban conditions, such as low infrastructure, limited coverage of green and recreational areas, and greater economic vulnerability. The implementation of intersectoral proposals to strengthen primary care may contribute to reducing health inequities and consequently avoidable hospitalizations.