Impacto da Atenção Primária à Saúde sobre as internações por condições sensíveis no estado da Paraíba

Abstract

In Brazil’s Unified Health System (Sistema Único de Saúde – SUS), Primary Health Care (PHC) constitutes the first level of care and is responsible for coordinating patient care and organizing actions and services within the health care network. Over the years, PHC has undergone successive transformations, making it essential to assess the effectiveness of these changes. To this end, the number of Hospitalizations for Ambulatory Care Sensitive Conditions (ACSC) is used as an indicator, referring to hospital admissions that could be avoided through effective, accessible, and high-quality PHC. The objective of this study was to analyze the profile and determinants of ACSC in the state of Paraíba in 2023, investigating the correlation between health care performance and socioeconomic and demographic indicators. An ecological and retrospective study was conducted across the 223 municipalities of Paraíba, using data from the Hospital Information System of the Unified Health System (SIH/SUS), e-Gestor AB, and the Brazilian Institute of Geography and Statistics (IBGE). Data systematization was performed using the csapAIH package in the R environment. For association analysis, Beta regression with a complementary log-log link function was applied. A total of 67,229 ACSC hospitalizations were recorded, with urinary tract infections, cerebrovascular diseases, and pneumonia being the most prevalent causes, predominantly affecting females. Although regional health hubs concentrated the highest absolute volumes of hospitalizations, the highest rates were observed in small municipalities, with an atypical persistent pattern identified in Uiraúna. The model (R² = 0.2774) indicated that the number of Family Health Strategy (FHS) teams exerts a robust protective effect. However, the positive association between the volume of registered individuals and ACSC suggests that nominal expansion of coverage, without corresponding clinical resolutiveness, may increase hospital demand. Notably, Gross Domestic Product (GDP) and the Municipal Human Development Index (MHDI) were not statistically significant, indicating that health system organization outweighs isolated economic determinants in explaining avoidable hospitalizations. It is concluded that the consolidation of the health care network depends on overcoming the hospital-centered model and strengthening longitudinal clinical management within PHC.