Desigualdades intraurbanas de taxas de internações por condições sensíveis à atenção primária na região central do Brasil / Intra-urban differences in rates of admissions for ambulatory care sensitive conditions in Brazil´s Center-West region

RESUMO

Resumo Internações por condições sensíveis à atenção primária (ICSAP) é um indicador útil para avaliar efetividade da atenção primária (APS). Este artigo avaliou as taxas de ICSAP e as causas nas áreas intraurbanas do município de Goiânia-Goiás. Estudo ecológico das taxas de ICSAP nos Distritos Sanitários (DS) de Goiânia, de 2008 a 2013. Utilizou-se dados das Autorizações de Internação Hospitalar (AIH) do SIH municipal, georreferenciadas nos 07 DS. Calculou-se taxas padronizadas de ICSAP por DS, e grupos de causas e faixa etária com respectivos Intervalos de Confiança de 95%. A taxa média de ICSAP foi de 155,5 por 10.000 habitantes. O Distrito Sul teve a maior taxa e o Sudoeste a menor. O grupo de Gastroenterites apresentou a maior taxa e o grupo Anemia a menor. As faixas etárias de 0 a 9 anos e idosos tiveram as taxas mais elevadas. No Distrito Noroeste houve maiores taxas em 09 grupos de causas, destaque para as Doenças Crônicas não Transmissíveis na faixa etária adulta. Os resultados possibilitaram identificar as desigualdades nas taxas de ICSAP entre os DS, apontou deficiências de cobertura de APS, problemas de qualidade e insuficiência do modelo assistencial em regiões com alta cobertura.

ABSTRACT

Abstract Admissions for ambulatory care sensitive conditions (ACSCs) represent a useful indicator of assess to and the effectiveness of primary health care. This article examined rates of admissions for ACSCs and the main causes of admissions in intra-urban areas of the municipality of Goiânia, capital of the State of Goiás. An ecological study was conducted to determine rates of admissions in Goiânia’s seven health districts between 2008 and 2013 using data from Hospital Admission Authorization forms obtained from the municipality’s Hospital Information System. Admissions were georeferenced throughout the seven health districts. Age-adjusted rates of admissions for ACSCs were calculated and the most common causes of admissions were identified for each age group. A 95% confidence interval was calculated as a measure of precision of the rates. The average overall rate of admissions for ACSCs was 155.5 per 10,000 population. Rates were highest in the Southern District and lowest in the Southwest District. Rates were highest in the youngest and oldest age groups. The Northwest District showed the highest rates in nine groups of causes, notably chronic non-communicable diseases among adults. Our findings showed that there are major differences in rates across health districts, pointing to shortfalls in primary health coverage, quality problems and an inadequate care model in districts with high coverage.