Primary health care and potentially avoidable admissions: a 10-year assessment from the perspective of a health care plan

Abstract

Introduction: The rate of admissions for ambulatory care sensitive conditions has been used in various parts of the world in the assessment and monitoring of access to the health system and its performance. In Brazil, some studies have been performed within the public system. Objective: To examine, in a series of 10 years, the evolution of the rate in beneficiaries of a health care plan, identifying, from the results, strategies that will enable the improvement of the health situation of the population and the appropriate allocation of resources. Methods: Retrospective analysis of 212,360 hospital admissions, occurring between 1999 and 2008, among beneficiaries of a health care plan, resident in all regions of Brazil. The outcome of the study was the proportion of admissions for primary care sensitive conditions, identified by CID-10 and distributed in twenty groups of causes. The proportion of these admissions in relation to the total hospital admissions was established, as well as the quotient for the number of hospital admissions and the population, either total or by age group and specific causes, besides hospital direct costs. The significance was tested with the program Epi Info™, version 3.3.2. Estimates of the rates were defined based on their 95% confidence intervals (CI 95%). Results: In 10 years, admissions for primary care sensitive conditions accounted for 55,307 of 212,360 admissions reimbursed by the operator (26.0%), excluding births. The global crude mean rate was 300.2 per 10 thousand beneficiaries of the health care plan and the number of admissions per beneficiary was 1.6. The rate of admission for primary care sensitive conditions fell by 28.0% during the period (from 347.6 to 250.3 per 10 thousand). In 2008, the most frequent cause was gastroenteritis (30.9%), followed by arterial hypertension (13.6%), cerebrovascular diseases (9.6%), heart failure (8.1%), kidney and urinary tract infections (6.8%), diabetes mellitus (5.8%) and angina pectoris (5.5%). Each of the remaining diagnoses corresponded to less than 5.0% of admissions for primary care sensitive conditions. The mean annual expenditure on admissions was R$ 15,232,494 against R$ 51,440,680 for other conditions, representing 22.8% of the total. Conclusion: The gradual reduction observed in the global rate of admissions for primary care sensitive conditions suggests possible improvements in primary health care. Further actions and strategies should prioritise determined causes and age groups as the object of on-going monitoring. Investment in measures to reduce the number of avoidable admissions could contribute not only to an improvement in the quality of care, but also to the financial balance of the health care plan.