Internações por condições sensíveis à atenção primária em diferentes níveis de gestão antes, durante e após a pandemia da COVID-19

Abstract

This study analyzed the proportion of Hospitalizations for Primary Care Sensitive Conditions (HPCSC) in the municipality of Comendador Levy Gasparian-RJ, in the Centro Sul Fluminense-RJ health region and in the State of Rio de Janeiro (Brazil), between the years 2018 and 2024. It also verified the distribution by sex and age group. This is a descriptive study conducted in three distinct periods (2018-2019, pre-pandemic; 2020-2022 during the pandemic; 2023-2024, post-pandemic COrona VIrus Disease, COVID-19) and over time (2018-2024) based on secondary data obtained from the Hospital Information System of the Unified Health System. For the classification of HPCSC, the Brazilian list published by the Ministry of Health was used. To automate the classification process, the csapAIH function in R* (version 4.3.0) was employed. The five main HPCSC conditions with the highest proportions were selected, categorized according to sex and three age groups (0-19 years, 20-59 years, ≥ 60 years), and the data were determined in relative proportions. Analyses of HPCSC at the municipal, regional, and state levels revealed some notable trends, especially during the COVID-19 pandemic. "Cerebrovascular diseases" were the most prevalent condition across all three levels, in all periods analyzed. "Angina" was also a frequent cause, especially in the municipality and among males; while in the state, "urinary tract infection" was the second most common cause for females in all periods and over time. During the pandemic, "heart failure" was the second most common cause in the health region and the state. However, "cerebrovascular diseases" showed an increase of 2.6% in the municipality, 1.0% in the health region, and 1.8% in the state. Regarding gender, the decrease in HPCSC during the pandemic period was greater for women. In the analyses by age group, the largest decreases in HPCSC during the pandemic were observed in the municipality in the three age groups analyzed (0-19, 20-59, and ≥ 60 years) with 3.6%, 5.2%, and 5.1%, respectively. In the age group of sixty years or older, the proportion of HPCSC was significantly higher compared to younger groups. It was concluded that during the COVID-19 pandemic (2020-2022), there was a decrease in the total number of HPCSC cases in all three areas analyzed. During the pandemic, both men and women experienced a decrease in the total number of HPCSC cases. In the municipality, the decrease was 0.8% for males and 5.5% for females. Over time, the proportion of HPCSC due to "cerebrovascular diseases" progressively decreased from the municipality to the health region and, from there, to the state.