Hospitalizations among children and adolescents within the scope of a Primary Care Service

Abstract

The hospitalization of a child, in addition to bringing about major family distress, is a costly event for the health system. Besides, it can often be avoided on an outpatient care basis. The aim of this study was to identify the percentage of hospitalizations for Ambulatory Care Sensitive (ACS) conditions, i.e. those for which effective and timely care can avoid hospital admission. We investigated 3.329 hospitalizations of patients under 19 years of age, occurred between 2001 and 2004 in four hospitals of the Brazilian Health System (SUS), the main references for a population of areas astricted to a primary care service (PCS). The hospitalizations in this population were identified using the hospital information system of the GHC (Grupo Hospitalar Conceição). Univariate and multivariate analysis were employed to verify associations between independent variables and the occurrence of admissions for ACS conditions. A hospitalization rate of 2.9% was found for the studied age group. Respiratory system disorders were the leading cause of admission (36%), followed by perinatal diseases (14%), infectious and parasitic diseases (10%), disorders of the digestive system (9%), and external causes (6%). Readmission accounted for 16% of the total admissions. The hospitalization rate for ACS conditions was 35.6%, ranging from 25% to 43% across the Health Care Centers of the PCS. The variables associated with higher occurrence of hospitalizations for this  reason were: age between 1 and 4 years (p<0.01); having gone straight to the hospital because the Unit was closed (p=0.04); and having gone straight to the hospital due to the severity of the case (p=0.03). The study points to the need for a better monitoring of hospitalizations for ACS conditions - occurring more frequently in the winter months and involving children from 1 to 9 years of age for being more vulnerable to respiratory diseases - and of the number of readmissions, which did not decrease over the last four years.