title: Trends in primary health care-sensitive conditions in Brazil: the role of the Family Health Program (Project ICSAP-Brazil).
abstract: BACKGROUND
  This study describes trends in hospital admission rates for primary healthcare-sensitive conditions (PHCSC) in Brazil.
  
  
  OBJECTIVE
  To evaluate the impact of increased primary healthcare availability through the implementation of the Family Health Program (FHP) on PHCSC admissions rates at the national, regional, and state-levels between 1999 and 2007.
  
  
  METHODS
  An ecologic panel data study was used and a fixed effects multivariate negative binomial model was used to estimate the association of PHCSC admission rate and FHP controlling for other relevant covariates.
  
  
  RESULTS
  It was shown that, at the national level, PHCSC hospital admissions declined by 24%-over 2.5 times more rapidly than the decline in hospitalizations for all other (non-PHCSC) conditions. Greater reductions in the PHCSC admission rates when compared with the non-PHCSC admission rates were also observed when the data were divided by regions and states. Regression models showed that at the state level the greater the FHP coverage, the less was the PHCSC hospital admissions even when controlling for confounding variables.
  
  
  CONCLUSIONS
  The results of this study have important implications for the healthcare model in countries that base their national health systems on primary healthcare. This is the first study to evaluate the association between FHP coverage and PHCSC admissions rates in all the Brazilian states over a long and relevant period for the consolidation of FHP in the country.
authors: Instituto de Saúde Coletiva, Federal University of Bahia (UFBA), Salvador, BA, Brasil. maines@ufba.br
authors: Ines
authors: I
authors: Dourado
authors: Veneza B
authors: VB
authors: Oliveira
authors: Rosana
authors: R
authors: Aquino
authors: Palmira
authors: P
authors: Bonolo
authors: Maria Fernanda
authors: MF
authors: Lima-Costa
authors: Maria Guadalupe
authors: MG
authors: Medina
authors: Eduardo
authors: E
authors: Mota
authors: Maria A
authors: MA
authors: Turci
authors: James
authors: J
authors: Macinko
mesh_terms: D000553:Ambulatory Care / Q000639:trends*; D001938:Brazil / Q000453:epidemiology; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D015999:Multivariate Analysis; D009313:National Health Programs; D010343:Patient Admission / Q000639:trends*; D011320:Primary Health Care / Q000639:trends*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000639:trends; D012959:Socioeconomic Factors