title: Trends in hospitalizations for primary care sensitive conditions following the implementation of Family Health Teams in Belo Horizonte, Brazil.
abstract: OBJECTIVE
  How to provide effective and efficient care to the burgeoning and aging populations of the major cities of low- and middle-income countries constitutes one of the principle public health issues of our times. We evaluated the Family Health Strategy, the Brazilian national health system's public approach to primary health care, in the major city of Belo Horizonte, describing trends and factors associated with hospitalizations for primary care sensitive conditions following the implementation of 506 family health teams, most of which were established in 2002.
  
  
  METHODS
  We conducted an ecological study covering 2003 to 2006, using mixed models to investigate time trends in public system hospitalizations as well as their association with social vulnerability and primary care team characteristics.
  
  
  RESULTS
  Sensitive conditions accounted for 115,340 (26.4%) hospitalizations. Over the 4-year period, hospitalizations for sensitive conditions declined by 17.9%, vs only 8.3% for non-sensitive ones (P<0.001). Hospitalization for sensitive conditions declined 22% for women in areas of high social vulnerability vs 9% for women in areas of low vulnerability (P<0.001); for men, 17% vs 10% (P=0.11).
  
  
  CONCLUSIONS
  Though the ecologic nature of our study limits the confidence with which conclusions can be affirmed, the Family Health Strategy appears to have contributed to a major reduction in hospitalizations due to primary care sensitive conditions in this large Brazilian metropolis, while at the same time promoting greater health equity.
authors.affiliation: Departamento de Atenção Básica, Secretaria de Atenção à Saúde, Ministério da Saúde, Brasília, DF, Brazil. claunara@uol.com.br
authors.forename: Claunara Schilling
authors.initials: CS
authors.lastname: Mendonça
authors.forename: Erno
authors.initials: E
authors.lastname: Harzheim
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Duncan
authors.forename: Luciana Neves
authors.initials: LN
authors.lastname: Nunes
authors.forename: Werner
authors.initials: W
authors.lastname: Leyh
mesh_terms: D000328:Adult; D001938:Brazil; D019352:Censuses; D005192:Family Health; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011320:Primary Health Care; D055815:Young Adult