title: Primary health care quality and hospitalizations for ambulatory care sensitive conditions in the public health system in Porto Alegre, Brazil.
abstract: To investigate the relation of hospitalization for ambulatory care sensitive conditions (ACSC) with the quality of public primary care health services in Porto Alegre, Brazil.
  
  
  
  Cohort study constructed by probabilistic record linkage performed from August 2006 to December 2011 in a population ≥18 years of age that attended public primary care health services. The Primary Care Assessment Tool (PCATool-Brazil) was used for evaluation of primary care services.
  
  
  
  Of 1200 subjects followed, 84 were hospitalized for primary care sensitive conditions. The main causes of ACSC hospital admissions were cardiovascular (40.5%) and respiratory (16.2%) diseases. The PCATool average score was 5.3, a level considerably below that considered to represent quality care. After adjustment through Cox proportional hazard modelling for covariates, >60 years of age [hazard ratio (HR): 1.13; P = 0.001), lesser education (HR: 0.66; P = 0.02), ethnicity other than white (HR: 1.77; P = 0.01) and physical inactivity (HR: 1.65; P = 0.04) predicted hospitalization, but higher quality of primary health care did not.
  
  
  
  Better quality of health care services, in a setting of overwhelmingly low quality services not adapted to the care of chronic conditions, did not influence the rate of avoidable hospitalizations, while social and demographic characteristics, especially non-white ethnicity and lesser schooling, indicate that social inequities play a predominant role in health outcomes.
authors.affiliation: Federal University of Rio Grande do Sul Rua Ramiro Barcellos, 2400/2º andar 90035-003 Porto Alegre, RS, Brazil marcelorog@gmail.com.
authors.forename: Marcelo Rodrigues
authors.initials: MR
authors.lastname: Gonçalves
authors.affiliation: Federal University of Rio Grande do Sul Rua Ramiro Barcellos, 2400/2º andar 90035-003 Porto Alegre, RS, Brazil.
authors.forename: Lisiane
authors.initials: L
authors.lastname: Hauser
authors.affiliation: Federal University of Rio Grande do Sul Rua Ramiro Barcellos, 2400/2º andar 90035-003 Porto Alegre, RS, Brazil.
authors.forename: Isaías Valente
authors.initials: IV
authors.lastname: Prestes
authors.affiliation: Federal University of Rio Grande do Sul Rua Ramiro Barcellos, 2400/2º andar 90035-003 Porto Alegre, RS, Brazil.
authors.forename: Maria Inês
authors.initials: MI
authors.lastname: Schmidt
authors.affiliation: Federal University of Rio Grande do Sul Rua Ramiro Barcellos, 2400/2º andar 90035-003 Porto Alegre, RS, Brazil.
authors.forename: Bruce Bartholow
authors.initials: BB
authors.lastname: Duncan
authors.affiliation: Federal University of Rio Grande do Sul Rua Ramiro Barcellos, 2400/2º andar 90035-003 Porto Alegre, RS, Brazil.
authors.forename: Erno
authors.initials: E
authors.lastname: Harzheim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D001938:Brazil; D002908:Chronic Disease / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011634:Public Health; D011787:Quality of Health Care / Q000592:standards*; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Cohort Study; health service research; hospitalization; primary health care.