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Impacto da crise económica e financeira nos internamentos potencialmente evitáveis
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RESUMO - Introdução: Ambulatory Care Sensitive Conditions (ACSC) são patologias cujo os cuidados de ambulatório poderiam evitar o internamento. Estes internamentos potencialmente evitáveis geram danos para os utentes e sistema de saúde. Em 2009, Portugal foi atingido por uma grave crise económica e financeira, tendo em 2011 recorrido à ajuda externa (“Memorando de Entendimento” (2011-2014)), que suscitou a aplicação de medidas para diminuir despesas. O impacto destas medidas deve ser previsto e monitorizado. A dissertação apresentada pretende testar a associação entre a crise económica e financeira e os internamentos por ACSC.
Métodos: Desenvolveu-se um estudo ecológico, analítico, retrospetivo, longitudinal, com dados da Base de Dados de Morbilidade Hospitalar dos municípios de Portugal Continental, através da qual se obteve os internamentos gerados por ACSC (pneumonia, doença pulmonar obstrutiva crónica, insuficiência cardíaca, hipertensão, infeção do trato urinário, diabetes), segundo os Prevention Quality Indicators utilizados na metodologia AHRQ, entre 2007 e 2016. Comparou-se entre si os dados de pré-crise, crise e pós-crise dos internamentos e da taxa de inscritos no centro de emprego e ganhos médios mensais, para que se percebesse se existiam diferenças. Efetuou-se uma correlação de Spearman entre as variáveis socioeconómicas e os internamentos.
Resultados: 10,94% dos internamentos foram gerados por ACSC, correspondendo cerca de 40% a pneumonia. Entre 2007 e 2016, os internamentos totais e os internamentos por ACSC aumentaram, sendo as regiões centro e norte interior do país as mais afetadas. Não foi encontrada correlação entre as variáveis socioeconómicas e as taxas de internamento.
Conclusão: Durante o período de crise económica e financeira ocorreu um aumento dos internamentos potencialmente evitáveis gerados por ACSC, havendo disparidades entre os municípios de Portugal Continental. A procura das razões destes acontecimentos e a importância da monitorização dos efeitos de uma crise são fatores que a gestão em saúde deve ter em conta.
ABSTRACT - Background: Ambulatory care sensitive conditions (ACSC) are pathologies whose outpatient care could prevent hospitalization. These potentially preventable hospitalizations cause harm to users and to the health system In 2009, Portugal was hit by a severe economic and financial crisis and in 2011 it resorted to foreign assistance ("Memorandum of understanding " (2011-2014)), which led to the implementation of measures in order to reduce expenses. The impact of these measures should be foreseen and monitored. The dissertation presented aims to test the association between the economic and financial crisis and the hospitalizations by ACSC. Methods: An ecological, analytical, retrospective, longitudinal study was developed, using hospitalization data from the Portugal municipalities, through which was obtained information on hospitalizations by ACSC (pneumonia, chronic obstructive pulmonary disease, heart failure, hypertension, urinary tract infections, diabetes) according to the Prevention Quality Indicators used in AHRQ methodology, between 2007 and 2016. The pre-crisis, crisis and post-crisis data of hospitalizations for ACSC, the rate of registrants in the employment center and mean monthly earnings were compared to see if there were differences. A Spearman's correlation between socioeconomic variables and hospitalizations was performed. Results: 10.94% of hospitalizations were caused by ACSC, for which 40% corresponded to pneumonia. Between 2007 and 2016, the total hospitalizations and hospitalizations by ACSC increased, with the central and northern regions of the country being the most affected. No correlation between socioeconomic variables and hospitalization rates was found. Conclusions: During the period of economic and financial crisis there was an increase in potentially preventable hospitalizations caused by ACSC, with disparities between the Portugal municipalities. The search for the reasons for these events and the importance of monitoring the effects of a crisis are factors that health management must take into account.
ABSTRACT - Background: Ambulatory care sensitive conditions (ACSC) are pathologies whose outpatient care could prevent hospitalization. These potentially preventable hospitalizations cause harm to users and to the health system In 2009, Portugal was hit by a severe economic and financial crisis and in 2011 it resorted to foreign assistance ("Memorandum of understanding " (2011-2014)), which led to the implementation of measures in order to reduce expenses. The impact of these measures should be foreseen and monitored. The dissertation presented aims to test the association between the economic and financial crisis and the hospitalizations by ACSC. Methods: An ecological, analytical, retrospective, longitudinal study was developed, using hospitalization data from the Portugal municipalities, through which was obtained information on hospitalizations by ACSC (pneumonia, chronic obstructive pulmonary disease, heart failure, hypertension, urinary tract infections, diabetes) according to the Prevention Quality Indicators used in AHRQ methodology, between 2007 and 2016. The pre-crisis, crisis and post-crisis data of hospitalizations for ACSC, the rate of registrants in the employment center and mean monthly earnings were compared to see if there were differences. A Spearman's correlation between socioeconomic variables and hospitalizations was performed. Results: 10.94% of hospitalizations were caused by ACSC, for which 40% corresponded to pneumonia. Between 2007 and 2016, the total hospitalizations and hospitalizations by ACSC increased, with the central and northern regions of the country being the most affected. No correlation between socioeconomic variables and hospitalization rates was found. Conclusions: During the period of economic and financial crisis there was an increase in potentially preventable hospitalizations caused by ACSC, with disparities between the Portugal municipalities. The search for the reasons for these events and the importance of monitoring the effects of a crisis are factors that health management must take into account.
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Ambulatory Care Sensitive Conditions Internamentos potencialmente evitáveis Crise económica e financeira Potentially preventable admissions Economic and financial crisis