Ambulatory care sensitive hospitalizations are a set of conditions for which access to effective primary care can reduce the likelihood of hospitalization. These hospitalizations have been used as an indicator of primary care performance in several countries and in three Brazilian states, but there is little consensus on which conditions should be included in this indicator. This paper presents a description of the steps undertaken to construct and validate a list for Brazil. The final list includes 20 groups of diagnostic conditions that represented 28.3% of a total of 2.8 million hospitalizations in the National Unified Health System in 2006. Gastroenteritis and complications, congestive heart failure, and asthma represented 44.1% of all ambulatory care sensitive hospitalizations. From 2000 to 2006, ambulatory care sensitive hospitalizations decreased by 15.8%, and this reduction was more significant than that observed in all other hospitalizations. The article concludes with potential applications and limitations of the proposed Brazilian list.

/pdf/internacoes-por-condicoes-sensiveis-a-atencao-primaria-a-e58nqj9so0.pdf

Internações por condições sensíveis à atenção primária: a construção da lista brasileira como ferramenta para medir o desempenho do sistema de saúde (Projeto ICSAP - Brasil)

The persistence of negative perinatal outcomes in Rio de Janeiro suggests problems in the quality of prenatal care. The most recent study in the city showed that only 38% of prenatal care was adequate. This study aimed to evaluate the adequacy of prenatal care under the Brazilian Unified National Health System in the city of Rio de Janeiro. A cross-sectional study in 2007-2008 interviewed 2,422 women receiving prenatal care for low-risk pregnancy. Evaluation of care used the PHPN index, based on guidelines from the Program for Humanization of Prenatal Care and Childbirth (Brazilian Ministry of Health) and an expanded PHPN index, which included clinical-obstetric procedures, prescription of supplementary ferrous sulfate, and educational activities. According to the PHPN index, 38.5% of prenatal care was adequate, as compared to 33.3% based on the expanded PHPN index. Strategies to expand early entry of pregnant women into prenatal care and better use of their contact with the health services in order to promote healthcare measures are essential to correct this situation.

/pdf/avaliacao-da-adequacao-da-assistencia-pre-natal-na-rede-sus-4jhdcw8wnj.pdf

Avaliação da adequação da assistência pré-natal na rede SUS do Município do Rio de Janeiro, Brasil

Trends in premature avertable mortality from non-communicable diseases for 195 countries and territories, 1990-2017: a population-based study.

OBJETIVO: Analisar a assistencia pre-natal na prevencao da transmissao vertical da sifilis. METODOS: Estudo transversal representativo para as gestantes de baixo risco atendidas em unidades de saude do municipio do Rio de Janeiro, RJ, periodo de 2007 a 2008. A identificacao de gestantes com diagnostico de sifilis na gestacao foi feita por meio de entrevistas, verificacao do cartao de pre-natal e busca de casos notificados em sistemas publicos de informacao em saude. Os casos de sifilis congenita foram identificados por meio de busca nos sistemas de informacao em saude: Sistema de Informacao de Agravos de Notificacao (Sinan), Sistema de Informacao sobre Mortalidade (SIM) e Sistema de Informacoes Hospitalares (SIH) do SUS. RESULTADOS: Foram identificados 46 casos de sifilis na gestacao e 16 casos de sifilis congenita com uma prevalencia estimada de 1,9% (IC95% 1,3;2,6) de sifilis na gestacao e de 6/1.000 (IC95% 3;12/1.000) de sifilis congenita. A taxa de transmissao vertical foi de 34,8% e tres casos foram fatais, um abortamento, um obito fetal e um obito neonatal, com proporcoes elevadas de baixo peso e prematuridade. A trajetoria assistencial das gestantes mostrou falhas na assistencia, como inicio tardio do pre-natal, ausencia de diagnostico na gravidez e ausencia de tratamento dos parceiros. CONCLUSOES: Estrategias inovadoras, que incorporem melhorias na rede de apoio diagnostico, sao necessarias para enfrentamento da sifilis na gestacao, no manejo clinico da doenca na gestante e seus parceiros e na investigacao dos casos como evento sentinela da qualidade da assistencia pre-natal.

/pdf/sifilis-congenita-evento-sentinela-da-qualidade-da-hlt4d3n3kj.pdf

Sífilis congênita: evento sentinela da qualidade da assistência pré-natal

List of avoidable causes of deaths due to interventions of the

/pdf/lista-de-causas-de-mortes-evitaveis-por-intervencoes-do-3xvxys02up.pdf

Lista de causas de mortes evitáveis por intervenções do Sistema Único de Saúde do Brasil

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List of avoidable causes of deaths due to interventions of the

Lista de causas de mortes evitáveis por intervenções do Sistema Único de Saúde do Brasil