Internações por condições sensíveis à atenção primária no estado de São Paulo Internment for conditions suitable for primary healthcare in Sao Paulo state

Internações Sensíveis à Atenção Primária se constitui num novo indicador, utilizado em alguns países, para medir indiretamente o funcionamento e a capacidade de resolução da Atenção Primária. Este estudo tem como objetivo apresentar o panorama das internações sensíveis à atenção primária no Estado de São Paulo. Trata-se de um estudo descritivo ecológico, realizado no período de 2000 a 2007. Os dados foram gerados por município de residência do paciente e agregados por Departamentos Regionais de Saúde. Para obtenção dos mesmos foram utilizados os Sistemas de Informação do Ministério da Saúde e estimativa populacional do IBGE. As internações sensíveis à atenção primária no Estado seguem uma tendência de redução sugerindo relação com a adoção da Estratégia de Saúde da Família. Observa-se redução nas internações por diabetes e chama atenção o aumento de internações por doenças relacionadas ao pré-natal e parto. Considerando a publicação recente da Lista Brasileira de Diagnósticos, os estudos que se utilizem dela podem ser de grande valia para os gestores envolvidos com a atenção primária, podendo funcionar como balizadores de sua qualidade contribuindo para avaliação da implantação das políticas de saúde no Brasil.<br>Internments suitable for Primary Healthcare constitute a new indicator used in some countries to indirectly measure the resolution capability of Primary Healthcare. The scope of this study is to present the panorama of the internments suitable for primary healthcare in Sao Paulo State. An ecological descriptive study was carried out for the period from 2000 to 2007. The data were generated by patient's county of residence and grouped by Regional Health Departments. The Information Systems of the Health Ministry and the population estimates of the Brazilian Institute of Geography and Statistics (IBGE) were used to obtain the data of all patients. The internments suitable for primary healthcare in the state follow a tendency toward reduction suggesting a connection with the adoption of the Family Health Program. A reduction in internments for diabetes was detected and attention was drawn to the increase of internment for illnesses related to prenatal care and childbirth. In light of the recent publication of the Brazilian Diagnostics List, studies that analyze the statistics from it can be very useful for managers involved with primary care, and can serve as benchmarks for quality and contribute to assessment for the implementation of health policies in Brazil

Prevalence and incidence density rates of chronic comorbidity in type 2 diabetes patients: An exploratory cohort study

Contains fulltext : 109144.pdf (publisher's version ) (Open Access)ABSTRACT: BACKGROUND: Evidence-based diabetes guidelines generally neglect comorbidity, which may interfere with diabetes management. The prevalence of comorbidity described in patients with type 2 diabetes (T2D) shows a wide range depending on the population selected and the comorbid diseases studied. This exploratory study aimed to establish comorbidity rates in an unselected primary-care population of patients with T2D. METHODS: This was a cohort study of 714 adult patients with newly diagnosed T2D within the study period (1985-2007) in a practice-based research network in the Netherlands. The main outcome measures were prevalence and incidence density rates of chronic comorbid diseases and disease clusters. All chronic disease episodes registered in the practice-based research network were considered as comorbidities. We categorised comorbidity into 'concordant' (that is, shared aetiology, risk factors, and management plans with diabetes) and 'discordant' comorbidity. Prevalence and incidence density were assessed for both categories of comorbidity. RESULTS: The mean observation period was 17.3 years. At the time of diabetes diagnosis, 84.6% of the patients had one or more chronic comorbid disease of 'any type', 70.6% had one or more discordant comorbid disease, and 48.6% and 27.2% had three or more chronic comorbid diseases of 'any type' or of 'discordant only', respectively. A quarter of those without any comorbid disease at the time of their diabetes diagnosis developed at least one comorbid disease in the first year afterwards. Cardiovascular diseases (considered concordant comorbidity) were the most common, but there were also high rates of musculoskeletal and mental disease. Discordant comorbid diseases outnumbered concordant diseases. CONCLUSIONS: We found high prevalence and incidence density rates for both concordant and discordant comorbidity. The latter may interfere with diabetes management, thus future research and clinical practice should take discordant comorbidity in patients with T2D into account.10 p