THE IMPACT OF THE COVID-19 PANDEMIC ON HOSPITALIZATION LEVELS FOR PRIMARY CARE SENSITIVE CONDITIONS (PCSC)

Abstract

The Brazilian Unified Health System (SUS) is organized into three levels of increasing complexity, which structure the treatments and services offered. In this context, the indicator of Hospitalizations for Primary Care Sensitive Conditions (ICSAP) encompasses conditions that could be avoided if adequately managed in primary care. The COVID-19 pandemic directly impacted this indicator due to the suspension of services, social isolation, and the consequent reduction in demand for basic health services. This descriptive ecological study analyzed data from the SUS Hospital Information System for Brazil and the state of São Paulo, between 2018 and 2023, expressed as hospitalization rates per 100,000 inhabitants. The three main causes of hospitalization in both scenarios were bacterial pneumonia, cerebrovascular diseases, and heart failure. In Brazil, the largest increases during the period occurred in hospitalizations for cerebrovascular diseases, anemia, and epilepsy, while the largest reductions involved hypertension and infectious gastroenteritis. In São Paulo, the largest increases were observed in asthma and cerebrovascular diseases, and the largest decreases in infectious gastroenteritis and hypertension. Between 2018 and 2020, hospitalizations for ambulatory care-sensitive conditions (ACSCs) decreased for the ten main causes of hospitalization in both scenarios; however, from 2021 to 2023, they increased in Brazil for all these causes, while in São Paulo the largest increases occurred in bacterial pneumonia, asthma, and skin and subcutaneous tissue infections. It is concluded that delayed care during the pandemic contributed to the increase in hospitalizations for ACSCs in 2023, especially for bacterial pneumonia, cerebrovascular diseases, and heart failure.