Enhancing primary care is key to the Canadian health care reform. Considered as an indicator of primary care access and quality, hospitalisations for ambulatory care sensitive (ACS) conditions are commonly reported by Canadian organisations as sentinel events signaling problems with the delivery of primary care. However, the literature calls for further research to identify what lies behind ACS hospitalisation rates in regions with a predominantly urban population benefiting from universal access to health care. A theoretical model was built and, using an ecological design, multiple regressions were implemented to identify which neighbourhood characteristics explained the socio-economic gradient in ACS hospitalisation rates observed in Ottawa. Among these neighbourhoods, healthy behaviour and - to a certain extent - health status were significantly associated with ACS hospitalisation rates. Evidence of an association with primary care accessibility was also signaled for the more rural neighbourhoods. Smoking prevention and cessation campaigns may be the most relevant health care strategies to push forward by policy makers hoping to prevent ACS hospitalisations in Ottawa. From a health care equity perspective, targeting these campaigns to neighbourhoods of low socio-economic status may contribute to closing the gap in ACS hospitalisations described in this current study. Reducing the socio-economic inequalities of neighbourhoods would also contribute to health equity.

Enhancing primary care is key to the Canadian health care reform. Considered as an indicator of primary care access and quality, hospitalisations for ambulatory care sensitive (ACS) conditions are commonly reported by Canadian organisations as sentinel events signaling problems with the delivery of primary care. However, the literature calls for further research to identify what lies behind ACS hospitalisation rates in regions with a predominantly urban population benefiting from universal access to health care. A theoretical model was built and, using an ecological design, multiple regressions were implemented to identify which neighbourhood characteristics explained the socio-economic gradient in ACS hospitalisation rates observed in Ottawa. Among these neighbourhoods, healthy behaviour and - to a certain extent - health status were significantly associated with ACS hospitalisation rates. Evidence of an association with primary care accessibility was also signaled for the more rural neighbourhoods. Smoking prevention and cessation campaigns may be the most relevant health care strategies to push forward by policy makers hoping to prevent ACS hospitalisations in Ottawa. From a health care equity perspective, targeting these campaigns to neighbourhoods of low socio-economic status may contribute to closing the gap in ACS hospitalisations described in this current study. Reducing the socio-economic inequalities of neighbourhoods would also contribute to health equity.

Objective¡G The purpose of this research is (1) to find out the overall trends of the common avoidable hospitalization diseases in Taiwan since the implementation of the National Health Insurance (NHI), (2) to compare the different distributions of the common avoidable hospitalization diseases across age groups, genders, regions, and the hospital¡¦s characters, (3) to make the related useful information and suggestions of improving avoidable hospitalizations to the policy makers, hospitals, and the general public. Method¡G Standardized rates of avoidable hospitalization from 1997 to 2004 were derived from the National Health Insurance database and the Taiwan census data. In this research, we focus on the four main diseases¡GAsthma, Pneumonia, Diabetes, Hypertension as the avoidable hospitalization diseases. Logistic regression and chi-squire tests are used to detect and describes trends in data. Results¡G During the 8-year research period, AHCs (Avoidable Hospitalization Conditions)of Asthma and Hypertension decline overall, conversely, AHCs of Pneumonia and Diabetes show increasing trends overall¡Fin the hospital characters aspects, AHCs are mostly occurred in the local hospitals¡Ffrom the viewpoint of the patients¡¦ characters, AHCs of Asthma and Pneumonia are always occurred in children male, on the other hand, AHCs of Diabetes and Hypertension are always occurred in female and above 65 years old¡Fin the regional aspect, the AHCs of Asthma and Pneumonia are comparatively higher in east Taiwan. Conclusion¡G According to the results of this research, we can find that the avoidable hospitalizations in Taiwan still need to be improved. We suggest the policy makers and the hospitals may use the ¡uavoidable hospitalization¡vas an indicator to monitor the quality of care and the outpatient care quality in Taiwan¡¦s healthcare system. Thus can not only reduce the unnecessary expenditure, but also can offer the general public better quality of healthcare and improve their quality of life.

Enhancing primary care is key to the Canadian health care reform. Considered as an indicator of primary care access and quality, hospitalisations for ambulatory care sensitive (ACS) conditions are commonly reported by Canadian organisations as sentinel events signaling problems with the delivery of primary care. However, the literature calls for further research to identify what lies behind ACS hospitalisation rates in regions with a predominantly urban population benefiting from universal access to health care. A theoretical model was built and, using an ecological design, multiple regressions were implemented to identify which neighbourhood characteristics explained the socio-economic gradient in ACS hospitalisation rates observed in Ottawa. Among these neighbourhoods, healthy behaviour and - to a certain extent - health status were significantly associated with ACS hospitalisation rates. Evidence of an association with primary care accessibility was also signaled for the more rural neighbourhoods. Smoking prevention and cessation campaigns may be the most relevant health care strategies to push forward by policy makers hoping to prevent ACS hospitalisations in Ottawa. From a health care equity perspective, targeting these campaigns to neighbourhoods of low socio-economic status may contribute to closing the gap in ACS hospitalisations described in this current study. Reducing the socio-economic inequalities of neighbourhoods would also contribute to health equity.

This study examined the intersection of rurality and community area deprivation using a nine-state sample of inpatient hospitalizations among children (<18 years of age) from 2011. One state from each of the nine US census regions with substantial rural representation and varying degrees of community vulnerability was selected. An area deprivation index was constructed and used in conjunction with rurality to examine differences in the rate of ACSC hospitalizations among children in the sample states. A mixed model with both fixed and random effects was used to test influence of rurality and area deprivation on the odds of a pediatric hospitalization due to an ACSC within the sample. Of primary interest was the interaction of rurality and area deprivation. The study found rural counties are disproportionality represented among the most deprived. Within the least deprived counties, the likelihood of an ACSC hospitalization was significantly lower in rural than among their urban counterparts. However, this rural advantage declines as the level of deprivation increases, suggesting the effect of rurality becomes more important as social and economic advantage deteriorates. We also found ACSC hospitalization to be much higher among racial/ethnic minority children and those with Medicaid or self-pay as an anticipated source of payment. These findings further contribute to the existing body of evidence documenting racial/ethnic disparities in important health related outcomes.

Serious mental illness (SMI) affects 5% of the United States population and is associated with increased morbidity and mortality. Use of high-cost healthcare services is common, including hospitalizations and emergency department (ED) visits. Integrating behavioral and physical healthcare may improve care for consumers with SMI, but prior research findings have been mixed. This quantitative retrospective cohort study addressed the impact of integrated care on physical health and ambulatory care sensitive (ACS) utilization via a program evaluation of an integrated health clinic (IHC) at a community mental health center (CMHC). The research questions assessed whether there was a predictive relationship between IHC enrollment and physical health and ACS-specific service utilization for consumers with SMI when controlling for demographic characteristics and disease severity. Secondary administrative healthcare data, including authorization and electronic medical record data, were provided by the CMHC. Logistic regressions assessed the odds of experiencing an inpatient admission or ED visit before or after IHC enrollment; the predictive relationship between IHC enrollment and service utilization was assessed using multiple linear and Poisson regression analyses. There was no statistically significant impact of integrated care clinic enrollment on physical health or ACS-specific utilization. The sample had lower levels of physical health utilization than would have been expected. In terms of positive social change, results may help the CMHC assess the IHC program, overall clinic success, and use of data. Since policy and payment structures continue to support integrated care models, further research on different programs are encouraged, as each setting and practice pattern is unique.

A resolutividade da atenção básica à saúde deve se refletir na diminuição das hospitalizações por um grupo de causas específicas. As hospitalizações por causas sensíveis a atenção básica são um indicador indireto da efetividade do sistema de saúde, nessa instância de atenção, pressupondo que as internações decorrentes destas doenças não receberam atenção efetiva em momento oportuno, resultando em agravamento da condição clínica que exigiu a hospitalização. Objetivo: Apreender os atributos da atenção básica em saúde a partir do indicador de internação por condições sensíveis à atenção ambulatorial, mediante análise do caminho percorrido nos serviços de saúde por famílias de crianças menores de cinco anos hospitalizadas com doenças respiratórias. Método: Estudo qualitativo cujas bases conceituais estão centradas no cuidado em saúde, na vulnerabilidade e na hermenêutica. O material empírico foi produzido a partir de entrevistas com acompanhantes de crianças hospitalizadas, incluindo o mapa falante e com profissionais de saúde, na observação do processo de trabalho nos serviços de saúde e na análise documental dos prontuários de atendimento das crianças. A compreensão dos dados por meio da hermenêutica norteou a discussão do material empírico organizado em três unidades: perfil de morbidade hospitalar das crianças menores de cinco anos, hospitalizadas no hospital universitário, no período de 2005 a 2009; apreensão dos atributos da atenção primária em saúde; o caminho percorrido pelas famílias de crianças menores de cinco anos com problemas respiratórios em busca de atenção a saúde. Resultados: As doenças respiratórias foram responsáveis por mais da metade das hospitalizações de crianças menores de cinco anos; os atributos da atenção básica não estiveram presentes na organização dos serviços de atenção a saúde; as crianças com doenças respiratórias não tiveram resolutividade na atenção necessitando de hospitalização; o cuidado recebido foi procedimental, com a racionalidade técnica conduzindo o encontro de cuidado e a subjetividade que deveria estar perpassando essa relação não sendo mencionada. Para obtenção do cuidado as famílias passaram por unidades básicas de saúde, unidades de emergência, ambulatórios de hospitais privados e de hospital público, num intervalo entre consultas que variou de três no mesmo dia a uma por dia em três dias, gerando insatisfação com a atenção recebida, pois esta não evitou a hospitalização da criança. Considerações: Recomenda-se a adoção de um sistema integrado de serviços de saúde, adotando-se os princípios da atenção básica como norte, quais sejam a integralidade da atenção, o acesso de primeiro contato, a longitudinalidade, a coordenação dos serviços pela atenção básica, o foco do cuidado na família, a orientação comunitária. Propõe-se a adoção do acolhimento pelos serviços de saúde assumindo que estes sejam organizados com foco no usuário, reorganizando-se o processo de trabalho, deslocando-se o eixo central do cuidado do médico para a equipe multiprofissional, qualificando a relação entre profissional e usuário, baseada na humanização do cuidado, na ética, na solidariedade e na cidadania, buscando a resolutividade em saúde, por meio do diálogo entre os sujeitos que constituem o coletivo do setor saúde, construído em uma relação de cuidado. / The outcomes of primary health care should be reflected in the reduction of hospitalizations for a specific group of causes. The sensitive hospital admissions for primary care are an indirect indicator of the effectiveness of the health system, in this level of care, assuming that hospitalizations resulting from these diseases have not received attention in an effective time, resulting in worse clinical conditions that required hospitalization. Objective: Understanding the attributes of primary health care from the indicator of hospitalization for ambulatory care sensitive conditions, by analyzing the path followed by health services for families of children under five years old hospitalized with respiratory diseases. Method: A qualitative study which conceptual foundations are based on the care, vulnerability and hermeneutics. The empirical material was obtained through interviews with relatives of hospitalized children and with health professionals. However, the path map was used only with the relatives. The observation of working process in health services and document review of medical charts of children were also done. The understanding of data through hermeneutic analysis revealed three units: hospital morbidity of children under five years old hospitalized at University Hospital from 2005 to 2009, attribute seizures of primary health care, the path taken by the parents from the five-year-old children suffering from respiratory problems to seek health care. Results: Respiratory diseases were responsible for more than half of the hospitalizations of children under five years old, the attributes of primary care were not present in the organization of health care services, children with respiratory diseases have not had attention in solving requiring hospitalization, the care received was procedural, with the technical rationale conducting the meeting and subjectivity that care should be passing by this relationship not being mentioned. To obtain the care, their families went through basic health units, emergency units, outpatient clinics and private hospitals to public hospitals, ranging from queries that ranged from three on the same day to one per day over three days, causing dissatisfaction with the attention received, because it has not prevented the children\'s hospitalization. Considerations: It is recommended the adoption of an integrated health service, adopting the principles of primary health care as the north, which are integrated care, access to first contact, longitudinality, coordination of services for primary care, the focus of care in family, and community orientation. We propose the sheltered adoption by the health services assuming that they are organized to focus on the user, reorganizing the work process, moving the central axis of the doctor\'s care for the multidisciplinary team, describing the relationship between the professional and the user, based on the humanization of care, ethics, solidarity and citizenship, seeking to improve the outcomes in health, through dialogue among the subjects that constitute the public health sector, built on a care relationship.

Justificativa: Internações por Condições Sensíveis à Atenção Primária (ICSAP) são utilizadas como medida da efetividade da atenção à saúde e menores taxas estão associadas ao maior acesso à Atenção Primária à Saúde (APS). Poucos estudos utilizam instrumentos que medem a qualidade da APS e seu efeito nas taxas de internações. Esse estudo buscou identificar fatores individuais, contextuais e dos atributos da APS, medidos nas Equipes de Saúde da Família (ESF), associados com a variação das ICSAP. Métodos: Estudo ecológico das taxas de ICSAP e sua associação com as variáveis preditoras na população de Belo Horizonte, Minas Gerais, entre 2010 e 2013, analisadas por um modelo multinível. Resultados: Do total de 447.500 internações, excluídos os partos, 85.211 foram ICSAP, correspondendo a 19% do total de Internações. Dessas, 50,8% ocorreram em mulheres, 33% em menores de 18 anos, 32% em adultos e 35% em maiores de 60 anos. As taxas padronizadas anuais de ICSAP entre 2010 e 2013, foram maior nos homens (114,5/10.000) que nas mulheres (107,1/10.000). A vulnerabilidade socioeconômica da população está fortemente associada com o comportamento das taxas de internação. O aumento de 10% na população de alto risco ampliou em 4 ICSAP por 10.000 mulheres e em 3 ICSAP por 10.000 homens. Enquanto um aumento de 10% na população de baixo risco, uma redução de 6 ICSAP em mulheres e 5 nos homens, em cada Unidade Básica de Saúde. Nas análises realizadas na população adulta e idosa, para os grupos de doenças agudas e crônicas mais prevalentes nessa faixa etária, o aumento de uma unidade a mais no escore de qualidade da APS, reduz a taxa de ICSAP em 4% ao ano nas mulheres idosas com doenças crônicas. Conclusão: A utilização das ICSAP como medida da efetividade da APS/SF deve ter seu escopo ampliado, incluindo, além das características individuais e dos serviços, as socioeconômicas. Os melhores escores de qualidade da APS tem efeito significativo na redução das taxas de internações por condições crônicas, em mulheres idosas, ao longo dos anos. Como a vulnerabilidade socioeconômica esteve fortemente relacionada ao comportamento das taxas de ICSAP, esses achados reforçam a importância da APS na redução das iniquidades, ao atender uma população idosa e vulnerável, em um contexto de grandes desigualdades, como é o caso dessa metrópole brasileira. / Introduction. Ambulatory Care Sensitive Conditions (ACSC) have been used as a measure of the effectiveness of Primary Health Care (PHC). Few studies have, however, analysed changes in the rates of these hospitalizations using instruments that measure the quality of PHC and its effect on admission rates. This study aimed to identify individual factors, with the variation of ACSC. Methods. Ecological study of ACSC rates and their association with the predictor variables in the population of Belo Horizonte, Minas Gerais, between 2010 and 2013, analyzed by a multilevel model. Results. Of the total 447,500 admissions, excluding births, 85,211 were ICSAP, corresponding to 19% of total admissions. Of these, 50.8% occurred in women, 33% under 18, 32% in adults and 35% over 60 years. The annual standardized rates ACSC between 2010 and 2013 were higher in men (114.5 /10,000) than in women (107.1/10,000). The socio-economic vulnerability of the population is strongly associated with the trends of hospitalization rates. The 10% increase in high-risk population expanded by 4 and 3 ACSC per 10,000 women and men, respectively. While an increase of 10% in low-risk population, a reduction of 6 and 5 ACSC per 10.000 in women and men in each Basic Health Unit. In the analyzes in adults and the elderly, for most prevalent acute and chronic diseases in this age group, the increase of one more unit in the APS quality score, reduces ICSAP rate of 4% per year in older women with chronic diseases. Conclusion. The PHC best quality scores have significant effect in reducing hospitalization rates for chronic conditions in elderly women over the years. As the socioeconomic vulnerability was strongly related to the behavior of ACSC rates, these findings reinforce the importance of PHC in reducing inequities, particularly in large inequalities contexts, as in the case of a Brazilian metropolis. And reinforce the need to expand the assessment of the scope to use ACSC as a mesure of effectiveness of PHC, considering the individual, services and socio-economic characteristics.

A Atenção Primária à Saúde - APS é reconhecida como o nível fundamental e porta de entrada do sistema de atenção à saúde, sendo o lugar adequado onde pode ser atendida e resolvida a maior parte dos problemas de saúde. É considerada pela OMS como a principal proposta de modelo assistencial. Essa importância da APS leva a necessidade de pesquisas avaliativas dos seus resultados para adequação e melhoria de políticas e planos de ação delineados em relação à mesma. Pesquisas internacionais e nacionais são realizadas, nas quais indicadores relativos às atividades hospitalares estão sendo empregados com o objetivo de medir resultados como efetividade e acesso da APS. Um desses indicadores, desenvolvido por John Billings da Universidade de Nova York, na década de 90, consiste nas condições pelas quais as internações hospitalares por Condições Sensíveis à Atenção Ambulatorial (CSAA) deveriam ser evitadas caso os serviços da APS fossem efetivos e acessíveis. Utilizando-se o SIH-AIH/2008 e a lista brasileira de Internações por Condições Sensíveis a Atenção Primária, publicada em 2008, a proposta do presente trabalho é a de estudar os cuidados primários à saúde baseando-se nas ICSAA, na área urbana da cidade de Juiz de Fora-MG. Buscou-se responder sobre os efeitos que ocorrem nessas internações a partir das características individuais dos pacientes, das características das Unidades Básicas de Saúde-UBS (infraestrutura, produção e modelos assistenciais) e das condições sócio-econômicas/ambientais das áreas cobertas por UAPS e descobertas (sem UAPS), com a utilização de modelos multiníveis logísticos com intercepto aleatório. Buscou-se conhecer, também, a distribuição espacial das taxas padronizadas por idade das ICSAA nessas áreas e suas associações com as variáveis contextuais, utilizando-se ferramentas da análise espacial. Os resultados do presente trabalho mostraram que a porcentagem de internações por CSAA, foi de 4,1%. Os modelos assistenciais ESF e o Modelo Tradicional, base da organização da atenção primária no Brasil, não apresentaram no município, impacto significativo nas ICSAA, somente na forma de áreas descobertas tendo como referência as áreas cobertas. Também não foram significativas as variáveis de infraestrutura e produção das UAPS. Os efeitos individuais (idade e sexo) nas ICSAA foram significativos, apresentando probabilidades de significância menores que 1%, o mesmo acontecendo com o Índice de Desenvolvimento Social-IDS, que contempla as condições sociais, econômicas e ambientais das áreas analisadas. A distribuição espacial das taxas padronizadas por idade apresentou padrão aleatório e os testes dos Multiplicadores de Lagrange não foram significativos indicando o modelo de regressão clássico (MQO) como adequado para explicar as taxas em função das variáveis contextuais. Para a análise conjunta das áreas cobertas e descobertas foram fatores de risco: a variável econômica (% dos domicílios com renda até 2 SM), áreas descobertas tendo como referência as áreas cobertas e a região nordeste do município. Para as áreas cobertas as variáveis de produção das UAPS, econômica e a região nordeste apresentaram como fator de risco para as taxas de internação por CSAA. / The Primary Health Care - PHC is recognized as the primary and gateway to the health care system, and the proper place where it can be answered and solved most health problems. It is considered by WHO as the main tender treatment model. This importance of APS leads to the need for evaluative research of their results to adapt and improve policies and action plans outlined in relation to it. International and national surveys are conducted, in which indicators related to hospital activities are being employed with the aim of measuring effectiveness and access to PHC. One of these indicators, developed by John Billings of the University of New York in the 90s, consists of the conditions for which hospitalizations for Ambulatory Care Sensitive Conditions (ACSC) should be avoided if the PHC services were effective and accessible. Using the Brazilian list of ACSC, published in 2008, and SIH-AIH/2008 the purpose of this paper is to study the primary health care based on the hospitalization for ACSC, in the urban area Juiz de Fora-MG city. We tried to answer about the effects that occur in these admissions from the characteristics of individual patients, the characteristics of the Primary Health Care Unit-PHCU (infrastructure, production and care models) and the social conditions of the areas covered (with PHCU) and discoveries (not PHCU), with the use of multilevel logistic models with random intercept. We tried to know, too, the spatial distribution of standardized rates by age in these areas and their associations with contextual variables, using the tools of spatial analysis. The results of this study showed that the percentage of admissions for ACSC was 4.1%. Family Heath Strategy and Traditional models, the base of organization of primary care in Brazil, had no significant impact on the hospitalizations, only when analysed in form to uncovered areas with reference to the areas covered. Nor were significant variables for infrastructure and production of PHCU. The individual effects (age and sex) in ACSC were significant, with significance probabilities less than 1%, as did the Social Development Index-SDI, which includes the social, economic and environmental conditions in these areas examined. The spatial distribution of standardized rates by age showed random pattern and tests of Lagrange multipliers were not significant indicating the classical regression model (OLS) to explain these rates. For the joint analysis of covered and uncovered areas were risk factors: the economic variable (% of households with incomes up to 2 MW), the uncovered areas with reference to the areas covered and the Northeast. For areas covered variables economic, production from PHCU and Northeast were risk factors for admission rates for ACSC.

Justificativa: Internações por Condições Sensíveis à Atenção Primária (ICSAP) são utilizadas como medida da efetividade da atenção à saúde e menores taxas estão associadas ao maior acesso à Atenção Primária à Saúde (APS). Poucos estudos utilizam instrumentos que medem a qualidade da APS e seu efeito nas taxas de internações. Esse estudo buscou identificar fatores individuais, contextuais e dos atributos da APS, medidos nas Equipes de Saúde da Família (ESF), associados com a variação das ICSAP. Métodos: Estudo ecológico das taxas de ICSAP e sua associação com as variáveis preditoras na população de Belo Horizonte, Minas Gerais, entre 2010 e 2013, analisadas por um modelo multinível. Resultados: Do total de 447.500 internações, excluídos os partos, 85.211 foram ICSAP, correspondendo a 19% do total de Internações. Dessas, 50,8% ocorreram em mulheres, 33% em menores de 18 anos, 32% em adultos e 35% em maiores de 60 anos. As taxas padronizadas anuais de ICSAP entre 2010 e 2013, foram maior nos homens (114,5/10.000) que nas mulheres (107,1/10.000). A vulnerabilidade socioeconômica da população está fortemente associada com o comportamento das taxas de internação. O aumento de 10% na população de alto risco ampliou em 4 ICSAP por 10.000 mulheres e em 3 ICSAP por 10.000 homens. Enquanto um aumento de 10% na população de baixo risco, uma redução de 6 ICSAP em mulheres e 5 nos homens, em cada Unidade Básica de Saúde. Nas análises realizadas na população adulta e idosa, para os grupos de doenças agudas e crônicas mais prevalentes nessa faixa etária, o aumento de uma unidade a mais no escore de qualidade da APS, reduz a taxa de ICSAP em 4% ao ano nas mulheres idosas com doenças crônicas. Conclusão: A utilização das ICSAP como medida da efetividade da APS/SF deve ter seu escopo ampliado, incluindo, além das características individuais e dos serviços, as socioeconômicas. Os melhores escores de qualidade da APS tem efeito significativo na redução das taxas de internações por condições crônicas, em mulheres idosas, ao longo dos anos. Como a vulnerabilidade socioeconômica esteve fortemente relacionada ao comportamento das taxas de ICSAP, esses achados reforçam a importância da APS na redução das iniquidades, ao atender uma população idosa e vulnerável, em um contexto de grandes desigualdades, como é o caso dessa metrópole brasileira. / Introduction. Ambulatory Care Sensitive Conditions (ACSC) have been used as a measure of the effectiveness of Primary Health Care (PHC). Few studies have, however, analysed changes in the rates of these hospitalizations using instruments that measure the quality of PHC and its effect on admission rates. This study aimed to identify individual factors, with the variation of ACSC. Methods. Ecological study of ACSC rates and their association with the predictor variables in the population of Belo Horizonte, Minas Gerais, between 2010 and 2013, analyzed by a multilevel model. Results. Of the total 447,500 admissions, excluding births, 85,211 were ICSAP, corresponding to 19% of total admissions. Of these, 50.8% occurred in women, 33% under 18, 32% in adults and 35% over 60 years. The annual standardized rates ACSC between 2010 and 2013 were higher in men (114.5 /10,000) than in women (107.1/10,000). The socio-economic vulnerability of the population is strongly associated with the trends of hospitalization rates. The 10% increase in high-risk population expanded by 4 and 3 ACSC per 10,000 women and men, respectively. While an increase of 10% in low-risk population, a reduction of 6 and 5 ACSC per 10.000 in women and men in each Basic Health Unit. In the analyzes in adults and the elderly, for most prevalent acute and chronic diseases in this age group, the increase of one more unit in the APS quality score, reduces ICSAP rate of 4% per year in older women with chronic diseases. Conclusion. The PHC best quality scores have significant effect in reducing hospitalization rates for chronic conditions in elderly women over the years. As the socioeconomic vulnerability was strongly related to the behavior of ACSC rates, these findings reinforce the importance of PHC in reducing inequities, particularly in large inequalities contexts, as in the case of a Brazilian metropolis. And reinforce the need to expand the assessment of the scope to use ACSC as a mesure of effectiveness of PHC, considering the individual, services and socio-economic characteristics.