Hospitalizations for conditions sensitive to primary care in Maranhão: a historical review

Abstract

 Hospitalizations for Primary Care Sensitive Conditions (PCSC) are important indicators of the effectiveness of Primary Health Care (PHC), allowing the assessment of access, quality, and problem-solving capacity of health services. In Brazil, a country marked by regional inequalities and challenges in the organization of the healthcare network, it is relevant to analyze the behavior of these hospitalizations in the state of Maranhão considering the expansion of PHC coverage. This is a quantitative, analytical, and retrospective study conducted using secondary data obtained from DATASUS/SIH-SUS and reports from the Ministry of Health’s e-Gestor APS system. Data from 2016 to 2025 were organized in Microsoft Excel® spreadsheets and submitted to descriptive statistical analysis, including absolute and relative frequencies and hospitalization rates per inhabitants. During the analyzed period, Maranhão recorded 1,072,892 hospitalizations for primary care sensitive conditions. An increase in hospitalizations was observed between 2016 and 2018, followed by a significant reduction in 2020 during the Covid-19 pandemic, and a gradual increase in subsequent years. Infectious gastroenteritis and complications accounted for 31.2% of hospitalizations, followed by kidney and urinary tract infections (10.5%), diabetes mellitus (8.6%), skin and subcutaneous tissue infections (7.6%), and arterial hypertension (7.0%). Small municipalities showed the highest proportional hospitalization rates, especially Passagem Franca. Despite the expansion of PHC coverage, no proportional and sustained reduction in PCSC was identified. The findings demonstrate that PHC effectiveness depends not only on coverage expansion, but also on quality of care, continuity of assistance, healthcare network integration, and better structural conditions.