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Primary Care and Avoidable Hospitalizations: Evidence From Brazil

Guanais, Frederico PhD; Macinko, James PhD

Journal of Ambulatory Care Management: April-June 2009 - Volume 32 - Issue 2 - p 115–122
doi: 10.1097/JAC.0b013e31819942e51

This article provides evidence of the effectiveness of family-based, community-oriented primary healthcare programs on the reduction of ambulatory care sensitive hospitalizations in Brazil. Between 1998 and 2002, expansions of the Family Health Program were associated with reductions in hospitalizations for diabetes mellitus and respiratory problems and Community Health Agents Program expansions were associated with reductions in circulatory conditions hospitalizations. Results were significant for only the female population only, suggesting that these programs were more effective in reaching women than men. Program coverage may have contributed to an estimated 126 000 fewer hospitalizations between 1999 and 2002, corresponding to potential savings of 63 million US dollars.

Ministry of Social Development and Fight Against Hunger, Brasilia, Brazil (Dr Guanais); and Department of Nutrition, Food Studies, and Public Health, New York University, New York (Dr Macinko).

Corresponding Author: Frederico Guanais, PhD, Ministry of Social Development and Fight Against Hunger, Esplanada dos Ministerios, Bloco C, Sala 517, Brasilia-DF, Brazil 70046 (

The first author was supported by the Brazilian National Council for Research and Development (CNPq).

© 2009 Lippincott Williams & Wilkins, Inc.