Acesso aos serviços de urgência e internação hospitalar por crianças de 0 a 2 anos residentes em Juiz de Fora – MG

Abstract

Access to health services has been the subject of great interest in the field of public health, in which different authors adopt different concepts for the theme, including aspects related to services, users and their interaction. In this research, with the aim of identifying how the access of children under 2 years of the city of Juiz de Fora to services of emergency and hospitalization is, we used as a basis for theoretical reflection Mcintyre, Thiede and Birch (2009), defining access from the perspective of availability, affordability and acceptability. The interview data consisting of a household survey conducted in the municipality in 2010, responded by 325 parents of children younger than 2 years were analyzed. For this study we selected those children who had been treated by the emergency department and/or were hospitalized in the twelve months before the study period, amounting to 88 and 54 children respectively. The samples were divided into sub-samples, with the criterion for the division being the coverage or not by ESF (“Estratégia de Saúde da Família” – “Family Health Strategy”). Statistical analysis was performed using correspondence analysis and Cluster Analysis, in which it was possible to identify different characteristics for the four sub-samples, representing the access dimensions studied. Among the results, it is observed that the sub-sample 1 is mainly characterized by the dimension affordability, in which the variable indicating transportation costs is the most significant. The sub-sample 2 can also be characterized by the dimension affordability, however indirectly, because its most significant variable refers to waiting time higher than the average. Regarding the sub-sample 3, the access dimension that refers to availability is represented by the “presence of a previous referral from a health service”. The sub-sample 4, referring to the more subjective dimension of access, acceptability, was represented by the” presence of explanatory medical report after discharge”. Seeking to understand the association of socioeconomic data with the use of health services, we proceeded to binary logistic regression, in which we found that the child's age is positively related to the demand for emergency services characterized by an OR of 1,113 to p < 0.001. Regarding hospitalization, the child's age remains as an associated variable, with an OR of 1.046 (p= 0.054), also associated with the variable referring to the presence of a resident partner who is a protective factor for hospitalizations, with an OR 0.425 (p= 0.008). We conclude that access should be considered in a multidimensional approach, involving factors related both to the availability in terms of socioeconomic and cultural aspects. When one thinks about the access of children, peculiar children´s features should be considered in assessing access to health services.