Access to neonatal healthcare services: analysis of displacement networks between municipalities in the State of Paraná, Brazil

Detalhes bibliográficos
Autor(a) principal: Martins Silveira, Daniela
Data de Publicação: 2023
Outros Autores: Geremias dos Santos, Hellen
Tipo de documento: Artigo
Idioma: por
Título da fonte: Cadernos de Saúde Pública
Texto Completo: https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8183
Resumo: This study aimed to characterize hospitalizations of residents in Paraná State, Brazil, that occurred during the neonatal period in a municipality different from their place of residence from 2008 to 2019, and to describe displacement networks for the first and last biennium of the series, corresponding to periods before and after initiatives to regionalize health services in the state. Admissions of children aged from 0 to 27 days were obtained from the Hospital Information System of the Brazilian National Unified Health System (SIH-SUS) database. For each biennium and health region, the proportion of admissions that occurred outside the municipality of residence, the weighted average distance traveled, and indicators of health and service provision were calculated. Mixed models were fitted to evaluate the biennial trend of the indicators and to investigate factors associated with the neonatal mortality rate (NMR). In total, 76,438 hospitalizations were selected, ranging from 9,030 in 2008-2009 to 17,076 in 2018-2019. The comparison of the networks obtained for 2008-2009 and 2018-2019 revealed an increase in the number of frequent destinations and in the proportion of displacements within the same health region. A decreasing trend was observed for distance, the proportion of live births with 5-minute Apgar ≤ 7, and for NMR. In the adjusted analysis for NMR, besides the biennial effect (-0.64; 95%CI: -0.95; -0.28), only the proportion of live birth with gestational age < 28 weeks showed statistical significance (4.26; 95%CI: 1.29; 7.06). The demand for neonatal hospital care increased over the study period. The displacement networks suggest a positive impact of regionalization, although investment in regions with the potential to become healthcare centers is necessary.
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spelling Access to neonatal healthcare services: analysis of displacement networks between municipalities in the State of Paraná, BrazilAcceso a los servicios de atención hospitalaria en el período neonatal: análisis de las redes de desplazamiento entre municipios del estado del Paraná, en BrasilAcesso a serviços de atenção hospitalar no período neonatal: análise de redes de deslocamento entre municípios do Estado do Paraná, BrasilSistema de Informação HospitalarRegionalização da SaúdeServiços de Saúde NeonatalAtenção à SaúdeSistemas de Información en HospitalRegionalizaciónServicios de Salud NeonatalAtención a la SaludHospital Information SystemsRegional Health PlanningInfant Health ServicesHealth CareThis study aimed to characterize hospitalizations of residents in Paraná State, Brazil, that occurred during the neonatal period in a municipality different from their place of residence from 2008 to 2019, and to describe displacement networks for the first and last biennium of the series, corresponding to periods before and after initiatives to regionalize health services in the state. Admissions of children aged from 0 to 27 days were obtained from the Hospital Information System of the Brazilian National Unified Health System (SIH-SUS) database. For each biennium and health region, the proportion of admissions that occurred outside the municipality of residence, the weighted average distance traveled, and indicators of health and service provision were calculated. Mixed models were fitted to evaluate the biennial trend of the indicators and to investigate factors associated with the neonatal mortality rate (NMR). In total, 76,438 hospitalizations were selected, ranging from 9,030 in 2008-2009 to 17,076 in 2018-2019. The comparison of the networks obtained for 2008-2009 and 2018-2019 revealed an increase in the number of frequent destinations and in the proportion of displacements within the same health region. A decreasing trend was observed for distance, the proportion of live births with 5-minute Apgar ≤ 7, and for NMR. In the adjusted analysis for NMR, besides the biennial effect (-0.64; 95%CI: -0.95; -0.28), only the proportion of live birth with gestational age < 28 weeks showed statistical significance (4.26; 95%CI: 1.29; 7.06). The demand for neonatal hospital care increased over the study period. The displacement networks suggest a positive impact of regionalization, although investment in regions with the potential to become healthcare centers is necessary.El presente trabajo tuvo como objetivo caracterizar las hospitalizaciones de residentes en el Paraná, Brasil, ocurridas en el período neonatal en un municipio diferente al de su residencia entre el 2008 y el 2019, y describir las redes de desplazamiento para el primer y último bienio de la serie, correspondientes al período anterior y posterior a iniciativas de regionalización de servicios de salud en el Estado. Las hospitalizaciones de niños con edades entre 0 y 27 días se obtuvieron del Sistema de Información Hospitalaria del Sistema Único de Salud (SIH-SUS) y, para cada bienio y regional de salud, se calculó la proporción de ingresos hospitalarios que ocurrieron fuera del municipio de residencia, la distancia media calculada por el flujo de desplazamientos, así como indicadores de salud y de oferta de servicios. Se ajustaron modelos mixtos para evaluar la tendencia bianual de los indicadores y para verificar factores asociados a la tasa de mortalidad neonatal (TMN). En total, se seleccionaron 76.438 hospitalizaciones, que varían desde 9.030 en 2008-2009 a 17.076 en 2018-2019. La comparación de las redes obtenida para 2008-2009 y 2018-2019 mostró un aumento en el número de destinos frecuentes y en la proporción de desplazamientos dentro de la misma regional de salud. Se observó una tendencia decreciente para la distancia, la proporción de nacidos vivos con Apgar al 5º minuto ≤ 7 y para la TMN. En el análisis ajustado para la TMN, además del efecto de bienio (-0,64; IC95%: -0,95; -0,28), solo la proporción de nacidos vivos con edad gestacional < 28 semanas presentó significativa estadística (4,26; IC95%: 1,29; 7,06). La demanda de asistencia hospitalaria en el período neonatal aumentó a lo largo del período estudiado. Las redes de desplazamiento sugieren un impacto positivo de la regionalización, aunque es necesaria la inversión en regiones con potencial para convertirse en polos asistenciales.Este trabalho objetivou caracterizar internações de residentes no Paraná, Brasil, ocorridas no período neonatal em município diferente do de residência, entre 2008 e 2019, e descrever redes de deslocamento para o primeiro e o último biênio da série, correspondentes aos períodos anterior e posterior a iniciativas de regionalização dos serviços de saúde no estado. Dados sobre internações de crianças com idade entre 0 e 27 dias foram obtidos por meio do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS). Para cada biênio e regional de saúde, foram calculados a proporção de internações ocorridas fora do município de residência, a distância média ponderada pelo fluxo dos deslocamentos, bem como indicadores de saúde e de oferta de serviços. Modelos mistos foram ajustados para avaliar a tendência bianual dos indicadores e para verificar fatores associados à taxa de mortalidade neonatal (TMN). No total, 76.438 internações foram selecionadas, variando de 9.030, em 2008-2009, a 17.076, em 2018-2019. A comparação entre as redes obtidas para 2008-2009 e as existentes em 2018-2019 evidenciou aumento no número de destinos frequentes e na proporção de deslocamentos dentro da mesma regional de saúde. Observou-se tendência decrescente para a distância, para a proporção de nascidos vivos com Apgar no quinto minuto ≤ 7 e para a TMN. Na análise ajustada para a TMN, além do efeito de biênio (-0,64; IC95%: -0,95; -0,28), apenas a proporção de nascidos vivos com idade gestacional inferior a 28 semanas apresentou significância estatística (4,26; IC95%: 1,29; 7,06). A demanda por assistência hospitalar no período neonatal aumentou ao longo do período estudado. As redes de deslocamento sugerem impacto positivo da regionalização, embora o investimento em regiões com potencial para se tornarem polos assistenciais seja necessário.Reports in Public HealthCadernos de Saúde Pública2023-06-26info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/xmlapplication/pdfhttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8183Reports in Public Health; Vol. 39 No. 6 (2023): JuneCadernos de Saúde Pública; v. 39 n. 6 (2023): Junho1678-44640102-311Xreponame:Cadernos de Saúde Públicainstname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZporhttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8183/18342https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8183/18343Copyright (c) 2023 Cadernos de Saúde Públicainfo:eu-repo/semantics/openAccessMartins Silveira, DanielaGeremias dos Santos, Hellen2023-07-10T13:04:27Zoai:ojs.teste-cadernos.ensp.fiocruz.br:article/8183Revistahttps://cadernos.ensp.fiocruz.br/ojs/index.php/csphttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/oaicadernos@ensp.fiocruz.br||cadernos@ensp.fiocruz.br1678-44640102-311Xopendoar:2024-03-06T13:09:22.015254Cadernos de Saúde Pública - Fundação Oswaldo Cruz (FIOCRUZ)true
dc.title.none.fl_str_mv Access to neonatal healthcare services: analysis of displacement networks between municipalities in the State of Paraná, Brazil
Acceso a los servicios de atención hospitalaria en el período neonatal: análisis de las redes de desplazamiento entre municipios del estado del Paraná, en Brasil
Acesso a serviços de atenção hospitalar no período neonatal: análise de redes de deslocamento entre municípios do Estado do Paraná, Brasil
title Access to neonatal healthcare services: analysis of displacement networks between municipalities in the State of Paraná, Brazil
spellingShingle Access to neonatal healthcare services: analysis of displacement networks between municipalities in the State of Paraná, Brazil
Martins Silveira, Daniela
Sistema de Informação Hospitalar
Regionalização da Saúde
Serviços de Saúde Neonatal
Atenção à Saúde
Sistemas de Información en Hospital
Regionalización
Servicios de Salud Neonatal
Atención a la Salud
Hospital Information Systems
Regional Health Planning
Infant Health Services
Health Care
title_short Access to neonatal healthcare services: analysis of displacement networks between municipalities in the State of Paraná, Brazil
title_full Access to neonatal healthcare services: analysis of displacement networks between municipalities in the State of Paraná, Brazil
title_fullStr Access to neonatal healthcare services: analysis of displacement networks between municipalities in the State of Paraná, Brazil
title_full_unstemmed Access to neonatal healthcare services: analysis of displacement networks between municipalities in the State of Paraná, Brazil
title_sort Access to neonatal healthcare services: analysis of displacement networks between municipalities in the State of Paraná, Brazil
author Martins Silveira, Daniela
author_facet Martins Silveira, Daniela
Geremias dos Santos, Hellen
author_role author
author2 Geremias dos Santos, Hellen
author2_role author
dc.contributor.author.fl_str_mv Martins Silveira, Daniela
Geremias dos Santos, Hellen
dc.subject.por.fl_str_mv Sistema de Informação Hospitalar
Regionalização da Saúde
Serviços de Saúde Neonatal
Atenção à Saúde
Sistemas de Información en Hospital
Regionalización
Servicios de Salud Neonatal
Atención a la Salud
Hospital Information Systems
Regional Health Planning
Infant Health Services
Health Care
topic Sistema de Informação Hospitalar
Regionalização da Saúde
Serviços de Saúde Neonatal
Atenção à Saúde
Sistemas de Información en Hospital
Regionalización
Servicios de Salud Neonatal
Atención a la Salud
Hospital Information Systems
Regional Health Planning
Infant Health Services
Health Care
description This study aimed to characterize hospitalizations of residents in Paraná State, Brazil, that occurred during the neonatal period in a municipality different from their place of residence from 2008 to 2019, and to describe displacement networks for the first and last biennium of the series, corresponding to periods before and after initiatives to regionalize health services in the state. Admissions of children aged from 0 to 27 days were obtained from the Hospital Information System of the Brazilian National Unified Health System (SIH-SUS) database. For each biennium and health region, the proportion of admissions that occurred outside the municipality of residence, the weighted average distance traveled, and indicators of health and service provision were calculated. Mixed models were fitted to evaluate the biennial trend of the indicators and to investigate factors associated with the neonatal mortality rate (NMR). In total, 76,438 hospitalizations were selected, ranging from 9,030 in 2008-2009 to 17,076 in 2018-2019. The comparison of the networks obtained for 2008-2009 and 2018-2019 revealed an increase in the number of frequent destinations and in the proportion of displacements within the same health region. A decreasing trend was observed for distance, the proportion of live births with 5-minute Apgar ≤ 7, and for NMR. In the adjusted analysis for NMR, besides the biennial effect (-0.64; 95%CI: -0.95; -0.28), only the proportion of live birth with gestational age < 28 weeks showed statistical significance (4.26; 95%CI: 1.29; 7.06). The demand for neonatal hospital care increased over the study period. The displacement networks suggest a positive impact of regionalization, although investment in regions with the potential to become healthcare centers is necessary.
publishDate 2023
dc.date.none.fl_str_mv 2023-06-26
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dc.language.iso.fl_str_mv por
language por
dc.relation.none.fl_str_mv https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8183/18342
https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8183/18343
dc.rights.driver.fl_str_mv Copyright (c) 2023 Cadernos de Saúde Pública
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Copyright (c) 2023 Cadernos de Saúde Pública
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv text/xml
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dc.publisher.none.fl_str_mv Reports in Public Health
Cadernos de Saúde Pública
publisher.none.fl_str_mv Reports in Public Health
Cadernos de Saúde Pública
dc.source.none.fl_str_mv Reports in Public Health; Vol. 39 No. 6 (2023): June
Cadernos de Saúde Pública; v. 39 n. 6 (2023): Junho
1678-4464
0102-311X
reponame:Cadernos de Saúde Pública
instname:Fundação Oswaldo Cruz (FIOCRUZ)
instacron:FIOCRUZ
instname_str Fundação Oswaldo Cruz (FIOCRUZ)
instacron_str FIOCRUZ
institution FIOCRUZ
reponame_str Cadernos de Saúde Pública
collection Cadernos de Saúde Pública
repository.name.fl_str_mv Cadernos de Saúde Pública - Fundação Oswaldo Cruz (FIOCRUZ)
repository.mail.fl_str_mv cadernos@ensp.fiocruz.br||cadernos@ensp.fiocruz.br
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