Hospitalizations for Ambulatory Care Sensitive Conditions and Provider-to-Provider Telephone Consultations in Brazil: An Ecological Study from TelessaúdeRS

INTRODUCTION: Provider-to-provider consultations may improve primary health care (PHC), but empirical data are limited. Hospitalizations for ambulatory care sensitive conditions (ACSC) indicate PHC quality. We aim to address the effects of synchronous telephone-based discussions on ACSC hospitalizations. METHODS: We performed an ecological observational temporal series study based on secondary data. All municipalities of Rio Grande do Sul (Brazil's southernmost state) were eligible; lack of data was the sole exclusion criterion. The main factor explored was the annual rate of consultations per 1,000 inhabitants from 2014 to 2019. Other factors considered included municipality typology (urban or nonurban), poverty, hospital bed rate, PHC coverage, and non-ACSC hospitalizations. The primary outcome was the rate of ACSC hospitalizations per 1,000 inhabitants from 2014 to 2019. Both comparisons between and within municipalities were assessed. The association between the exposure variables and the outcome was explored using a hierarchical multivariable model with a generalized estimating equations (GEE) analysis. RESULTS: Out of 497 municipalities, one was excluded due to lack of data. Between 2014 and 2019, there was an increase in the usage of consultations and a reduction in ACSC hospitalizations. In the final model, time, poverty, municipality typology, hospital bed rate, non-ACSC hospitalization, and consultations were all associated with ACSC hospitalization. After adjusting for the possible confoundings, the GEE model prediction showed that a higher number of consultations between- and within-municipalities was associated with a lower rate of ACSC hospitalization. DISCUSSION: The presented data suggest that increased consultation usage is associated with improved PHC performance.