Role of Primary Health Care in child hospitalization due to pneumonia: a case-control study.
Juliana Coelho Pina, Suzana Alves de Moraes, Isabel Cristina Martins de Freitas and 1 others
PMID 28562701WHAT IT FOUND
Primary care rated better for easy access, continuity, broad services and coordination was associated with fewer pneumonia hospitalizations among young children.
Delayed vaccination, wheezing, daycare attendance and lower family income were associated with more hospitalizations.
Key findings
01Essential primary health care score quartile 3 had adjusted OR 0.50 (0.28 to 0.88), and quartile 4 had adjusted OR 0.57 (0.32 to 0.99), versus quartile 1.
02Delayed vaccination had adjusted OR 2.81 (1.76 to 4.49) compared with up-to-date vaccination.
03Wheezing episodes had adjusted OR 2.13 for 1 episode and 2.37 for 3 or more episodes compared with 0 episodes.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study cannot prove that primary care caused lower hospitalization because it compared children already hospitalized with pneumonia to hospital controls. Some exposures, including medication use and gastroesophageal reflux, relied on parent or guardian recall and were not fully specified or confirmed. The primary care measure reflected only users' perspective, not professional or facility records. The study was done in a Brazilian city with a specific public health system, so results may not apply elsewhere. Multiple variables were tested, and some confidence intervals crossed the null value, so chance cannot be ruled out.
Declared interests
The study was supported by FAPESP and was extracted from a doctoral dissertation. No commercial funding or author conflicts of interest are reported in the supplied text.
The easy way to misread this
Do not read these associations as proof that better primary care prevents pneumonia hospitalization. This was a case-control study of children already hospitalized, and several exposures relied on recall or were not confirmed, so cause and effect cannot be separated.