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"resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Describir la variabilidad en las tasas de hospitalización por procesos sensibles a cuidados ambulatorios (PSCA) entre municipios del área de referencia de un hospital de tercer nivel, y determinar la influencia de las características de la atención primaria, los factores socioeconómicos, el nivel de salud de la población y la accesibilidad geográfica al hospital.</p> <span class="elsevierStyleSectionTitle">Método</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se realizó un estudio ecológico en 34 municipios del área del Hospital Virgen de las Nieves (Granada), abarcando todas las hospitalizaciones por PSCA de 1997 a 1999. Las tasas de hospitalización se calcularon por separado para varones y mujeres y se estandarizaron por el método indirecto según la edad. Se exploraron como variables independientes las siguientes: características de la atención primaria (tipo de modelo y centro), socioeconómicas (desempleo, renta, comercios, tamaño del municipio), de salud (mortalidad) y accesibilidad (crona: minutos desde el municipio al hospital). Se realizó un análisis de regresión lineal múltiple.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">El 9,8% de los ingresos ocurridos en el hospital fueron por PSCA. La tasa media anual fue de 10 ingresos por 1.000 habitantes, siendo superior en varones y en los mayores de 74 años. En el 56% de los municipios las razones de hospitalización estandarizadas no fueron estadísticamente diferentes de 1, en un 26% fueron menores y en un 18%, mayores. Un 62% de la variabilidad en las tasas de los varones se explicó por la crona al hospital, el tamaño del municipio, la interacción entre ambas variables y la mortalidad. Las tasas en mujeres se explicaron en un 18% por la crona y la tasa de desempleo.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La variabilidad de las tasas de hospitalización por PSCA no se asoció a las características de la atención primaria en el ámbito geográfico estudiado. La mayor accesibilidad en tiempo al hospital fue la única variable asociada a mayores tasas en varones y mujeres. Las tasas en mujeres fueron superiores cuanto mayor era el desempleo, y las tasas en varones fueron más altas en los pueblos grandes y con mayor mortalidad.</p>"
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"titulo" => "Abstract"
"resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To describe variability in admission rates for ambulatory care sensitive conditions (ASSC) in municipalities in the catchment area of a tertiary hospital and to determine the influence of primary care characteristics, socioeconomic factors, health of the population, and geographical accessibility to the hospital on this variability.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">An ecological study was carried out in 34 municipalities in the area served by the <span class="elsevierStyleItalic">Hospital Virgen de las Nieves</span> in Granada (Spain) including all admissions for ASSC from 1997 to 1999. The admission rates for men and women were calculated separately and were age-standardized by the indirect method. The following factors were analyzed as independent variables: characteristics of primary care (type of healthcare model and type of center), socioeconomic factors (unemployment rate, income per capita, number of business establishments, size of municipality), health (mortality rate), and accessibility (time in minutes from the municipality to the hospital). A multiple lineal regression model was estimated.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 9.8% of all hospital admissions were due to ASSC. The mean annual admission rate was 10 admissions per 1.000 inhabitants. This rate was higher for men and for persons aged more than 74 years. The standardized admission ratios were not statistically different from 1 in 56% of the municipalities and were higher than 1 in 26% and lower than 1 in 18%. Sixty-two percent of the variability in rates for men was associated with time taken to reach the hospital, size of municipality, the interaction between both variables, and mortality. Eighteen percent of the variability in rates for women was associated with time taken to reach the hospital and the unemployment rate.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Variability in admission rates for ASSC was not associated with primary care characteristics in the geographical area analyzed. Accessibility (measured as time to the hospital) was the only variable associated with higher rates in both men and women. Admission rates for ASSC among women were higher when unemployment rates were higher, and rates among men were higher in larger municipalities and in those with higher mortality.</p>"
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