Fluxos assistenciais na alta complexidade e desigualdades de acesso na pandemia de Covid-19: uma análise intraurbana no município do Rio de Janeiro

Abstract

This study aimed to investigate the use of health services (hospitalization) by patients over 15 years old suffering from Severe Acute Respiratory Syndrome (SARS) due to SARS-CoV-2 and unspecified causes, characterizing the offer of these services and the assistance flows in the Municipality of Rio de Janeiro. This is an ecological, descriptive study on care flows in two moments of the Covid-19 pandemic: from epidemiological week 1 to 17 and from 18 to 33. From the methodology of the dominant flows, hierarchical trees were constructed, that represent the care flows between the Administrative Regions of the municipality, referring to the total of hospitalizations, hospitalizations in ICU beds and hospitalizations according to the type of administration of the health unit (public or private). Public access data on SARS hospitalizations, obtained from the SIVEP – Gripe Information System, were used, in addition to data on the supply of inpatient beds obtained from the National Registry of Health Establishments (CNES). The Administrative Regions were characterized according to epidemiological indicators and assistance resources. The results suggest a re-accommodation of flows regarding the distribution of beds in the second moment of the pandemic. Some hospitals were more relevant to the flow of admissions, revealing their role in the permanent tertiary care network. There are also intra-municipal inequalities in the distribution of hospital services by the municipality, based on the differences between the supply of beds and the parameters established by the Ministry of Health for installed capacity. The work contributes to a better understanding of access to health services, bottlenecks and back-ends of the network in the context of the Covid-19 pandemic. Additionally, the identification of relationships between territories, specifically regarding the flows of hospitalizations, are fundamental for the design of network organization strategies that guarantee universal and equitable access to health.