Determinantes sociais condicionantes das altas clínicas dos utentes da rede nas UCCI: um estudo de caso
Miniatura indisponível
Data
2014
Autores
Título da revista
ISSN da revista
Título do Volume
Editora
Resumo
Introdução: O adiamento das altas clínicas nas Unidades de Cuidados Continuados Integrados (UCCI) por motivos sociais é actualmente considerado um dos principais motivos que impedem a integração atempada de novos clientes na Rede Nacional de Cuidados Continuados, RNCC, daqui em diante designada como a REDE. Este atraso tem impacto ao nível da recuperação e estabilização dos utentes, bem como ao nível de eficiência e eficácia da UCCI, não podendo deixar de se considerarem os aspectos sociais e económicos.
Objectivo Geral: Identificar os determinantes que influenciam as altas clínicas em UCCI.
Métodos e População do Estudo: Este é um estudo de caso colectivo, em que os dados observacionais, transversais, são recolhidos por meio de questionário de auto-relato (por cada área de intervenção directa) e por análise dos processos de consulta de pacientes. O objecto desta pesquisa abrange dois grupos: o grupo de amostra composto por 70 profissionais de saúde que lidam directamente com os utentes e o grupo amostra composto de utentes internados na UCCI L Nostrum, com alta clínica entre 1/1/2011 e 31/12/2012, e que foram integrados através da REDE. Foram recolhidos os dados de 293 utentes sendo objecto de estudo os casos de 83 utentes integrados através da REDE e com prolongamento de internamento por motivos sociais.
Resultados: Na percepção dos profissionais de saúde, as respostas institucionais apresentam-se como a condicionante mais indicada, tanto para os utentes em geral, com 22 indicações (88%) como para os utentes da REDE, com 10 indicações (40%). Relativamente aos motivos familiares há referência de 76% para os utentes em geral e de 36% para os utentes da REDE. Os motivos económicos também apresentam, para os profissionais inquiridos, um valor expressivo (68%) nos utentes em geral, estando nos da REDE este factor condicionante a par com os motivos familiares (36%). Os motivos estruturais têm menor expressão tanto nos utentes em geral (32%) como nos utentes da REDE (16%). “Outros” para os utentes em geral, refere-se a dependência funcional (4%). Nos motivos familiares, para os utentes em geral, 23 (92%) foi mais vezes indicada a insuficiência de suporte familiar, para os utentes da REDE, 13 (52%). A ausência de suporte familiar, para os utentes em geral, representa 48% das respostas, seguindo-se o suporte inadequado (28%) e a ausência de cuidadores (24%). Para os utentes da REDE, o suporte inadequado apresenta-se como segundo motivo (7%), seguindo-se a ausência de suporte familiar (16%). Na percepção dos profissionais, os utentes da REDE estão também condicionados pela distância geográfica (8%) da sua área residencial. Em termos estruturais, os motivos mais assinalados pelos profissionais para a generalidade dos utentes foram as barreiras físicas à mobilidade (80%) e a habitação sem condições básicas de habitabilidade (78%). Os mesmos motivos foram assinalados para os utentes da REDE, barreiras físicas à mobilidade (40%) e habitação sem condições de habitabilidade (28%). No entanto, relativamente aos utentes em geral, a ausência de habitação (29%) e a distância geográfica (4%) também foram motivos assinalados.
Dos motivos económicos percebidos pelos profissionais, a insuficiência de rendimentos é o factor mais assinalado pela generalidade dos utentes (84%) e pelos da REDE (68%), seguida da percepção da capacidade de reposta limitada das instituições, 64% para a generalidade dos utentes e 28% para os da REDE e por fim os tipos de respostas insuficientes para as necessidades individuais dos utentes (20% dos utentes em geral e 12% da REDE).
No total dos dois anos, 2011 e 2012, verificaram-se na UCCI L Nostrum 293 prorrogações (100%) das quais 210 (71,6%) foram consideradas dentro do prazo e justificadas com motivos clínicos, enquanto 83 (28,3%) foram efectivamente protelamentos por motivos sociais, tendo em conta que nestes casos os utentes já não tinham critérios clínicos que justificassem a sua permanência na UCCI. Das 210 prorrogações consideradas dentro do prazo e justificadas com motivos clínicos, 93 (44,3%) foram-no por tempo de espera para transferência de UCCI. Em 2011, dos 146 utentes com alta protelada (100%), 50 utentes (34,2%) permaneceram na UCCI por motivos sociais, enquanto em 2012 houve registo de 33 casos de protelamento (22,4%) em 147 (100%) altas prorrogadas.
Conclusões: Dos factores identificados como motivo de protelamento nos 83 utentes, estritamente por motivos sociais, destaca-se o protelamento de alta por espera de integração em equipamento/resposta adequada, nomeadamente lar ou serviços de apoio domiciliário (79,5%), seguindo-se a insuficiência de rendimentos do utente/familiares para contratação de serviços ou resposta institucional (74,7%), a inexistência de condições habitacionais para regresso ao domicílio (63,9%) e a insuficiência de suporte familiar (54,2%). Regista-se também a inadequação do suporte familiar (31,3%), a inexistência de suporte familiar (28,9%) e, em menor percentagem, a ausência de condições estruturais (13,3%). A ausência de domicílio (sem abrigo) (8,4%) e a ausência de rendimentos (4,8%) também foram factores inibidores da alta clínica. Dos 293 utentes identificados que tiveram protelamento da alta por motivos sociais verificou-se que 144 (49,1%) dos utentes permaneceram unicamente pela existência de condicionantes institucionais e familiares/estruturais.
Aspectos éticos: ao longo deste estudo, foram assegurados e respeitados, todos os procedimentos de garantia da confidencialidade e rigor na recolha dos dados, e a não interferência nas dinâmicas da instituição, dos utentes e dos profissionais.
Introduction: The postponement of clinical discharges from Integrated Continuous Care Units (UCCI) for social reasons is currently considered one of the main reasons that prevent the timely integration of new patients in the National Network for Continuing Care, RNCC, hereinafter referred to as the network REDE. This delay has an impact on the recovery and stabilization of the users as well as at the level of efficiency and effectiveness of the UCCI, reason why we cannot fail to consider the social and economic aspects. General Objective: To identify determinants those influence the clinical discharges in a particular UCCI. Study Population and Methods: This is a collective case study observational, cross-sectional, where data are collected through self-report questionnaires (one for each area of direct intervention) and based on analysis of consultation processes of patients. The purpose of this research covers two groups: the sample consists of 70 health professionals who deal directly with patients and the sample group composed of users admitted to the UCCI L Nostrum, with clinical discharge between 1/1/2011 and 31/ 12 / 2012 who were integrated within the REDE. Data from 293 users were collected being further subject to this study 83 cases of users integrated in the network REDE characterized by prolonged hospitalization for social reasons. Results: In the perception of health professionals, institutional responses are presented as the most suitable condition for both general users, with 22 (88 %) nominations and for REDE users with 10 nominations (40 %). With regard to family reasons there are reports of 76 % professionals for general users and 36% for REDE users. Economic grounds also feature, for the respondents professionals, as a significant amount (68 %) among general users, being this factor pointed out for REDE users along with family reasons (36 %). The structural motifs have lower expression in both general users (32 %) as the REDE users (16 %). "Others" to users in general, refers to the functional dependency (4%). In regard to familiar reasons perceived to general users 23 (92%), insufficient family support were more times 13 (52%) indicated for users of the REDE The absence of familiar support to general users represents 48% of the responses, followed by inadequate support (28%) and the absence of caregivers (24%). For users of the network REDE, inadequate support is shown as a second issue (7%), followed by the absence of a family aid (16%). In the perception of professionals, users of REDE are also constrained by geographical distance (8 %) of their residential area. In structural terms, two reasons reported by more professionals for the majority of users were physical barriers to mobility (80 %) and housing without basic living conditions (78 %). The same reasons were reported although with different figures for users of REDE, 9 physical barriers to mobility (40 %) and housing unfit for use (28 %). However, for users in general, the absence of housing (29%) and geographical distance (4%) were also marked reasons. Economic reasons perceived by professionals were insufficient income as the factor most quoted by the majority of users (84 %) and REDE users (68 %) followed by the perception of limited response capacity of institutions, 64 % for the general users and 28 % for users of the NETWORK. Yet been reported and finally the types of insufficient responses for the needs of individual users (20% of general clients and 12 % of REDE clients). In the two years 2011 and 2012, there was a value of 293 extensions (100 %) in total in UCCI L Nostrum, of which 210 (71.6 %) were considered and justified within clinical grounds, while 83 (28.3 %) were actually postponed for social reasons, taking into account that in these cases the users have had no clinical criteria to justify their stay at UCCI. Among the 210 postponements considered as extensions of the deadline and all justified on clinical grounds, 93 (44.3 %) were due to waiting time for transfer of UCCI. In 2011, of the 146 (100%), users with a delayed discharge, 50 clients (34.2 %) remained in the UCCI for social reasons while in 2012 there were registered 33 cases of postponement (22.4 %) in 147 (100 %) extended discharges. Conclusions: Of the factors identified by health care professionals as a reason for postponing discharges in the proven cases associated to social reasons, encompassing 83 users, waiting for integration in equipment / adequate response is highlighted, in particular nursing home or domestic support services (79.5 %), followed by insufficient income from user/family to hire services or institutional home care (74.7 %) , lack of housing conditions to return home (63.9 %) and lack of family support (54.2 %) . Also recorded is the inadequacy of family support (31.3 %), lack of family support (28.9 %) and, to a lesser extent, the absence of infrastructural conditions (13.3% ). The absence of home (homeless) (8.4%) and lack of income (4.8%) were also clinical discharge factors inhibitors. Of those 293 users who had delayed discharge for social reasons, 144 (49.1) % had institutional factors and family / infrastructural determinants. Ethical aspects: Consultation of clinical registers has been previously allowed by the direction of the UCC under study. Data collection, storing and analyses have assured the anonymity of participants (users and health care professionals).
Introduction: The postponement of clinical discharges from Integrated Continuous Care Units (UCCI) for social reasons is currently considered one of the main reasons that prevent the timely integration of new patients in the National Network for Continuing Care, RNCC, hereinafter referred to as the network REDE. This delay has an impact on the recovery and stabilization of the users as well as at the level of efficiency and effectiveness of the UCCI, reason why we cannot fail to consider the social and economic aspects. General Objective: To identify determinants those influence the clinical discharges in a particular UCCI. Study Population and Methods: This is a collective case study observational, cross-sectional, where data are collected through self-report questionnaires (one for each area of direct intervention) and based on analysis of consultation processes of patients. The purpose of this research covers two groups: the sample consists of 70 health professionals who deal directly with patients and the sample group composed of users admitted to the UCCI L Nostrum, with clinical discharge between 1/1/2011 and 31/ 12 / 2012 who were integrated within the REDE. Data from 293 users were collected being further subject to this study 83 cases of users integrated in the network REDE characterized by prolonged hospitalization for social reasons. Results: In the perception of health professionals, institutional responses are presented as the most suitable condition for both general users, with 22 (88 %) nominations and for REDE users with 10 nominations (40 %). With regard to family reasons there are reports of 76 % professionals for general users and 36% for REDE users. Economic grounds also feature, for the respondents professionals, as a significant amount (68 %) among general users, being this factor pointed out for REDE users along with family reasons (36 %). The structural motifs have lower expression in both general users (32 %) as the REDE users (16 %). "Others" to users in general, refers to the functional dependency (4%). In regard to familiar reasons perceived to general users 23 (92%), insufficient family support were more times 13 (52%) indicated for users of the REDE The absence of familiar support to general users represents 48% of the responses, followed by inadequate support (28%) and the absence of caregivers (24%). For users of the network REDE, inadequate support is shown as a second issue (7%), followed by the absence of a family aid (16%). In the perception of professionals, users of REDE are also constrained by geographical distance (8 %) of their residential area. In structural terms, two reasons reported by more professionals for the majority of users were physical barriers to mobility (80 %) and housing without basic living conditions (78 %). The same reasons were reported although with different figures for users of REDE, 9 physical barriers to mobility (40 %) and housing unfit for use (28 %). However, for users in general, the absence of housing (29%) and geographical distance (4%) were also marked reasons. Economic reasons perceived by professionals were insufficient income as the factor most quoted by the majority of users (84 %) and REDE users (68 %) followed by the perception of limited response capacity of institutions, 64 % for the general users and 28 % for users of the NETWORK. Yet been reported and finally the types of insufficient responses for the needs of individual users (20% of general clients and 12 % of REDE clients). In the two years 2011 and 2012, there was a value of 293 extensions (100 %) in total in UCCI L Nostrum, of which 210 (71.6 %) were considered and justified within clinical grounds, while 83 (28.3 %) were actually postponed for social reasons, taking into account that in these cases the users have had no clinical criteria to justify their stay at UCCI. Among the 210 postponements considered as extensions of the deadline and all justified on clinical grounds, 93 (44.3 %) were due to waiting time for transfer of UCCI. In 2011, of the 146 (100%), users with a delayed discharge, 50 clients (34.2 %) remained in the UCCI for social reasons while in 2012 there were registered 33 cases of postponement (22.4 %) in 147 (100 %) extended discharges. Conclusions: Of the factors identified by health care professionals as a reason for postponing discharges in the proven cases associated to social reasons, encompassing 83 users, waiting for integration in equipment / adequate response is highlighted, in particular nursing home or domestic support services (79.5 %), followed by insufficient income from user/family to hire services or institutional home care (74.7 %) , lack of housing conditions to return home (63.9 %) and lack of family support (54.2 %) . Also recorded is the inadequacy of family support (31.3 %), lack of family support (28.9 %) and, to a lesser extent, the absence of infrastructural conditions (13.3% ). The absence of home (homeless) (8.4%) and lack of income (4.8%) were also clinical discharge factors inhibitors. Of those 293 users who had delayed discharge for social reasons, 144 (49.1) % had institutional factors and family / infrastructural determinants. Ethical aspects: Consultation of clinical registers has been previously allowed by the direction of the UCC under study. Data collection, storing and analyses have assured the anonymity of participants (users and health care professionals).
Descrição
Orientação: Maria do Céu Costa ; co-orientação: Osvaldo Santos
Palavras-chave
ENVELHECIMENTO, CUIDADOS DE SAÚDE, CUIDADOS CONTINUADOS, SAÚDE, HEALTH, CONTINUING CARE, HEALTH CARE, AGEING, ESTUDOS DE CASO, CASE STUDIES, PORTUGAL, MESTRADO EM CUIDADOS CONTINUADOS INTEGRADOS