Avaliação da qualidade da transição do cuidado e fatores associados de indivíduos com doenças crônicas: do serviço hospitalar para o domicílio

Abstract

The transition of care is a process of continuous care, starting from the transfer of the user from hospital care to the home environment, with articulation of tertiary and primary care services, as it begins from the moment of admission to the post-treatment period. high. The objective of this study is to evaluate the quality of care transition and associated factors of individuals with Chronic Diseases after hospital discharge to home in a municipality in the north of Minas Gerais. Cross-sectional study, carried out with 320 individuals, after hospitalization in a public hospital, located in the north of Minas Gerais. Data were collected at the first moment of hospital admission and after discharge through telephone calls to individuals, their families and/or caregivers. A questionnaire with sociodemographic data was used and the individual's perception of the transition of care was assessed through the application of the Care Transitions Measure (CTM-15 Brasil) scale, a version validated for Brazil to assess the transition of care. The Care Transitions Measure (CTM-15 Brasil) scale contains the outcome variable of this study “care transition”. The instrument consists of 15 items, which are divided into four factors: “Preparation for self-management”, “Understanding about medications”, “Assured preferences” and “Care plan”. Initially, descriptive analysis of the data was carried out. In addition to calculating quality averages for care transition for each of the CTM-15 Brasil domains, which was obtained through the calculation of average scores. Next, the existence of a statistical association between the dependent variable and the independent variables was investigated. To this end, bivariate analyzes were conducted (Pearson's chi-square test, or Ficher's exact test) adopting a significance level < 0.20 to include the independent variables in the multiple model. The final model was generated using Poison regression analysis with robust variance and the variables that were associated with the transition of care were maintained in the final model up to a significance level of 5% (p < 0.05). A score equal to or greater than 70% is considered to make the transition of care satisfactory. In this study, the transition of care was 57.5% adequate and 42.5% inadequate. The variables that were maintained in the final model and that were associated with transition of care with a significance level of 5% (p < 0.05). The transition of care was worse or inadequate among people without a partner and who lived alone. On the other hand, it was better or more appropriate among those who were advised to seek the ESF and among those who were hospitalized due to complications from chronic infectious diseases. The transition of care, evaluated from the perspective of CTM-15 Brazil, was considered unsatisfactory in the general assessment compared to other studies. New studies are needed in this area, and may contribute with new scientific evidence that will allow for early and effective interventions focused on the transition of care.