Desospitalização e atenção domiciliar na rede pública de saúde

Abstract

The national program 'Melhor em Casa' is characterized by offering home care, within the scope of the Unified Health System network. The general objective of the dissertation was to analyze the demographic and clinical profile of patients discharged from hospital assumed by 'Melhor em Casa' and cover the provisions of primary health care to the process of dehospitalization. The dissertation was composed of technical products (Dehospitalization Evaluation Form - FAD; flowcharts in order to contribute to the performance of different flows of patients, hospitals or the Family Health Strategy for 'Melhor em Casa', identifying the role of the parties and informative videos) in addition to scientific products. Below is detailed the scientific product from a cross-sectional analytical study, with data from patients discharged from a reference hospital in the northern region of Minas Gerais, Brazil and with continuity of home care. The data refer to the period from January 2016 to December 2019. Bivariate and multiple analysis methods were performed. The patients' median age was compared and associations between clinical conditions and demographic and clinical profile were verified, with a significance level of p <0.05. The statistical analysis took place in the IBM SPSS 22.0 Software. Data from 254 patients were analyzed. The demographic and clinical profile was: men (56.3%), elderly (57.9%), people with diseases prior to hospitalization (80.3%), in bed condition at hospital discharge (90.6%), in need of tubes (74.4%), tracheostomized (35.0%), with pressure injury (39.8%) and with ostomies (38.2%). Men compared to women were younger (p = 0.030) and had a higher frequency of using probes (p <0.05). Among people with a pre-existing and bedridden disease record, the highest frequency was for men, 53.4% and 57.4%, respectively, with no significant difference when compared to women. The use of a probe was 11% higher in men and 35% higher among bedridden (p <0.05). Both among tracheostomized patients and those with ostomy, the highest frequency of these clinical conditions was in non-elderly and bedridden patients (p <0.05). Pressure injuries showed a 22% higher prevalence among bedridden patients. It is concluded that the patients in dehospitalization assumed by the ‘Melhor em Casa’ are mostly elderly, men, bedridden, with the use of tubes and diseases prior to hospitalization. The fact of being bedridden was associated with clinical conditions: use of a probe, tracheostomy, ostomy and pressure injury. The results may support the planning of interventions appropriate to home care. The aging of the population is a factor that should encourage the health system to expand this new model of care.