Atenção domiciliar no âmbito da saúde pública no Brasil

Abstract

In Brazil, Home Care (HC) is seen as an alternative to meet the demands that arise from changes in the health-disease process, mainly due to population aging, as a way to provide long-term care to people with chronic diseases. It emerged as a way to reduce the length of stay of patients in hospitals and, therefore, reduce costs. This study aims to characterize the panorama of home care in the public health network in Brazil. This is an analytical ecological study with HC indicators, in the care network of the Unified Health System (SUS). The data refer to records in the Federative Units (UF) of Brazil, in 2018, and data from Minas Gerais (MG), northern Minas Gerais and Montes Claros (a hub city in northern MG), from 2016 to 2018. The variables used were: care by sex, home care modality (HC1, HC2, HC3), scheduled or unscheduled care, and clinical outcomes. Descriptive analysis and Spearman's correlation (rs) were performed, with a significance level of p < 0.05. In 2018, in Brazil, 2,497,610 home care services were recorded, of which 50.64% were provided to women. The states with the highest number of services were São Paulo, MG, and Rio de Janeiro, and the lowest number were in Amapá and Mato Grosso. In the country, most services were previously scheduled (92.13%). The clinical outcome ‘stay’ in HC was for 93.0% of services, emergencies (0.20%), hospitalizations (0.20%), and deaths (0.50%). HC2 was the majority (83.04%). The increase in the number of AD1 visits in the states was more strongly correlated with the increase in patients with clinical/administrative discharge (rs=0.83), AD2 with the stay in services (rs=0.99) and AD3 with the outcome death (rs=0.79), p <0.05. In the AD cut for the state of MG, in the three-year period 2016 to 2018, 665,395 home visits were carried out. The number of visits after death increased each year, totaling 891 in the three-year period. AD2 home care corresponded to 92.70% in the north of Minas Gerais and 98.10% in the city of Montes Claros. Most patients remained in home care in MG (88.24%). In Montes Claros, the outcomes urgency/emergency (0.05%), hospital admission (0.09%), administrative/clinical discharge (0.26%) and death (0.45%) were low. It is concluded that most of the care was previously scheduled, demonstrating organization of the service regarding the survey of health demands for home care. The low frequency of emergencies, hospitalizations and deaths, both in the national analysis and in the state of Minas Gerais, in the northern macro-region of Minas Gerais and in the municipality of Montes Claros, suggests that home care contributes to the maintenance/recovery of patients' health.