Desenvolvimento, validação e implementação de protocolo de telemonitoramento de pacientes pós alta com COVID-19
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Data
2023-07-10
Autores
Santos, Janaina Cristina Celestino
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Universidade Estadual Paulista (Unesp)
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Introdução: A COVID-19 representou a maior dificuldade sanitária em escala global do século XXI e suas complicações tardias ainda são pouco conhecidas. O manejo ideal para o paciente acometido deve ser realizado através da integração de todos os níveis de atenção à saúde. Objetivo: integrar um serviço de referência de alta complexidade para tratamento de pacientes com COVID-19 com a atenção básica através de uma sistematização da assistência de acompanhamento domiciliar após a alta hospitalar. Método: Estudo prospectivo de outubro de 2020 a outubro de 2021 no Hospital das Clínicas da Faculdade de Medicina de Botucatu, envolvendo pacientes de 13 municípios da DRS-VI – Polo Cuesta do estado de SP. Os participantes do estudo foram indivíduos maiores de 18 anos, hospitalizados com diagnóstico de COVID-19. Após a alta hospitalar, os pacientes foram acompanhados pelo período de 90 dias, com registro e monitoramento sobre cumprimento de isolamento e complicações tardias identificadas pelo instrumento de sistematização desenvolvido e validado nesta pesquisa. No período de monitoramento, foi utilizada uma plataforma virtual, para a integração do hospital com as Unidades Básicas de Saúde do município de origem do paciente. Resultados: foram acompanhados 302 pacientes, com média de 12 dias de internação. Destes, 54,3% eram do sexo masculino com média de idade de 57.51 anos, 46,69% com ensino fundamental, 51,35% com alguma comorbidade associada, sendo mais prevalentes a cardiopatia e hipertensão. Identificou-se que 64,9% dos indivíduos ficaram em leito de enfermaria e não precisaram de ventilação mecânica. Foi observado que 62,91% dos pacientes não necessitaram de recomendação para isolamento após a alta hospitalar pois no momento da alta já tinham cumprido o período de isolamento. Constatou-se baixa adesão das unidades básicas na utilização à plataforma disponibilizada (13,56%) para contato com o hospital terciário sobre os pacientes. Durante o período de monitoramento foi identificado maior cumprimento das orientações de alta nos primeiros 15 dias, com um declinio entre 45 e 90 dias. As complicações tardias idenficadas foram cansaço ao caminhar (77.81%), mialgia (28.47%) e cansaço ao realizar atividades rotineiras (22.18%). Entre 45 e 90 dias , 47% dos pacientes ainda relatavam cansaço , 2.3% tosse e 3.9% referiram mialgia. Os demais (46.8%) relataram desaparecimento total dos sintomas. Dos pacientes que receberam alta hospitalar, 2,64% necessitaram de reinternação por complicações, no periodo de até 90 dias. Observou-se maior risco de reinternação nos pacientes que tiveram internação primária inferior a cinco dias em relação aos que foram mantidos por maior tempo internados, assim como maior risco para aqueles que necessitaram de ventilação mecânica. O isolamento e seguimento nas orientações de alta foram identificados como fator protetor em relação aos que não cumpriram. Conclusão: a sistematização de um instrumento de orientação de alta possibilitou a padronização das informações com melhor compreensão e adesão dos usuários.
Introduction: COVID-19 represented the most significant health difficulty on a global scale in the 21st century, and its late complications are still little known. The ideal management for the affected patient must integrate all levels of health care. Objective: to integrate a COVID-reference tertiary hospital with primary care through a systematization of home follow-up care after hospital discharge. Method: Prospective study from October 2020 to October 2021 at Hospital das Clínicas da Faculdade de Medicina de Botucatu, involving patients from 13 cities from DRS-VI – Polo Cuesta in the state of SP. Study participants were individuals over 18 years old, hospitalized with a diagnosis of COVID-19. After hospital discharge, patients were followed up for 90 days, recording and monitoring compliance with isolation and late complications identified by the systematization instrument developed and validated in this research. During the monitoring period, a virtual platform was used to integrate the hospital with the Basic Health Units in the patient's hometown. Results: 302 patients were followed up, with an average of 12 days of length of stay. Of these, 54.3% were male with a mean age of 57.51 years, 46.69% had primary education, 51.35% had some associated comorbidity, heart disease, and hypertension being more prevalent. It was identified that 64.9% of the individuals stayed in a ward bed and did not need mechanical ventilation. 62.91% of the patients did not need a recommendation for isolation after hospital discharge, as they had already completed the isolation period by discharge. There was low adherence of the basic units in using the available platform (13.56%) for contacting the tertiary hospital about the patients. During the monitoring period, greater compliance with discharge guidelines was identified in the first 15 days, with a decline between 45 and 90 days. Late complications identified were tiredness when walking (77.81%), myalgia (28.47%), and tiredness when performing routine activities (22.18%). Between 45 and 90 days, 47% of patients still reported tiredness, 2.3% cough, and 3.9% reported myalgia. The others (46.8%) reported complete disappearance of symptoms. Of the patients discharged from the hospital, 2.64% required readmission due to complications within up to 90 days. A higher risk of readmission was observed in patients with a primary hospital stay of fewer than five days compared to those who were kept hospitalized for a longer time and a higher risk for those who required mechanical ventilation. Isolation and following the discharge guidelines were identified as protective factors concerning those who did not comply. Conclusion: the systematization of a discharge guidance instrument enabled the standardization of information with better user understanding and adherence.
Introduction: COVID-19 represented the most significant health difficulty on a global scale in the 21st century, and its late complications are still little known. The ideal management for the affected patient must integrate all levels of health care. Objective: to integrate a COVID-reference tertiary hospital with primary care through a systematization of home follow-up care after hospital discharge. Method: Prospective study from October 2020 to October 2021 at Hospital das Clínicas da Faculdade de Medicina de Botucatu, involving patients from 13 cities from DRS-VI – Polo Cuesta in the state of SP. Study participants were individuals over 18 years old, hospitalized with a diagnosis of COVID-19. After hospital discharge, patients were followed up for 90 days, recording and monitoring compliance with isolation and late complications identified by the systematization instrument developed and validated in this research. During the monitoring period, a virtual platform was used to integrate the hospital with the Basic Health Units in the patient's hometown. Results: 302 patients were followed up, with an average of 12 days of length of stay. Of these, 54.3% were male with a mean age of 57.51 years, 46.69% had primary education, 51.35% had some associated comorbidity, heart disease, and hypertension being more prevalent. It was identified that 64.9% of the individuals stayed in a ward bed and did not need mechanical ventilation. 62.91% of the patients did not need a recommendation for isolation after hospital discharge, as they had already completed the isolation period by discharge. There was low adherence of the basic units in using the available platform (13.56%) for contacting the tertiary hospital about the patients. During the monitoring period, greater compliance with discharge guidelines was identified in the first 15 days, with a decline between 45 and 90 days. Late complications identified were tiredness when walking (77.81%), myalgia (28.47%), and tiredness when performing routine activities (22.18%). Between 45 and 90 days, 47% of patients still reported tiredness, 2.3% cough, and 3.9% reported myalgia. The others (46.8%) reported complete disappearance of symptoms. Of the patients discharged from the hospital, 2.64% required readmission due to complications within up to 90 days. A higher risk of readmission was observed in patients with a primary hospital stay of fewer than five days compared to those who were kept hospitalized for a longer time and a higher risk for those who required mechanical ventilation. Isolation and following the discharge guidelines were identified as protective factors concerning those who did not comply. Conclusion: the systematization of a discharge guidance instrument enabled the standardization of information with better user understanding and adherence.
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Palavras-chave
Assistência domiciliar, Telemonitoramento, Covid19, Rede de atenção à saúde, Home care, Health care network