Caracterização da atenção à saúde da criança do centro de saúde escola de botucatu-uvl: relação entre a utilização de serviços de assistência
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2018-12-10
Autores
Tiba, Carlos Alexandre Hattori
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Universidade Estadual Paulista (Unesp)
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A assistência à saúde da criança tem um papel muito importante e, pode fazer uma grande diferença para o crescimento e desenvolvimento infantil, bem como na prevenção de agravos futuros à saúde do adulto. As influências de um modelo centrado em pronto-atendimento e consultas em locais de maior tecnologia dura ainda é um desafio para a ampliação do cuidado na atenção primária em saúde, grande desafio na organização da assistência e na gestão dos serviços de Saúde da criança e do adolescente. No Centro de Saúde Escola, unidade da Vila dos Lavradores (CSE-UVL) de Botucatu o programa de saúde da criança (PSC) é centrado no atendimento médico, e a primeira consulta do recém-nascido é realizada em outra Unidade de Saúde, em todo o município, com posterior encaminhamento às Unidades Básicas e, o Pronto Socorro Infantil (PSI) tem uma proximidade geográfica com o CSE-UVL. Nos últimos quatro anos verificou-se um decréscimo do número de crianças atendidas em consultas de rotina no CSE-UVL. Assim, objetivamos caracterizar a utilização dos serviços do PSI e da CB, praticada pelas crianças atendidas na unidade da Vila dos Lavradores do Centro de Saúde Escola de Botucatu (CSE). Trata-se de um estudo descritivo retrospectivo, com levantamentos de registros em prontuários físicos do CSE e eletrônicos do Pronto Socorro Infantil (PSI). A partir de 251elegíveis para o estudo foi incluída uma amostra de conveniência de 173 lactentes e crianças, com até dois anos incompletos, que tiveram ao menos um atendimento pediátrico, durante o período de janeiro de 2016 a janeiro de 2017. Foram levantados dados: escolaridade materna, idade nas consultas no CSE e na Clínica do Bebê (CB), local de realização do teste de triagem neonatal e da vacina BCG. Houve a classificação quanto à adequação do seguimento no PSC segundo calendário do Ministério da Saúde (adequado, incompleto, irregular e não realizado). O número e tipos de consultas realizadas pelas crianças foram avaliados; das consultas do PSI foi realizada classificação de adequação quanto ao período/dia da consulta e ao quanto à classificação de urgência/emergência da queixa, com nível de Kappa considerado para o grau de concordância. Projeto aprovado pelo Comitê de Ética em Pesquisa. Análise estatística realizada pelo SAS. Como resultados obtivemos um total de 1388 consultas no CSE-UVL e de 1216 consultas no PSI, 28 crianças (16,18%) não tiveram nenhuma consulta no PSI. No CSE-UVL, o número médio de consultas foi 8,02 consultas, com o mínimo de uma consulta e o máximo de 32 consultas; a média de idade na 1ª consulta foi 57,06 dias, somente 15,69% das crianças chegaram à unidade antes de 30 dias vida; das consultas 87,96% foram médicas e somente 7,92% de enfermagem, houve 10,04% de faltosos, que ocorreram em sua maioria, em pacientes com seguimento Irregular ou Incompleto. O seguimento no PSC foi adequado para 57,23% das crianças; foi significante o bom nível de escolaridade materna e o adequado número de consultas realizadas (p<0,001), o mesmo não ocorrendo para o número de consultas do PSI. Na CB foram realizadas a maioria das vacinas BCG e a coleta do teste de triagem neonatal, 71,93% e 67,44% respectivamente; a idade média na 1ª consulta foi de 15,74 dias e, 46,52% dos bebês foram consultados antes dos 15 dias de vida. No PSI a média de consultas foi 9,07, com mínimo de 01 e máximo de 54 consultas; a adequação da sua utilização quanto ao período e a queixa, segundo classificação adotada, somente 7,14% foram consideradas adequados quanto a estes dois critérios; 453 consultas (39,36%) foram durante o período no qual o CSE-UVL estava aberto e 798 (60,64%) foram em horário adequado. O nível de concordância entre as duas adequações foi pobre (Kappa = 0,06). Conclusões: O Centro Saúde Escola – UVL perdeu seu papel como principal contato e organizador da assistência no Sistema Único de Saúde para a população do estudo, devido à dificuldade no acesso e à ruptura do vínculo com a unidade, assim, sendo subutilizado. Enquanto, o Pronto Socorro Infantil foi utilizado de forma inadequada com distorção de sua função na assistência às urgências/emergências.
Child health care plays a very important role and can make a big difference to child growth and development, as well as preventing future health problems in the adulthood. The influences of a model centered on emergency services and appointment on places with more hard technology is still a challenge for the expansion of primary health care, a major challenge in the organization and management of child and adolescent health services. In the Botucatu School Health Center, unit of Vila dos Lavradores (CSE-UVL), the Child Health Program (CHP) is centered on medical care, the first consultation of the newborn is performed in another Health Unit, in the entire municipality, with subsequent referral to the Basic Units, and the Emergency Room for Children (ERC) has a geographical proximity to the CSE-UVL. In the last four years, there has been a decrease in the number of children seen in routine visits to the CSE-UVL. Thus, we aimed to characterize the use of PSI and CB services, practiced by the children attending the CSE-UVL. This is a retrospective descriptive study, with data collection in the patient’s medical record of the CSE-UVL and eletronic medical records of the ERC. From 215 eligible children, a convenient sample of 173 infants and young children with up to two incomplete years who had at least one pediatric care during the period from January 2016 to January 2017 was included in the study. The data collected were level of maternal education, age at the consultations at the CSE-UVL and at the Baby Clinics (BC), where the neonatal screening test and the BCG vaccine were performed. There was classification as to the adequacy of follow-up in the PSC according to the Ministry of Health of Brazil calendar (adequate, incomplete, irregular and unrealized). The number and types of consultations were evaluated; among the PSI consultations, a classification of adequacy regarding the period / day of the consultation and the emergency / urgency classification of the complaint was performed, with a Kappa level considered for the degree of agreement. Project approved by the Ethical and Research Committee. Statistical analysis performed by SAS. As results we obtained a total of 1388 consultations in the CSE-UVL and of 1216 consultations in the ERC, 28 children (16.18%) had no consultation in the ERC. In the CSE-UVL, the average number of medical consultation was 8.02, with a minimum of one and a maximum of 32 consultation; the mean age at the 1st consultation was 57.06 days, only 15.69% of the children arrived at the unit before 30 days of life; of the consultations, 87.96% were performed by doctors and only 7.92% by nursing; 10.04% of the patients had a historic of absence, which occurred mostly among patients with irregular or incomplete follow-up. CHP follow-up was adequate for 57.23% of the children; a good level of maternal education and the adequate number of consultations were significant (p <0.001), the same did not occur with the number of ERC consultations. In BC, the majority of BCG vaccines and the collection of the neonatal screening test were 71.93% and 67.44%, respectively; the mean age at the first visit was 15.74 days, and 46.52% of the infants were consulted before 15 days of life. In the ERC the average number of consultations was 9.07, with a minimum of 1 and a maximum of 54 consultations; the adequacy of its use for the period and the complaint, according to classification adopted, only 7.14% were considered adequate for these two criteria; 453 consultations (39.36%) were during the period in which the CSE-UVL was open and 798 (60.64%) were on appropriate time. The level of agreement between the two adaptations was poor (Kappa = 0.06). Conclusions: The School Health Center - UVL lost its role as the main contact and organizer of care in the Unified Health System for the study population, due to the difficulty in access and the rupture of the bond with the unit, thus being underutilized. Meanwhile, the Child Emergency Room was used in an inadequate way, with a distortion of its function in emergency / emergency care.
Child health care plays a very important role and can make a big difference to child growth and development, as well as preventing future health problems in the adulthood. The influences of a model centered on emergency services and appointment on places with more hard technology is still a challenge for the expansion of primary health care, a major challenge in the organization and management of child and adolescent health services. In the Botucatu School Health Center, unit of Vila dos Lavradores (CSE-UVL), the Child Health Program (CHP) is centered on medical care, the first consultation of the newborn is performed in another Health Unit, in the entire municipality, with subsequent referral to the Basic Units, and the Emergency Room for Children (ERC) has a geographical proximity to the CSE-UVL. In the last four years, there has been a decrease in the number of children seen in routine visits to the CSE-UVL. Thus, we aimed to characterize the use of PSI and CB services, practiced by the children attending the CSE-UVL. This is a retrospective descriptive study, with data collection in the patient’s medical record of the CSE-UVL and eletronic medical records of the ERC. From 215 eligible children, a convenient sample of 173 infants and young children with up to two incomplete years who had at least one pediatric care during the period from January 2016 to January 2017 was included in the study. The data collected were level of maternal education, age at the consultations at the CSE-UVL and at the Baby Clinics (BC), where the neonatal screening test and the BCG vaccine were performed. There was classification as to the adequacy of follow-up in the PSC according to the Ministry of Health of Brazil calendar (adequate, incomplete, irregular and unrealized). The number and types of consultations were evaluated; among the PSI consultations, a classification of adequacy regarding the period / day of the consultation and the emergency / urgency classification of the complaint was performed, with a Kappa level considered for the degree of agreement. Project approved by the Ethical and Research Committee. Statistical analysis performed by SAS. As results we obtained a total of 1388 consultations in the CSE-UVL and of 1216 consultations in the ERC, 28 children (16.18%) had no consultation in the ERC. In the CSE-UVL, the average number of medical consultation was 8.02, with a minimum of one and a maximum of 32 consultation; the mean age at the 1st consultation was 57.06 days, only 15.69% of the children arrived at the unit before 30 days of life; of the consultations, 87.96% were performed by doctors and only 7.92% by nursing; 10.04% of the patients had a historic of absence, which occurred mostly among patients with irregular or incomplete follow-up. CHP follow-up was adequate for 57.23% of the children; a good level of maternal education and the adequate number of consultations were significant (p <0.001), the same did not occur with the number of ERC consultations. In BC, the majority of BCG vaccines and the collection of the neonatal screening test were 71.93% and 67.44%, respectively; the mean age at the first visit was 15.74 days, and 46.52% of the infants were consulted before 15 days of life. In the ERC the average number of consultations was 9.07, with a minimum of 1 and a maximum of 54 consultations; the adequacy of its use for the period and the complaint, according to classification adopted, only 7.14% were considered adequate for these two criteria; 453 consultations (39.36%) were during the period in which the CSE-UVL was open and 798 (60.64%) were on appropriate time. The level of agreement between the two adaptations was poor (Kappa = 0.06). Conclusions: The School Health Center - UVL lost its role as the main contact and organizer of care in the Unified Health System for the study population, due to the difficulty in access and the rupture of the bond with the unit, thus being underutilized. Meanwhile, the Child Emergency Room was used in an inadequate way, with a distortion of its function in emergency / emergency care.
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Palavras-chave
Atenção Primária a Saúde, Saúde da Criança, Acesso aos Serviços de Saúde, Serviços Médicos de Emergência