Uso da rede de urgência e emergência e suas conexões com as unidades de atenção básica: uma análise transversal
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Data
2017-02-24
Autores
Altino, Rita de Cássia [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução. A Rede de Atenção à Urgência e Emergência (RUE), organizada por Unidades de Pronto Atendimento (UPA) e outros serviços de urgência tem finalidade de oferecer assistência à saúde de complexidade intermediária entre a rede de Atenção Básica à Saúde (ABS) e a Rede Hospitalar. Contudo, estudos têm apontado a utilização expressiva das UPA, por usuários não urgentes, que poderiam ser atendidos em Unidades de Atenção Básica e da Família, alocadas nas regiões das UPA. Objetivo geral. Analisar a utilização de usuários, acima de 13 anos, da RUE de município do interior paulista, levando-se em consideração o aparelhamento da ABS adscrita às UPA. Método. Pesquisa epidemiológica do tipo transversal, conduzida junto à RUE, em município com 366.769 habitantes. Coletou-se dados secundários, de 2014 a 2015, referentes a atendimentos de usuários em unidades de urgência e emergência, a partir de sistema de informações, assim como realizou-se análise documental de planilhas sobre classificação de risco. Esses dados integraram o banco de dados em planilhas eletrônicas e foram analisados por estatística descritiva. Resultados. A população adscrita às UPA totalizou 328.900, a qual conta com 21 unidades da ABS, sendo 15 Unidades Básicas de Saúde (UBS) e seis Unidades Saúde da Família (USF). Dos 270.990 usuários submetidos à classificação de risco, apenas 6% configurou-se em atendimentos de emergência (vermelho) e urgência (amarela) e a maioria (94%) pouco urgente (verde) e não urgente (azul). Dos agrupamentos de doenças, propostos pelo CID, destacou nas UPA (18 a 23%) sintomas, sinais e achados anormais de exames clínicos e de laboratório, seguido de 15 a 17% de doenças do aparelho respiratório. As faixas etárias de usuários economicamente produtivos foram as mais acometidas por esse perfil diagnóstico. O período diurno reuniu 75% dos atendimentos realizados. O intervalo de quatro a sete vezes atendimentos anuais abarcou a maior porcentagem de usuários frequentes, de oito a 11%. Apenas um por cento dos usuários atendidos nas UPA tiveram desfecho para internação hospitalar. De acordo com a Correlação de Pearson, o número de usuários classificados como não urgentes (verde e azul), independe do número de UBS e USF alocadas nas regiões das UPA. Conclusões. As UPA que contam com maior número de unidades da ABS por habitante, não apresentaram números menores de atendimentos de usuários, com classificação de risco não urgente (verde e azul). Considera-se este estudo contribuir, principalmente, para reestruturação da acessibilidade de usuários a partir da ABS, para então reduzir o número de atendimentos não urgentes nas UUE. A originalidade deste estudo está na resposta à objeto escasso de pesquisa, analisando usuários da RUE, com o número de unidades e população adscrita à ABS.
Introduction. The Urgent and Emergency Care Network (RUE), organized by Emergency Care Units (UPAs), and other urgent services have the purpose of providing intermediate-complexity health care between the Primary Health Care Network (ABS) and the Hospital Network. However, studies have shown the expressive use of UPAs by non-urgent users who could be treated at Primary Care and Family Units allocated in the regions surrounding the UPAs. Goal. To analyze the utilization of RUE by users older than 13 years in a city in inner in São Paulo state, taking into account the facilities found at the ABS adjoined to the UPAs. Method. This is a cross-sectional epidemiological study conducted at the RUE in a city with 366,769 inhabitants. Secondary data referring to 2014 and 2015 concerning the treatment provided to users at urgent and emergency units were collected from an information system. The documental analysis of spreadsheets containing risk classifications was also performed. These data integrated the database in the form of Excel spreadsheets and were analyzed by descriptive statistics. Results. The population adjoined to the UPAs totaled 328,900 inhabitants, and counted on 21 ABS units, of which 15 were Primary Health Care Units (UBSs) and six were Family Health Care Units (USFs). Of the 270,990 users who underwent risk classification, only 6% showed to be emergency (red) and urgent (yellow) treatments, and most of them (94%) were fairly urgent (green) and non-urgent (blue). Of the groups of diseases, as proposed by ICD, symptoms, signs and abnormal findings of clinical and laboratory tests (18 to 23%) were noteworthy at the UPAs, which was followed by 15 to 17% of diseases of the respiratory system. The age ranges of economically productive users were the ones most often affected by such diagnostic profile. 75% of the treatments were performed at daytime. The interval of four to seven annual treatments comprised the highest percentage of frequent users, from eight to 11%. Only 1% of the users treated at the UPAs had a hospitalization outcome. According to Pearson Correlation, de number of users classified as non-urgent (green and blue) does not depend on the number of UBSs or USFs allocated in the regions of the UPAs. Conclusions. The UPAs that have the largest number of ABS units per inhabitant do not show smaller numbers of users’ treatments with a non-urgent risk classification (green and blue). This study is thought to mainly contribute to the reorganization of users’ accessibility starting from ABS so as to then reduce the number of non-urgent treatments at the RUEs. The originality of this study lies in the response to a scarce research object by analyzing RUE users with the number of units and population adjoined to the ABS.
Introduction. The Urgent and Emergency Care Network (RUE), organized by Emergency Care Units (UPAs), and other urgent services have the purpose of providing intermediate-complexity health care between the Primary Health Care Network (ABS) and the Hospital Network. However, studies have shown the expressive use of UPAs by non-urgent users who could be treated at Primary Care and Family Units allocated in the regions surrounding the UPAs. Goal. To analyze the utilization of RUE by users older than 13 years in a city in inner in São Paulo state, taking into account the facilities found at the ABS adjoined to the UPAs. Method. This is a cross-sectional epidemiological study conducted at the RUE in a city with 366,769 inhabitants. Secondary data referring to 2014 and 2015 concerning the treatment provided to users at urgent and emergency units were collected from an information system. The documental analysis of spreadsheets containing risk classifications was also performed. These data integrated the database in the form of Excel spreadsheets and were analyzed by descriptive statistics. Results. The population adjoined to the UPAs totaled 328,900 inhabitants, and counted on 21 ABS units, of which 15 were Primary Health Care Units (UBSs) and six were Family Health Care Units (USFs). Of the 270,990 users who underwent risk classification, only 6% showed to be emergency (red) and urgent (yellow) treatments, and most of them (94%) were fairly urgent (green) and non-urgent (blue). Of the groups of diseases, as proposed by ICD, symptoms, signs and abnormal findings of clinical and laboratory tests (18 to 23%) were noteworthy at the UPAs, which was followed by 15 to 17% of diseases of the respiratory system. The age ranges of economically productive users were the ones most often affected by such diagnostic profile. 75% of the treatments were performed at daytime. The interval of four to seven annual treatments comprised the highest percentage of frequent users, from eight to 11%. Only 1% of the users treated at the UPAs had a hospitalization outcome. According to Pearson Correlation, de number of users classified as non-urgent (green and blue) does not depend on the number of UBSs or USFs allocated in the regions of the UPAs. Conclusions. The UPAs that have the largest number of ABS units per inhabitant do not show smaller numbers of users’ treatments with a non-urgent risk classification (green and blue). This study is thought to mainly contribute to the reorganization of users’ accessibility starting from ABS so as to then reduce the number of non-urgent treatments at the RUEs. The originality of this study lies in the response to a scarce research object by analyzing RUE users with the number of units and population adjoined to the ABS.
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Palavras-chave
Serviços médicos de emergência, Atenção primária à saúde, Avaliação de serviços de saúde, Estudos transversais, Emergency medical services, Primary health care, Health services evaluation, Health services accessibility, Cross-sectional studies