Cobertura vacinal de imunobiológicos especiais em pessoas portadoras de doenças crônicas internadas em hospital universitário
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2017-02-24
Autores
Gomes, Daniele de Oliveira [UNESP]
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Universidade Estadual Paulista (Unesp)
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Introdução: O envelhecimento da população brasileira, dentre outros fatores, tem sido responsável pela crescente prevalência de doenças crônicas, implicando em significante aumento da demanda aos serviços de saúde. Este grupo populacional apresenta risco elevado de infecção e/ou de complicações por doenças infecciosas imunopreveníveis. Para prevenção desses agravos, em casos específicos, são indicados imunobiológicos especiais, distribuídos nos Centros de Referência de Imunobiológicos Especiais (CRIE), os quais têm objetivo de facilitar o acesso de usuários a esses produtos. Tendo-se em vista esta política que visa à equidade e a escassez de estudos nacionais que analisam a cobertura de imunobiológicos especiais em pessoas portadoras de doenças crônicas, propôs-se a presente investigação. Objetivo: Analisar a cobertura vacinal de imunobiológicos especiais em pacientes com doenças crônicas com indicação, internados em Hospital Universitário e propor uma ferramenta de sinalização no sistema de informação hospitalar – SOUL da necessidade do uso dos mesmos. Métodos: Estudo transversal, descritivo e analítico, desenvolvido no Hospital das Clínicas da Faculdade de Medicina de Botucatu/UNESP (HCFMB). A amostra de conveniência abrangeu 150 pacientes portadores de doenças crônicas com indicação para receberem imunobiológicos especiais, internados em enfermaria de clínica médica. As variáveis independentes incluíram aspectos sociodemográficos, clínicos, relativos ao acesso à vacinação e adesão ao tratamento e a variável desfecho foi ter recebido a vacina pneumocócica 23 valente. Os dados foram obtidos por meio de aplicação de um questionário, consulta ao prontuário e ao Sistema de Informação do CRIE do HCFMB e analisados por meio da estatística descritiva e regressão logística. O estudo foi submetido e aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Medicina de Botucatu. Resultados: A mediana de idade e de anos de estudo concluídos dos pacientes foi de 64 anos (24-94) e quatro anos (0-15), respectivamente. A maioria era do sexo feminino (52,0%), branca (68,7%), em união estável (62,7%) e não tinha dificuldade em procurar o serviço de saúde para se vacinar (78,7%). Quase a metade dos pacientes (48,7%) fazia seguimento médico no HCFMB, 40,0% tinham diagnóstico de doença crônica há mais de 10 anos, 93,3% realizavam tratamento medicamentoso, 86,0% referiram adesão a todas as drogas prescritas, 87,3% a todas as doses e 82,0% a todos horários recomendados. As coberturas das vacinas pneumocócica, contra o meningococo C e hepatite A foram, respectivamente, 18,0%, 22,2% e 14,2% e nenhum paciente recebeu a vacina contra a varicela. Nenhuma das variáveis investigadas se associou com a cobertura da vacina pneumocócica 23 valente. Considerando-se os resultados da presente investigação, foi elaborada uma ferramenta no sistema informatizado de registro das informações dos pacientes do HCFMB para alertar os profissionais de saúde sobre a necessidade de indicação de imunobiológico para pacientes com doença crônica, visando aumentar a cobertura vacinal, neste grupo. Conclusão: O estudo aponta baixa cobertura vacinal de imunobiológicos especiais em pacientes com diagnóstico de doença crônica já estabelecida e em tratamento há vários anos, demonstrando perda de oportunidade vacinal, inclusive entre pacientes seguidos em hospital de referência, sede de um CRIE. Evidenciam-se, assim, necessidade de investimento em estratégias que aumentem a cobertura vacinal nesse grupo. Sugere-se, dentre outras, educação permanente dos profissionais de saúde, pacientes e familiares, monitoramento da condição vacinal na internação e/ou nos atendimentos ambulatoriais por médicos e enfermeiros e encaminhamento para vacinação, na ocasião do atendimento, além da sinalização no sistema de informação hospitalar.
Introduction: The Brazilian population aging, including other factors, has been responsible for the prevalence increasing of chronic diseases, implying a significant increasing demand for health services. This population group presents an elevated risk for infection and/or complications related to immunopreventable diseases. For the purpose of preventing such diseases, in specific cases, special immunobiologicals are indicated, wich are distributed in the Reference Centers for Special Immunobiological (CRIE), which facilitate the access of these products to users. Considering this policy, that aim the equity and the scarcity of national studies that analyze the special immunobiologicals coverage in people suffering from chronic diseases, it was proposed the present research. Objective: To analyze the special immunobiologicals immunization coverage in patients suffering from chronic diseases, hospitalized in a University Hospital and propose a signaling tool in the hospital computerized information registry system - SOUL about the necessity of their use. Methods: A cross-sectional, descriptive and analytical study developed at Clinical Hospital from Botucatu Medical School (HCFMB). The convenience sample included 150 patients suffering from chronic diseases who are hospitalized in specialized internal medicine infirmary, and had the indication for receiving special immunobiologicals. The independent variables included sociodemographic and clinical aspects related to accession to immunization and the adherence to the treatment. The outcome variable was to receive the pneumococcal 23-valent vaccine. The data were obtained by a questionnaire, medical record consultation and the Information System of CRIE from HCFMB and analyzed through descriptive statistics and logistic regression. The study was submitted and approved by the Research Ethics Committee of Botucatu Medical School. Results: The median age and completed study years of the patients were 64 years (24-94) and four years (0-15), respectively. The majority of them were female (52.0%), white (68.7%), in a stable union (62.7%) and had no difficulty in acessing the health service for being vaccinated (78.7%). Nearly half of the patients (48.7%) had been treated at HCFMB, 40.0% had been diagnosed with chronic disease for more than 10 years, 93.3% underwent drug treatment, 86.0% reported to take all prescribed drugs, 87.3% every prescribed drug dose and 82.0% take prescibed drugs during the recommended time. The coverage of vaccines against pneumococcal, meningococcus C and hepatitis A was 18.0%, 22.2% and 14.2%, respectively, and no patient received the vaccine against varicella. None of the variables investigated had been associated with pneumococcal 23-valent vaccine coverage. Considering the results of this present research, a tool was developed in the HCFMB computerized information registry system to alerting healthcare providers about the need for immunobiological indication for patients suffering from chronic diseases, aiming to increase immunization coverage in this group of pacients.Conclusion: The study indicates a low special immunobiologicals immunization coverage in patients who have an established chronic disease diagnosis and wich has been undergoing treatment for several years, demonstrating a loss of opportunity for offering immunization to this patients who are receiving treatment in a reference hospital wich serves as a headquarters to a CRIE. Thus, more investment in strategies that increase immunization coverage in this group of patients is needed. It is suggested, among other ones, the continuous education of healthcare providers, patients and their families and monitoring the immunization status during hospitalization and/or during medical and nursery outpatient care and the signaling in the hospital computerized information registry system.
Introduction: The Brazilian population aging, including other factors, has been responsible for the prevalence increasing of chronic diseases, implying a significant increasing demand for health services. This population group presents an elevated risk for infection and/or complications related to immunopreventable diseases. For the purpose of preventing such diseases, in specific cases, special immunobiologicals are indicated, wich are distributed in the Reference Centers for Special Immunobiological (CRIE), which facilitate the access of these products to users. Considering this policy, that aim the equity and the scarcity of national studies that analyze the special immunobiologicals coverage in people suffering from chronic diseases, it was proposed the present research. Objective: To analyze the special immunobiologicals immunization coverage in patients suffering from chronic diseases, hospitalized in a University Hospital and propose a signaling tool in the hospital computerized information registry system - SOUL about the necessity of their use. Methods: A cross-sectional, descriptive and analytical study developed at Clinical Hospital from Botucatu Medical School (HCFMB). The convenience sample included 150 patients suffering from chronic diseases who are hospitalized in specialized internal medicine infirmary, and had the indication for receiving special immunobiologicals. The independent variables included sociodemographic and clinical aspects related to accession to immunization and the adherence to the treatment. The outcome variable was to receive the pneumococcal 23-valent vaccine. The data were obtained by a questionnaire, medical record consultation and the Information System of CRIE from HCFMB and analyzed through descriptive statistics and logistic regression. The study was submitted and approved by the Research Ethics Committee of Botucatu Medical School. Results: The median age and completed study years of the patients were 64 years (24-94) and four years (0-15), respectively. The majority of them were female (52.0%), white (68.7%), in a stable union (62.7%) and had no difficulty in acessing the health service for being vaccinated (78.7%). Nearly half of the patients (48.7%) had been treated at HCFMB, 40.0% had been diagnosed with chronic disease for more than 10 years, 93.3% underwent drug treatment, 86.0% reported to take all prescribed drugs, 87.3% every prescribed drug dose and 82.0% take prescibed drugs during the recommended time. The coverage of vaccines against pneumococcal, meningococcus C and hepatitis A was 18.0%, 22.2% and 14.2%, respectively, and no patient received the vaccine against varicella. None of the variables investigated had been associated with pneumococcal 23-valent vaccine coverage. Considering the results of this present research, a tool was developed in the HCFMB computerized information registry system to alerting healthcare providers about the need for immunobiological indication for patients suffering from chronic diseases, aiming to increase immunization coverage in this group of pacients.Conclusion: The study indicates a low special immunobiologicals immunization coverage in patients who have an established chronic disease diagnosis and wich has been undergoing treatment for several years, demonstrating a loss of opportunity for offering immunization to this patients who are receiving treatment in a reference hospital wich serves as a headquarters to a CRIE. Thus, more investment in strategies that increase immunization coverage in this group of patients is needed. It is suggested, among other ones, the continuous education of healthcare providers, patients and their families and monitoring the immunization status during hospitalization and/or during medical and nursery outpatient care and the signaling in the hospital computerized information registry system.
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Palavras-chave
Cobertura vacinal, Doenças crônicas, Pacientes internados