Integração das Reses de Atenção à Saúde a partir de um serviço de Urgência e Emergência
Carregando...
Arquivos
Data
2017-12-18
Autores
Cyrino, Claudia Maria Silva
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: O Sistema Único de Saúde tem como objetivo organizar e integrar as ações de saúde por meio da articulação tanto de promoção e de prevenção das doenças quanto de cura e reabilitação. No entanto, ainda é um desafio, atender às pessoas com qualidade e resolubilidade. Nas últimas décadas, grandes esforços têm sido realizados, envolvendo toda a rede assistencial do país, desde a atenção primária e atendimento pré-hospitalar móvel até a rede hospitalar de alta complexidade e reabilitação. Com o aumento da morbimortalidade e da transição demográfica resultante de uma população em processo rápido de envelhecimento e seus fatores de risco, houve uma sobrecarga dos serviços de atendimento às urgências e emergências. Soma-se a isso, a estruturação fragmentada das Redes de Atenção à Saúde podendo afetar a continuidade do cuidado oferecido aos pacientes. Para atender a essa demanda, foi instituída pelo Ministério da Saúde a Rede de Urgência e Emergência (RUE). O Serviço de Atendimento Móvel de Urgência (SAMU 192) é o componente móvel da RUE e é o responsável pela ligação entre os diversos serviços de saúde que compõem a Rede. Ele tem como objetivo chegar precocemente ao paciente que sofreu um agravo de qualquer natureza e oferecer o atendimento e transporte adequado para um serviço de saúde. Os atendimentos do SAMU 192 são acompanhados por uma Central de Regulação das Urgências, a qual foi caracterizada pelo Ministério da Saúde como um observatório privilegiado do SUS, pois, apresenta a possibilidade de organizar os fluxos das urgências e emergências e evidenciar quaisquer deficiências da Rede. Assim, este estudo torna-se importante, pois ao caracterizar o paciente atendido em situação de urgência e emergência pode contribuir para a organização e a articulação dos serviços. Objetivo: Monitorar e avaliar a integração e articulação da Rede de Atenção à Urgência no município de Botucatu a partir de um serviço de urgência e emergência, conforme evolução, desfecho e recidiva do paciente que necessitou do serviço. Materiais e métodos: Estudo transversal prospectivo e descritivo realizado na Central de Regulação das Urgências do SAMU 192 da cidade de Botucatu e no Pronto Socorro Referenciado do Hospital das Clínicas de Botucatu. Pergunta-se: Qual a evolução, desfecho e recidiva de atendimento do usuário do SAMU 192 de Botucatu? A amostra constou-se de 600 pacientes adultos que foram atendidos pelo SAMU 192 no ano de 2015 e que foram encaminhados para outro serviço de saúde após o atendimento pré-hospitalar móvel. Os dados foram coletados pela própria pesquisadora pelas fichas de registro de atendimentos do SAMU 192 e por meio do prontuário eletrônico intra-hospitalar do paciente para caracterizar seu fluxo após o atendimento pré-hospitalar. Os dados foram compilados para o programa Excel e software SPSS 21.0 para posterior análise. Foi realizada análise descritiva das variáveis quantitativas, regressão logística múltipla ajustada em cada bloco de variáveis para relacionar à ocorrência de recidivas ao atendimento pré-hospitalar. Teste Exato de Fischer para identificar a região da cidade com maior recidiva de atendimento. Utilizou-se p<0,05 como nível de significância. O modelo assistencial embasado em Redes de Atenção proposto pelas políticas nacionais e a Teoria dos Sistemas de Betty Neuman foram os referenciais teóricos desse estudo. Resultados: Dos 600 pacientes analisados, 51,7% eram do sexo masculino e apresentaram uma idade média de 55 anos (18-104). As ocorrências clínicas prevaleceram em 80% dos atendimentos, sendo estas, sobretudo, caracterizados como dispneia, dor torácica e convulsão. A região Central da cidade foi a de maior prevalência de atendimentos (26,3%). O tempo resposta médio global foi de 11 minutos. A maioria dos pacientes, 71,8%, foi encaminhada para o Pronto Socorro Referenciado da cidade e permaneceram internados por uma média de nove dias(1-90), tendo como principal desfecho, a alta médica (85%). Dos pacientes que evoluíram para o desfecho alta, 41% foram encaminhados para outro serviço de saúde, pertencente a Rede de Atenção às Urgências, para a continuidade do tratamento. A recidiva desses pacientes, novamente ao serviço pré-hospitalar móvel aconteceu em 27% dos casos e a chance disso acontecer aumentou em 64,7% entre os pacientes que receberam esse encaminhamento após a alta médica. A recidiva de atendimentos também apresentou correlação estatisticamente significativa nos pacientes com diagnósticos médicos de epilepsia (p=0,027), câncer (p=0,001) e em portadores de doença respiratória crônica (p= 0,023), sobretudo na região Oeste da cidade. Conclusão: Os atendimentos realizados pelo serviço pré-hospitalar móvel, SAMU 192, no ano de 2015, caracterizaram-se, principalmente, por atendimentos clínicos em homens com idade média de 55 anos na região Central da cidade. Prevaleceram os atendimentos aos pacientes com diagnósticos médicos de dispneia, dor torácica e convulsão e que foram encaminhados para o Pronto Socorro Referenciado após as primeiras intervenções. O tempo médio de internação foi de 9 dias e o principal desfecho foi a alta médica. A demanda de recidivas ao serviço pré-hospitalar móvel predominou-se em pacientes da região Oeste da cidade e foram pertinentes em relação as características e gravidade das doenças as quais se associaram estatisticamente. A realização de estudos como este ajuda a caracterizar o perfil dos pacientes inseridos na RUE e apontar possíveis falhas na assistência que possam prejudicar a continuidade e integralidade do cuidado além de instigar novas pesquisas nesse âmbito. Ressalta-se que o estudo foi realizado em um serviço de atendimento móvel de urgência e os resultados não podem ser generalizados.
Introduction: The “Sistema Único de Saúde” (SUS) aims to organize and integrate the health actions through the articulation of both promotion and prevention of diseases as well as healing and rehabilitation. However, an organization of health services to attend people with quality and solvability is still a challenge. In the last decades, great projects have been carried out involving the entire healthcare network in the country, from primary care and prehospital care to a hospital network of high complexity and rehabilitation. With the increase in morbidity and mortality due to external causes, together with a demographic transition resulting from a rapidly aging population and its risk factors, there was an overload of urgency and emergency services. That is, among other things, the fragmented structure of Health Care Networks can affect the continuity care of patients. To comply this demand the “Rede de Urgência e Emergência” (RUE) was established through the Ministry of Health. The “Serviço de Atendimento Móvel de Urgência” (SAMU 192) is the mobile component of the RUE and it is responsible for the link between the various health services that make up the Network. It aims rush to the patient with an injury of any nature and provide care and proper transportation to a health service center. The SAMU 192 services are followed by an Emergency Regulation Center that enable urgencies and emergencies flow and evidences deficiencies of the Network. Thus, this study is important to characterize the patient attended in an urgency and emergency situation, for an organization and an articulation of the services. Objective: To evaluate the integration and articulation of the Emergency Care Network in Botucatu city, based on an urgency and emergency service according to the evolution, outcome and recurrence of the patient in need of the service. Materials and methods: prospective and descriptive study performed at the Emergency Regulation Center of SAMU 192 in Botucatu city and at the Emergency Room of the Hospital School of Botucatu. The question is: What is an evolution, outcome and recurrence of patient assisted by SAMU 192 in Botucatu? A sample consisted of 600 patients attended by SAMU 192 in 2015 who were taken to another health service. The data was collected by the researcher from the SAMU 192 records and the electronic in-patient medical record to characterize their hospital flow. The data was compiled in the Excel program and SPSS 21.0 software for further analysis. A descriptive analysis of the quantitative variables and multiple logistic regression were peformed. Fischer's Exact Test was used to identify a region of the city with the greatest recurrence of care. P <0.05 was used as the level of significance. The assistance model based on Networks of Attention proposed by national policies and Betty Neuman Systems Theory were the theoretical references of the study. RESULTS: From the 600 patients analyzed, 51.7% were males with an average age of 55 years old (18-104). The clinical occurrences were 80% of the visits, being the, majority them, dyspnea, chest pain and seizure. The highest prevalence of care (26.3%) was in the City Center. The global response time was 11 minutes. The majority of patients, 71.8%, was taken to the Emergency Room of the School Hospital and they were hospitalized for an average of nine days, having as main outcome, medical discharge (85%). Of the patients who progressed to the medical discharge outcome, 41% were referred to another health service, inside the Emergency Care Network, to continue the treatment. The recurrence of these patients to the mobile prehospital service, occurred in 27% of the cases and the chance of this happens increased in 64.7% among the patients who received this referral after the medical discharge. The recurrence rate was also statistically significant in patients with medical diagnosis of epilepsy (p = 0.027), cancer (p = 0.001) and in patients with chronic respiratory diseases (p = 0.023), especially in the western region of the city. Conclusion: The care performed by the pre-hospital mobile service, SAMU 192, in the year of 2015, was mainly clinical nature in men with mean age of 55 years old in the central region of the city. The care in patients with dyspnea, chest pain and seizures were prevailed. They were referred to the Emergency Room of the School Hospital after the first interventions. The mean length of stay was 9 days and the main outcome was medical discharge. The demand for recurrence to the mobile prehospital service was majority in patients from the West region of the city and were pertinent to the characteristics and severity of the diseases. Such studies help characterize the profile of the patients attended in the RUE and point out possible failures in care that may impair the continuity of care, as well as instigate new research in this topic. It should be emphasized that the study was performed in an emergency mobile service and the results can not be generalized.
Introduction: The “Sistema Único de Saúde” (SUS) aims to organize and integrate the health actions through the articulation of both promotion and prevention of diseases as well as healing and rehabilitation. However, an organization of health services to attend people with quality and solvability is still a challenge. In the last decades, great projects have been carried out involving the entire healthcare network in the country, from primary care and prehospital care to a hospital network of high complexity and rehabilitation. With the increase in morbidity and mortality due to external causes, together with a demographic transition resulting from a rapidly aging population and its risk factors, there was an overload of urgency and emergency services. That is, among other things, the fragmented structure of Health Care Networks can affect the continuity care of patients. To comply this demand the “Rede de Urgência e Emergência” (RUE) was established through the Ministry of Health. The “Serviço de Atendimento Móvel de Urgência” (SAMU 192) is the mobile component of the RUE and it is responsible for the link between the various health services that make up the Network. It aims rush to the patient with an injury of any nature and provide care and proper transportation to a health service center. The SAMU 192 services are followed by an Emergency Regulation Center that enable urgencies and emergencies flow and evidences deficiencies of the Network. Thus, this study is important to characterize the patient attended in an urgency and emergency situation, for an organization and an articulation of the services. Objective: To evaluate the integration and articulation of the Emergency Care Network in Botucatu city, based on an urgency and emergency service according to the evolution, outcome and recurrence of the patient in need of the service. Materials and methods: prospective and descriptive study performed at the Emergency Regulation Center of SAMU 192 in Botucatu city and at the Emergency Room of the Hospital School of Botucatu. The question is: What is an evolution, outcome and recurrence of patient assisted by SAMU 192 in Botucatu? A sample consisted of 600 patients attended by SAMU 192 in 2015 who were taken to another health service. The data was collected by the researcher from the SAMU 192 records and the electronic in-patient medical record to characterize their hospital flow. The data was compiled in the Excel program and SPSS 21.0 software for further analysis. A descriptive analysis of the quantitative variables and multiple logistic regression were peformed. Fischer's Exact Test was used to identify a region of the city with the greatest recurrence of care. P <0.05 was used as the level of significance. The assistance model based on Networks of Attention proposed by national policies and Betty Neuman Systems Theory were the theoretical references of the study. RESULTS: From the 600 patients analyzed, 51.7% were males with an average age of 55 years old (18-104). The clinical occurrences were 80% of the visits, being the, majority them, dyspnea, chest pain and seizure. The highest prevalence of care (26.3%) was in the City Center. The global response time was 11 minutes. The majority of patients, 71.8%, was taken to the Emergency Room of the School Hospital and they were hospitalized for an average of nine days, having as main outcome, medical discharge (85%). Of the patients who progressed to the medical discharge outcome, 41% were referred to another health service, inside the Emergency Care Network, to continue the treatment. The recurrence of these patients to the mobile prehospital service, occurred in 27% of the cases and the chance of this happens increased in 64.7% among the patients who received this referral after the medical discharge. The recurrence rate was also statistically significant in patients with medical diagnosis of epilepsy (p = 0.027), cancer (p = 0.001) and in patients with chronic respiratory diseases (p = 0.023), especially in the western region of the city. Conclusion: The care performed by the pre-hospital mobile service, SAMU 192, in the year of 2015, was mainly clinical nature in men with mean age of 55 years old in the central region of the city. The care in patients with dyspnea, chest pain and seizures were prevailed. They were referred to the Emergency Room of the School Hospital after the first interventions. The mean length of stay was 9 days and the main outcome was medical discharge. The demand for recurrence to the mobile prehospital service was majority in patients from the West region of the city and were pertinent to the characteristics and severity of the diseases. Such studies help characterize the profile of the patients attended in the RUE and point out possible failures in care that may impair the continuity of care, as well as instigate new research in this topic. It should be emphasized that the study was performed in an emergency mobile service and the results can not be generalized.
Descrição
Palavras-chave
Atendimento Pré-Hospitalar, Serviços de Atendimento de Emergência, Encaminhamentos, Continuidade da Assistência ao Paciente, Emergency Medical Services, Referral, Continuity of Patient Care