Estratégia de apoio às famílias para prevenção de internação pediátrica por condições sensíveis à Atenção Primária à Saúde
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2018-02-28
Autores
Lima, Lilian de
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Universidade Estadual Paulista (Unesp)
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Introdução: as internações por condições sensíveis à atenção primária - ICSAP são ocorrências que podem ser evitadas caso a Atenção Primária à Saúde exerça sua função corretamente, ou seja, realizando o tratamento de doenças agudas e o devido controle de doenças crônicas, sendo hospitalizados somente aqueles que necessitem de atenção especializada e de nível tecnológico avançado. Objetivo: elaborar material educativo sobre ICSAP para pais/responsáveis de crianças usuárias de unidades básicas de saúde, considerando as causas de internação mais prevalentes em hospital de referência de um município do interior paulista. Aspectos metodológicos: trata-se de pesquisa de abordagem mista, realizada em três etapas. Na primeira etapa, foi realizado um estudo observacional sobre as ICSAP de crianças no primeiro ano de vida, internadas em hospital público estadual de julho de 2015 a junho de 2016, com dados coletados dos seus prontuários. Para verificar a associação das condições mais prevalentes e variáveis explanatórias foi realizado teste quiquadrado ou Exato de Fisher, considerando-se o valor de p<0,05 para nível de significância, com cálculo de Odds Ration e respectivos intervalos de confiança. Para realizar as análises foi empregado o programa Epinfo, versão 7.2.2.2. A segunda etapa foi realizada no primeiro semestre de 2017, quando foram entrevistadas mães/responsáveis de crianças internadas por CSAP sobre suas concepções e experiências quanto à atenção à saúde de seus filhos pelas unidades básicas de saúde. Os depoimentos foram analisados segundo técnicas de Análise de Conteúdo, na vertente Temática. O material educativo foi desenvolvido na terceira etapa, com base nos achados das etapas anteriores Resultados: Das 253 hospitalizações infantis, 53,3% foram por CSAP. A maioria dessas crianças tinha menos de seis meses (66,4%), nasceu a termo (78,8%), de parto vaginal (51,9%), não era o primeiro filho (72,2%), tinha mãe adulta (89,8%) e com mais de oito anos de estudo (63,5%). E, também, a maior parte não possuía hospitalização prévia (71,5%), não foi internada em UTI (94,2%) e tinha vacinação atualizada (92,7%). As CSAP mais prevalentes foram respiratórias (69,3%) e essas tinham menores chances de ocorrer entre as mães primíparas (p=0,0085, OR=0,35, IC=0,16 – 0,77). Sobre as concepções e experiências apreendidas, configuraram-se dois temas: Atenção à saúde das crianças pelos serviços públicos de saúde e Motivos atribuídos à hospitalização da criança. Sobre o material educativo, contando com a parceria de responsáveis pela rede pública de atenção primária à saúde, foram elaborados um folder e uma cartilha sob forma de história em quadrinhos, os quais abordam as doenças respiratórias, seus fatores relacionados, sua prevenção e outras informações pertinentes na ocorrência de casos. Considerações finais: os achados das etapas iniciais foram fundamentais para confirmar a relevância da elaboração da proposta educativa voltada à prevenção de internação por doenças respiratórias durante o primeiro ano de vida, fornecendo subsídios teóricos e metodológicos para a sua concretização, particularmente junto às mães multiparas.
Introduction: the hospitalizations for conditions sensitive to primary care - ICSAP are occurrences that can be avoided if Primary Health Care performs its function properly, that is, performing treatment of acute diseases and due control of chronic diseases, and hospitalized only those that require specialized attention and advanced technological level. Objective: to elaborate educational material on ICSAP for parents / guardians of children using basic health units, considering the most prevalent causes of hospitalization in a referral hospital in a city in the state of São Paulo. Methodological aspects: this is a mixed approach research, carried out in three stages. In the first stage, an observational study on the ICSAP of children in the first year of life was carried out, hospitalized in a state public hospital from July 2015 to June 2016, with data collected from their charts. To verify the association of the most prevalent conditions and explanatory variables, a chi-square or Fisher's exact test was performed, considering the value of p <0.05 for level of significance, with Odds Ration calculation and respective confidence intervals. Epinfo, version 7.2.2.2 was used to perform the analyzes. The second stage was carried out in the first semester of 2017, when mothers / guardians of children hospitalized by CSAP were interviewed about their conceptions and experiences regarding the health care of their children by the basic health units. The statements were analyzed according to Content Analysis techniques, in the Thematic area. The educational material was developed in the third stage, based on the findings of the previous stages. Results: Of the 253 infantile hospitalizations, 53,3% were by CSAP. The majority of these children were less than six months old (66.4%), born full term (78.8%), vaginally (51.9%), not the first child (72.2%), (89.8%) and with more than eight years of schooling (63.5%). Also, most of them did not have previous hospitalization (71.5%), were not admitted to the ICU (94.2%) and had updated vaccination (92.7%). The most prevalent CSAPs were respiratory (69.3%) and these were less likely to occur among primiparous mothers (p = 0.0085, OR = 0.35, CI = 0.16-0.77). On the conceptions and experiences seized, two themes were configured: Attention to the health of the children by the public health services and Reasons attributed to the hospitalization of the child. With regard to the educational material, with the partnership of the public primary health care network, a folder and a booklet in the form of a comic book were elaborated, which deal with respiratory diseases, their related factors, their prevention and other information cases. Final considerations: the findings of the initial stages were fundamental to confirm the relevance of the elaboration of the educational proposal aimed at the prevention of hospitalization for respiratory diseases during the first year of life, providing theoretical and methodological subsidies for its implementation, particularly with multiparous mothers.
Introduction: the hospitalizations for conditions sensitive to primary care - ICSAP are occurrences that can be avoided if Primary Health Care performs its function properly, that is, performing treatment of acute diseases and due control of chronic diseases, and hospitalized only those that require specialized attention and advanced technological level. Objective: to elaborate educational material on ICSAP for parents / guardians of children using basic health units, considering the most prevalent causes of hospitalization in a referral hospital in a city in the state of São Paulo. Methodological aspects: this is a mixed approach research, carried out in three stages. In the first stage, an observational study on the ICSAP of children in the first year of life was carried out, hospitalized in a state public hospital from July 2015 to June 2016, with data collected from their charts. To verify the association of the most prevalent conditions and explanatory variables, a chi-square or Fisher's exact test was performed, considering the value of p <0.05 for level of significance, with Odds Ration calculation and respective confidence intervals. Epinfo, version 7.2.2.2 was used to perform the analyzes. The second stage was carried out in the first semester of 2017, when mothers / guardians of children hospitalized by CSAP were interviewed about their conceptions and experiences regarding the health care of their children by the basic health units. The statements were analyzed according to Content Analysis techniques, in the Thematic area. The educational material was developed in the third stage, based on the findings of the previous stages. Results: Of the 253 infantile hospitalizations, 53,3% were by CSAP. The majority of these children were less than six months old (66.4%), born full term (78.8%), vaginally (51.9%), not the first child (72.2%), (89.8%) and with more than eight years of schooling (63.5%). Also, most of them did not have previous hospitalization (71.5%), were not admitted to the ICU (94.2%) and had updated vaccination (92.7%). The most prevalent CSAPs were respiratory (69.3%) and these were less likely to occur among primiparous mothers (p = 0.0085, OR = 0.35, CI = 0.16-0.77). On the conceptions and experiences seized, two themes were configured: Attention to the health of the children by the public health services and Reasons attributed to the hospitalization of the child. With regard to the educational material, with the partnership of the public primary health care network, a folder and a booklet in the form of a comic book were elaborated, which deal with respiratory diseases, their related factors, their prevention and other information cases. Final considerations: the findings of the initial stages were fundamental to confirm the relevance of the elaboration of the educational proposal aimed at the prevention of hospitalization for respiratory diseases during the first year of life, providing theoretical and methodological subsidies for its implementation, particularly with multiparous mothers.
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saúde da criança, atenção primária a saúde, hospitalização, child health, primary health care, hospitalization