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Internamentos de Urgência em Portugal: Perfil do Doente e Diferenças Regionais
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| 2.49 MB | Adobe PDF |
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Resumo(s)
RESUMO - Introdução: Como resultado do crescente aumento dos internamentos de urgência e seu
impacto negativo nos serviços de saúde e doentes, sua redução se tornou prioridade para
dos responsáveis pelas de políticas públicas de saúde. O presente trabalho tem o objetivo
de compreender o perfil do doente internado pela urgência e as diferenças regionais
existentes em Portugal Continental, contribuindo para o melhor entendimento de
particularidades regionais que permitem intervenções regionais específicas que reduzam
esse tipo de internamento.
Métodos: Foi desenvolvido um estudo ecológico analítico retrospetivo através do qual
foram analisados os episódios de internamentos não pediátricos e não obstétricos
ocorridos em Portugal Continental, em 2018. Inicialmente realizou-se a caracterização do
perfil do doente internado por tipo de admissão e região. Posteriormente foram calculadas,
por região e principais GCD: a proporção dos internamentos de urgência ajustada por idade
e sexo; e razão de internamentos ajustados por idade e sexo, que estima o risco de
internamento da população. Por fim, foram calculadas medidas de variação para o risco de
internamento entre as regiões, com destaque ao CSV que viabiliza a comparabilidade entre
estudos.
Resultados: Os internamentos de urgência representaram 67,5% dos 536.094
internamentos analisados. Entre os internamentos de urgência 50,9% dos episódios são
de doentes do sexo masculino, em 66,8% os doentes possuem 65 anos ou mais, 72,3%
possuem score de ICC igual ou superior a 4, 28,3% são doentes com a severidade
classificada como "major" ou "extremo", e as GCD mais prevalentes são GCD 4 (19,6%),
GCD 5 (14,0%), GCD 1 (10,1%) e GCD 8 (10,1%). Quanto ao perfil dos doentes internados
pela urgência, não houve grande heterogeneidade entre as regiões. Entretanto, ao avaliar
a proporção de internamentos pela urgência frente aos internamentos programados e a
estimativa de exposição ao risco a um internamento de urgência evidenciam-se diferenças
regionais. Ao analisar o CSV, as maiores variações regionais ocorreram nas GCD 4
(14,29%), GCD 10 (12,88%), GCD 11 (12,88%) e GCD 7 (12,27%). Já as GCD 6 (6,14%)
e GCD 8 (7,15%) apresentam as menores variações, inferiores a variação geral (7,98%).
Conclusão: Este estudo mostra que há uma homogeneidade do perfil do doente internado
pela urgência entre as regiões, entretanto essa homogeneidade não é observada ao avaliar
a utilização e exposição ao risco aos internamentos de urgência.
ABSTRACT - Introduction: As a result of the growing increase in emergency admissions and the negative impact on health services and patients, reducing emergency admissions has become a priority for those responsible for public health policies. The present work aims to understand the patient profile of emergency admissions and the regional differences that exist in mainland Portugal, contributing to a better understanding of regional particularities that allow for specific regional interventions that reduce this type of admission. Methods: A retrospective analytical ecological study was developed through which nonpediatric and non-obstetric hospitalizations in Portugal in 2018 were analyzed. Initially, the profile of the hospitalized patient was characterized by type of admission and region. Subsequently, by region and main GCD, the following were calculated: the proportion of emergency admissions adjusted by age and sex; and hospitalization ratio adjusted by age and sex, which estimates the population's risk of hospitalization. Finally, variation measures were calculated for the risk of hospitalization between regions, with emphasis on CSV, which enables comparability between studies. Results: Urgent admissions represented 67.5% of the 536,094 admissions analyzed. Among emergency hospitalizations, 50.9% of episodes are male patients, 66.8% of patients are 65 years old or older, 72.3% have an ICC score equal to or greater than 4, 28.3% are patients with severity classified as "major" or "extreme", and the most prevalent GCDs are GCD 4 (19.6%), GCD 5 (14.0%), GCD 1 (10.1%) and GCD 8 (10.1%). Regarding the profile of emergency admission patients, there was no great heterogeneity between regions. However, when evaluating the proportion of emergency admissions compared to scheduled admissions and the estimated risk exposure to an emergency admission, regional differences become evident. When analyzing the CSV, the most significant regional variations occurred in GCD 4 (14.29%), GCD 10 (12.88%), GCD 11 (12.88%) and GCD 7 (12.27%). GCD 6 (6.14%) and GCD 8 (7.15%) present the smallest variations, lower than the general variation (7.98%). Conclusion: This study shows that there is a homogeneity in the patient profile of emergency admissions between regions, however this homogeneity is not observed when evaluating the use and exposure to risk of emergency admissions.
ABSTRACT - Introduction: As a result of the growing increase in emergency admissions and the negative impact on health services and patients, reducing emergency admissions has become a priority for those responsible for public health policies. The present work aims to understand the patient profile of emergency admissions and the regional differences that exist in mainland Portugal, contributing to a better understanding of regional particularities that allow for specific regional interventions that reduce this type of admission. Methods: A retrospective analytical ecological study was developed through which nonpediatric and non-obstetric hospitalizations in Portugal in 2018 were analyzed. Initially, the profile of the hospitalized patient was characterized by type of admission and region. Subsequently, by region and main GCD, the following were calculated: the proportion of emergency admissions adjusted by age and sex; and hospitalization ratio adjusted by age and sex, which estimates the population's risk of hospitalization. Finally, variation measures were calculated for the risk of hospitalization between regions, with emphasis on CSV, which enables comparability between studies. Results: Urgent admissions represented 67.5% of the 536,094 admissions analyzed. Among emergency hospitalizations, 50.9% of episodes are male patients, 66.8% of patients are 65 years old or older, 72.3% have an ICC score equal to or greater than 4, 28.3% are patients with severity classified as "major" or "extreme", and the most prevalent GCDs are GCD 4 (19.6%), GCD 5 (14.0%), GCD 1 (10.1%) and GCD 8 (10.1%). Regarding the profile of emergency admission patients, there was no great heterogeneity between regions. However, when evaluating the proportion of emergency admissions compared to scheduled admissions and the estimated risk exposure to an emergency admission, regional differences become evident. When analyzing the CSV, the most significant regional variations occurred in GCD 4 (14.29%), GCD 10 (12.88%), GCD 11 (12.88%) and GCD 7 (12.27%). GCD 6 (6.14%) and GCD 8 (7.15%) present the smallest variations, lower than the general variation (7.98%). Conclusion: This study shows that there is a homogeneity in the patient profile of emergency admissions between regions, however this homogeneity is not observed when evaluating the use and exposure to risk of emergency admissions.
Descrição
Palavras-chave
Internamentos de urgência exposição ao risco variação regional Emergency hospitalizations exposure to risk regional variation