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RESUMO - Introdução: Os internamentos por causas sensíveis a cuidados de ambulatório (CSCA) são definidos como condições que, com cuidados de ambulatório atempados e efetivos, poderiam ser evitados. Existem diversos estudos sobre as CSCA, mas a evidência é escassa quanto à sua multiplicidade. O principal objetivo do presente estudo é realizar uma caracterização dos internamentos evitáveis múltiplos, identificando os fatores socioeconómicos associados aos mesmos.
Metodologia: Foi desenvolvido um estudo observacional transversal analítico com recurso a dados administrativos das altas do internamento das instituições hospitalares públicas de Portugal Continental, entre 2013 e 2015, para indivíduos com 18 ou mais anos. As CSCA foram identificadas através da metodologia Prevention Quality Indicators (AHRQ), e foi utilizado um identificador único do doente para identificar os episódios de internamento evitável múltiplo. A relação entre os internamentos evitáveis múltiplos e os fatores sociodemográficos foi testada para as variáveis individuais e de contexto, recorrendo ao Modelo Comportamental de Andersen.
Resultados: De 1.969.844 episódios, 7,3% representavam internamentos evitáveis múltiplos (com uma média de 2,7 episódios por indivíduo entre 2013 e 2015). Os indivíduos com internamentos evitáveis múltiplos eram mais velhos (+ 3 anos), apresentavam maior demora média (+0,81 dias) e maior número de co-morbilidades que aqueles com um único internamento evitável. Existe variabilidade geográfica na distribuição dos internamentos evitáveis múltiplos. Verificou-se que a idade, sexo, poder de compra per capita, divórcio, desemprego, distribuição dos recursos estruturais em saúde e a presença de co-morbilidades são fatores associados à multiplicidade dos internamentos evitáveis.
Conclusão: No âmbito das CSCA, a múltipla utilização do internamento é frequente e associada com fatores específicos: os indivíduos tendem a ser mais velhos, ter maior número de co-morbilidades e demora média mais elevada comparativamente aos indivíduos com um único episódio de internamento evitável. A frequência do fenómeno a nível geográfico apresentou variação, observando-se que esta está associada a fatores de predisposição, facilitadores e relacionados com as necessidades em saúde.
ABSTRACT - Introduction: Hospitalizations for ambulatory care sensitive conditions (ACSC) are defined as conditions which, with timely and effective ambulatory care, can be avoided. There are several studies about ACSC but evidence is scarce on patients’ multiple use for ACSC. The aim of this study is to describe the characteristics of the phenomenon, identifying the related sociodemographic factors. Methods: It was developed an observational analytical transversal study using administrative discharge dataset from public hospitals of mainland Portugal, between 2013 and 2015, of patients 18 years or older. ACSC were identified using Prevention Quality Indicators (AHRQ), and it was used an unique identifier to identify the multiple avoidable inpatient admissions. The relationship between multiple use for ambulatory care sensitive conditions and individual or contextual sociodemographic factors was tested, using the Andersen’s Behavioural Model. Results: Of 1.969.844 episodes, 7.3% were multiple admissions for ACSC (with an average of 2.7 episodes per patient between 2013 and 2015). These were older (+ 3 years), showed a higher length of stay (+0.81 days) and presented more comorbidities than the patients with only one avoidable admission. Geographic variation of the distribution of multiple avoidable admissions was identified. It was found that age, gender, purchase power, divorce, unemployment, structural resources in health and presence and severity of comorbidities were associated with the multiplicity of avoidable admissions. Conclusion: Amongst patients with ACSC, multiple use of inpatient services was frequent and associated with specific factors: patients with multiple avoidable admissions were older, had more comorbidities and stayed longer in the hospital compared with patients with a single avoidable admissions. Geographically, the frequency of the phenomena was unequally distributed, once the frequency of the phenomenon was associated the predisposing, enabling and need factors.
ABSTRACT - Introduction: Hospitalizations for ambulatory care sensitive conditions (ACSC) are defined as conditions which, with timely and effective ambulatory care, can be avoided. There are several studies about ACSC but evidence is scarce on patients’ multiple use for ACSC. The aim of this study is to describe the characteristics of the phenomenon, identifying the related sociodemographic factors. Methods: It was developed an observational analytical transversal study using administrative discharge dataset from public hospitals of mainland Portugal, between 2013 and 2015, of patients 18 years or older. ACSC were identified using Prevention Quality Indicators (AHRQ), and it was used an unique identifier to identify the multiple avoidable inpatient admissions. The relationship between multiple use for ambulatory care sensitive conditions and individual or contextual sociodemographic factors was tested, using the Andersen’s Behavioural Model. Results: Of 1.969.844 episodes, 7.3% were multiple admissions for ACSC (with an average of 2.7 episodes per patient between 2013 and 2015). These were older (+ 3 years), showed a higher length of stay (+0.81 days) and presented more comorbidities than the patients with only one avoidable admission. Geographic variation of the distribution of multiple avoidable admissions was identified. It was found that age, gender, purchase power, divorce, unemployment, structural resources in health and presence and severity of comorbidities were associated with the multiplicity of avoidable admissions. Conclusion: Amongst patients with ACSC, multiple use of inpatient services was frequent and associated with specific factors: patients with multiple avoidable admissions were older, had more comorbidities and stayed longer in the hospital compared with patients with a single avoidable admissions. Geographically, the frequency of the phenomena was unequally distributed, once the frequency of the phenomenon was associated the predisposing, enabling and need factors.
Descrição
Trabalho Final do Curso de Especialização em Administração Hospitalar
Palavras-chave
Causas sensíveis a cuidados de ambulatório Internamentos evitáveis Internamentos múltiplos Ambulatory care sensitive conditions avoidable hospitalizations Patients' multiple use
Contexto Educativo
Citação
Editora
Universidade Nova de Lisboa, Escola Nacional de Saúde Pública