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Resumo(s)
RESUMO - Enquadramento: A procura e o consumo de serviços de saúde variam ao longo do último ano de vida. A distribuição da utilização e dos custos por meses é sensível a diferentes características, entre as quais, idade, género, diagnóstico principal, comorbilidades, proximidade da morte e disponibilidade de recursos na comunidade. Assim, o principal propósito desta investigação é estudar a distribuição da utilização e do consumo de recursos de serviços de saúde, ao longo do último ano de vida.
Metodologia: A amostra foi constituída por todos os doentes com idade superior a 18 anos, que faleceram durante um internamento num hospital, no ano civil de 2013. Foram tidos em consideração os 12 meses anteriores, para cada um dos doentes, por forma a estudar o último ano de vida dos mesmos. Foram analisados a utilização e os custos nos serviços de internamento, urgência e consulta externa. Por forma a obter a distribuição da procura e do consumo de recursos pelos diferentes meses do último ano de vida, assim como a influência das características dos doentes nesta distribuição, apuraram-se os valores mensais da utilização e custos e a percentagem do último mês.
Resultados: Foram incluídos 484 doentes, sendo os doentes do género feminino (53,1%), com idade superior a 75 anos (64,7%) e com diagnóstico principal de sepsis (9,9%) os mais frequentes. A procura pelos cuidados de internamento aumentou no último mês (55%) e as urgências nos últimos três meses, sendo que atingiu o seu máximo no último mês de vida (34%). Os custos estão maioritariamente concentrados no último mês de vida (61%), sendo o internamento responsável por 98% das despesas no último mês de vida.
Conclusões: Os resultados obtidos permitem concluir que a utilização e os custos com os serviços de saúde estão essencialmente concentrados no último mês de vida. Por fim, e de forma a reduzir a utilização e os custos hospitalares no último ano de vida, torna-se basilar reorganizar a rede de cuidados de saúde, nomeadamente na criação de novas unidades de cuidados na comunidade, mais próximos dos doentes e que respondam às necessidades dos mesmos.
ABSTRACT - Context: The search and costs of healthcare services vary throughout a person's last year of life. The distribution of its use and costs per month are sensitive to different characteristics, such as age, gender, main diagnosis, comorbidities, proximity to death and availability of resources in the community. Therefore, the main purpose of this investigation is to study the distribution healthcare services requirements and the costs of resources in the last year of life. Methodology: The sample was constituted by all the patients aged above 18 years old, who died during hospitalization in the year of 2013. It was taken under consideration the 12 previous months for each one of the patients, aiming to study their last year of life. The analysis was focused on healthcare use and its costs, namely in wards, emergency department and outpatients. It was necessary to determine the monthly values of using healthcare services, its costs and the percentage of the last month, in order to obtain a distribution of the demand and consumption of resources through the last 12 months of their lives, as well as to understand the influence of patients' features in this distribution. Results: 484 patients were included, finding more frequently female patients, aged above 75 years old (64,7%), with the main diagnosis of sepsis (9,9%). The demand for hospitalization services increased in the last month of life (55%) as well as the admissions in the emergency department in the last three months, reaching as high as 34% in the last one. The costs are mainly concentrated in the last month of life (61%), being hospitalization responsible for 98% of the expenses in the last month. Conclusions: The final results allow the conclusion that healthcare services utilization and costs are essentially concentrated in the last month of life. Finally, as an attempt to reduce the healthcare demands and costs during that last year, it becomes crucial to reorganize the healthcare network, specially the foundation of new healthcare units in the community, closer to the patients and effectively fulfilling their needs.
ABSTRACT - Context: The search and costs of healthcare services vary throughout a person's last year of life. The distribution of its use and costs per month are sensitive to different characteristics, such as age, gender, main diagnosis, comorbidities, proximity to death and availability of resources in the community. Therefore, the main purpose of this investigation is to study the distribution healthcare services requirements and the costs of resources in the last year of life. Methodology: The sample was constituted by all the patients aged above 18 years old, who died during hospitalization in the year of 2013. It was taken under consideration the 12 previous months for each one of the patients, aiming to study their last year of life. The analysis was focused on healthcare use and its costs, namely in wards, emergency department and outpatients. It was necessary to determine the monthly values of using healthcare services, its costs and the percentage of the last month, in order to obtain a distribution of the demand and consumption of resources through the last 12 months of their lives, as well as to understand the influence of patients' features in this distribution. Results: 484 patients were included, finding more frequently female patients, aged above 75 years old (64,7%), with the main diagnosis of sepsis (9,9%). The demand for hospitalization services increased in the last month of life (55%) as well as the admissions in the emergency department in the last three months, reaching as high as 34% in the last one. The costs are mainly concentrated in the last month of life (61%), being hospitalization responsible for 98% of the expenses in the last month. Conclusions: The final results allow the conclusion that healthcare services utilization and costs are essentially concentrated in the last month of life. Finally, as an attempt to reduce the healthcare demands and costs during that last year, it becomes crucial to reorganize the healthcare network, specially the foundation of new healthcare units in the community, closer to the patients and effectively fulfilling their needs.
Descrição
Trabalho Final do Curso de Especialização em Administração Hospitalar
Palavras-chave
Distribuição Utilização Consumo Último ano de vida Cuidados hospitalares Distribution Utilization Costs Last year of life Hospital healthcare
Contexto Educativo
Citação
Editora
Universidade Nova de Lisboa, Escola Nacional de Saúde Pública