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Advisor(s)
Abstract(s)
Introdução: Os Cuidados Paliativos compreendem um conjunto de princípios de
intervenção na prevenção do sofrimento que acompanha a pessoa na vivência de uma
doença limitadora da qualidade e tempo de vida. É desconhecido o custo económico do
cuidado de enfermagem ao utente paliativo em admissão hospitalar evitável, pelo que se
considera a sua determinação o objetivo geral deste estudo.
Mais se reconhece, que a integração dos cuidados paliativos nos sistemas de saúde,
nomeadamente, a existência de uma rede de suporte comunitária pode prevenir estas
admissões e reduzir custos promovendo ganhos em saúde e em qualidade de vida.
Metodologia: O Estudo apresenta-se dividido em três etapas, a primeira que
compreende a revisão integrativa da literatura (RIL) sobre o conceito “urgência
evitável”, a segunda pela obtenção de consenso sobre o conceito “urgência evitável”
com recurso ao Processo Delphi e a terceira e última, pelo estudo observacional,
retrospetivo e analítico englobando os custos económicos dos cuidados de enfermagem
aos utentes paliativos, em serviço de urgência hospitalar.
Resultados: Na RIL obtivemos contributos de 5 artigos analisados, os quais
associados ao Processo Delphi realizado nos permitiu a definição do conceito de
urgência evitável. Do estudo em contexto hospitalar, obteve-se uma amostra de 273
utentes paliativos em admissões hospitalares evitáveis (76,3%,273,IC95%:71,7-80,8), falecidos,
no ano de 2019. Com uma mediana de 84 anos, cerca de 80% foram admitidos a partir
do seu domicílio, após 5h de queixas, maioritariamente, por sintomas respiratórios.
Estes permaneceram cerca de 24h em serviço de urgência geral (SUG) totalizando uma
mediana de 180,98€ de custos por admissão de utente. Extrapolados os dados à
realidade nacional pudemos inferir que os custos globais assumidos com as urgências
evitáveis (5.558.804,16€) poderiam ser realocados à contratação de 229 enfermeiros
(IC95%:216-243).
Discussão: Os resultados obtidos podem ser lidos como contextualizáveis à
evidência, com a limitação de amostras pequenas, estudos diversificados e escassos,
dificultando processos comparativos. Evidenciou-se que, com a poupança assumida e
extrapolada ao contexto nacional, seria possível contratar o número necessário de
enfermeiros para completar e/ou criar o número de equipas comunitárias de suporte em
cuidados paliativos em falta em Portugal e/ou reforçar os recursos humanos das equipas
intra-hospitalares de suporte em cuidados paliativos.
Conclusões: Releva-se a oportunidade de incrementar resultados, gerir recursos e
cimentar a integração dos cuidados paliativos nos sistemas de saúde, assumidos que
estão os seus benefícios como este estudo pôde comprovar.
Introduction: Palliative Care comprises a set of principles of intervention in preventing suffering that accompanies the person in the experience of a disease that limits the quality and time of life. The economic cost of nursing care to palliative patients in avoidable hospital admission is unknown, so its determination is considered the general objective of this study. Palliative care integration in health systems is recognized to prevent these admissions; a community support network can avoid and reduce costs, promoting health and quality of life gains. Methods: The study is divided into three stages, the first comprising the integrative literature review on the concept “avoidable urgency”, the second by obtaining consensus on the concept "avoidable urgency" using the Delphi Process and the third and last, through an observational, retrospective and analytical study encompassing the economic costs of nursing care to palliative patients in a hospital emergency department. Results: At RIL, we obtained contributions from 5 articles analyzed, which, associated with the Delphi Process carried out, allowed us to define the concept of avoidable urgency. From the study in a hospital context, we have a sample of 273 palliative users in preventable hospital admissions (76,3%,273,95%CI:71,7-80,8), deceased, in 2019. With a median of 84 years, about 80% were admitted home after 5 hours of complaints, mainly due to respiratory symptoms. These remained for approximately 24 hours in the general emergency department, totalling a median of €180.98 in costs per user admission. Extrapolating the data to the national reality, we could infer that the global costs incurred with avoidable emergencies (€5.558.804,16) could be reallocated to hiring 229 nurses (95%CI:216-243). Discussion: The results obtained can be read as contextualizing the evidence, with the limitation of small samples diversified and scarce studies, making comparative processes difficult. It was evident that with the savings assumed and extrapolated to the national context, it would be possible to hire the necessary number of nurses to complete and/or create the number of community support teams in palliative care lacking in Portugal and/or reinforce human resources of in-hospital palliative care support teams. Conclusions: There is an opportunity to increase results, manage resources and consolidate the integration of palliative care in health systems, assuming that its benefits are present, as this study was able to prove.
Introduction: Palliative Care comprises a set of principles of intervention in preventing suffering that accompanies the person in the experience of a disease that limits the quality and time of life. The economic cost of nursing care to palliative patients in avoidable hospital admission is unknown, so its determination is considered the general objective of this study. Palliative care integration in health systems is recognized to prevent these admissions; a community support network can avoid and reduce costs, promoting health and quality of life gains. Methods: The study is divided into three stages, the first comprising the integrative literature review on the concept “avoidable urgency”, the second by obtaining consensus on the concept "avoidable urgency" using the Delphi Process and the third and last, through an observational, retrospective and analytical study encompassing the economic costs of nursing care to palliative patients in a hospital emergency department. Results: At RIL, we obtained contributions from 5 articles analyzed, which, associated with the Delphi Process carried out, allowed us to define the concept of avoidable urgency. From the study in a hospital context, we have a sample of 273 palliative users in preventable hospital admissions (76,3%,273,95%CI:71,7-80,8), deceased, in 2019. With a median of 84 years, about 80% were admitted home after 5 hours of complaints, mainly due to respiratory symptoms. These remained for approximately 24 hours in the general emergency department, totalling a median of €180.98 in costs per user admission. Extrapolating the data to the national reality, we could infer that the global costs incurred with avoidable emergencies (€5.558.804,16) could be reallocated to hiring 229 nurses (95%CI:216-243). Discussion: The results obtained can be read as contextualizing the evidence, with the limitation of small samples diversified and scarce studies, making comparative processes difficult. It was evident that with the savings assumed and extrapolated to the national context, it would be possible to hire the necessary number of nurses to complete and/or create the number of community support teams in palliative care lacking in Portugal and/or reinforce human resources of in-hospital palliative care support teams. Conclusions: There is an opportunity to increase results, manage resources and consolidate the integration of palliative care in health systems, assuming that its benefits are present, as this study was able to prove.
Description
Keywords
Cuidados paliativos Serviço de urgência Custo Cuidados de enfermagem Palliative care Emergency service Cost Nursing care