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O custo de prevenção e tratamento de úlceras de pressão: revisão da literatura
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Introdução: As úlceras de pressão (UP) são consideradas um problema de saúde pública, comum em muitos ambientes de cuidados e um indicador da qualidade dos cuidados prestados (1). Esta problemática tem vindo a obter grande preocupação política e económica, devido aos encargos financeiros para os sistemas de saúde, perda e comprometimento de qualidade de vida, quer para o indivíduo portador de UP e dos seus cuidadores quer para a sociedade (2). A necessidade de cuidados de saúde de alta qualidade, enquanto os gastos são limitados, tem despertado interesse na elaboração de estudos com o objetivo de calcular o custo da prevenção e do tratamento das UP assim como o impacto nos utentes e sociedade (3). Objetivo: Analisar os custos da prevenção e tratamento das UP na população adulta, em qualquer ambiente de cuidados, através da análise de estudos que visam medir o impacto económico desta problemática. Material e Métodos: Nesta pesquisa foi realizada uma revisão da literatura sobre UP e custo dos artigos publicados nas bases de dados da BVS e EBSCOhost entre janeiro de 2005 e dezembro de 2015, escritos em português, inglês e espanhol. Foram utilizados os descritores MSH “cost of pressure ulcer or treatment and cost estimates and cost per patient or cost per patient per day”. A recolha e análise dos dados foram realizadas entre os meses de janeiro e fevereiro de 2016. Resultados / Discussão: Nesta pesquisa foram identificadas 84 publicações, após a análise do título e do resumo foram selecionadas 12 para integrar esta análise. Numa época em que assistimos a uma mudança organizacional dos cuidados de saúde e em que as instituições de saúde têm como objetivo estratégico prestar cuidados com maior eficiência, tanto em termos de custos como em termos clínicos, quantificar o custo das UP torna-se cada vez mais relevante porque permite realçar a magnitude desta problemática. A análise dos artigos publicados revelou uma grande discrepância nos resultados apresentados. O custo médio da prevenção das UP em utentes com risco foi estimado em 2,15 € por dia nos lares de idosos e 7,88 € nos hospitais e nos utentes sem risco variou entre 0,50 € por dia nos lares de idosos e 1,44 € nos hospitais (5). O custo estimado do tratamento de uma UP nos hospitais variou entre 24 € (categoria I) (4) e 11355 € (categoria IV) (3) e nos cuidados de saúde primários entre 108 € (categoria I) e 2868 € (categoria IV) (4). O principal fator pelos custos foi o custo associado aos cuidados de prevenção, devido ao reposicionamento regular e avaliação do risco, que variou ente 19% e 90% (3) (4). Para os gestores é relevante conhecer o custo potencial das UP porque os custos dos recursos para o hospital são suscetíveis de ser substanciais (3) (6). Dealey, Posnett e Walker (2012) verificaram que 5 a 8 dias de internamento hospitalar adicional, nos utentes que adquiriram uma UP, representou um aumento de 4,35 milhões € anuais e que uma redução de apenas 20% das UP poderia gerar uma poupança de cerca de 868762 € anuais (3). Estes dados destacam a importância da prevenção, implementação de medidas eficazes de identificação e tratamentos, de forma a evitar que a gravidade das UP aumente e os utentes fiquem mais suscetíveis a infeções e outras complicações que pode levar à hospitalização e com isso aumentar os custos dos tratamentos de forma substancial. Conclusão: Numa época pautada por uma profunda crise económica, é essencial compreender os custos relacionados com a prevenção e tratamento das UP. Os resultados destes estudos podem ajudar os políticos e gestores dos serviços de saúde a identificar os fatores de custo da prevenção e tratamento das UP e na tomada de decisões sobre o planeamento, a alocação de recursos e definição de prioridades das despesas de saúde para melhorar a implementação de medidas preventivas.
Introduction: Pressure ulcers (PU) are considered a public health problem, common in many care settings and an indicator of the quality care (1). This problem has been getting great political and economic concern, due to the financial burden on health system, loss and weakening of life quality, both for the PU patients, their caregivers and society (2). The need for high quality health care with in limited budget, has aroused interest in the preparation of studies in order to calculate the cost of prevention and treatment of PU as well as the impact on patients and society (3). Objective: Analysing costs of prevention and treatment of PU in adult population in any care environment through the analysis of studies aimed at measuring the economic impact of this problem. Material and Methods: In this research a literature review of PU and cost was carried out, using articles published in the databases of the BVS and EBSCOhost between January 2005 and December 2015, written in Portuguese, English and Spanish. MSH descriptors "cost of pressure ulcer or treatment and cost estimates and cost per patient or cost per patient per day" were used. The data collection and analysis was carried out from January to February 2016. Results / Discussion: In this research 84 publications were identified, after examining title and abstract 12 were selected to integrate this analysis. At a time when we witness an organizational change in health care, and that health institutions have a strategic goal to provide care more efficiently, both in costs and clinical terms, quantifying the cost of PU´s becomes increasingly more relevant because it allows to highlight the magnitude of this problem. It is important that doctors, nurses and managers understand the economic costs that are associated with the PU´s, so that they can ensure that the most effective means are used to prevent and treat the damage caused by pressure (4). The analysis of published articles revealed a large discrepancy in reported results. The average cost of prevention of PU´s patients at risk was estimated at 2.15 € per day in nursing homes and 7.88 € in hospitals and patients without risk ranged between 0.50 Euro per day in nursing homes and 1,44 € in hospitals (5). The estimated cost of treating a PU in hospitals ranged from 24 € (category I) (4) and 11,355 € (category IV) (3) and in primary health care between 108 € (category I) and 2868 € (category IV) (4). The main factor for the costs was the expense associated with preventive care due to regular repositioning and risk assessment, which ranged from 19% to 90% (3) (4). For managers it is important to know the potential cost of the PU´s because the resource costs for the hospital are likely to be substantial (3) (6). Dealey, Posnett and Walker (2012) found that 5 to 8 days of additional hospitalization in patients who developed PU´S, caused an increase of 4.35 million € per year, and a reduction of only 20% of the PU´s could generate savings about 868,762 € per year (3). These data highlight the importance of prevention, the implementation of effective identification and treatment measures in order to prevent the increase in PU’s severity and patients becoming more prone to infections and other complications that may lead to hospitalization and thus increase substantially the costs of treatments. Conclusion: At a time marked by a deep economic crisis, it is essential to understand the costs related to the prevention and treatment of PU’S. The results of these studies can help politicians and health services managers to identify the cost factors of prevention and treatment of PU´s and in making decisions on planning, resource allocation and prioritization of health spending to improve implementation of preventive measures.
Introduction: Pressure ulcers (PU) are considered a public health problem, common in many care settings and an indicator of the quality care (1). This problem has been getting great political and economic concern, due to the financial burden on health system, loss and weakening of life quality, both for the PU patients, their caregivers and society (2). The need for high quality health care with in limited budget, has aroused interest in the preparation of studies in order to calculate the cost of prevention and treatment of PU as well as the impact on patients and society (3). Objective: Analysing costs of prevention and treatment of PU in adult population in any care environment through the analysis of studies aimed at measuring the economic impact of this problem. Material and Methods: In this research a literature review of PU and cost was carried out, using articles published in the databases of the BVS and EBSCOhost between January 2005 and December 2015, written in Portuguese, English and Spanish. MSH descriptors "cost of pressure ulcer or treatment and cost estimates and cost per patient or cost per patient per day" were used. The data collection and analysis was carried out from January to February 2016. Results / Discussion: In this research 84 publications were identified, after examining title and abstract 12 were selected to integrate this analysis. At a time when we witness an organizational change in health care, and that health institutions have a strategic goal to provide care more efficiently, both in costs and clinical terms, quantifying the cost of PU´s becomes increasingly more relevant because it allows to highlight the magnitude of this problem. It is important that doctors, nurses and managers understand the economic costs that are associated with the PU´s, so that they can ensure that the most effective means are used to prevent and treat the damage caused by pressure (4). The analysis of published articles revealed a large discrepancy in reported results. The average cost of prevention of PU´s patients at risk was estimated at 2.15 € per day in nursing homes and 7.88 € in hospitals and patients without risk ranged between 0.50 Euro per day in nursing homes and 1,44 € in hospitals (5). The estimated cost of treating a PU in hospitals ranged from 24 € (category I) (4) and 11,355 € (category IV) (3) and in primary health care between 108 € (category I) and 2868 € (category IV) (4). The main factor for the costs was the expense associated with preventive care due to regular repositioning and risk assessment, which ranged from 19% to 90% (3) (4). For managers it is important to know the potential cost of the PU´s because the resource costs for the hospital are likely to be substantial (3) (6). Dealey, Posnett and Walker (2012) found that 5 to 8 days of additional hospitalization in patients who developed PU´S, caused an increase of 4.35 million € per year, and a reduction of only 20% of the PU´s could generate savings about 868,762 € per year (3). These data highlight the importance of prevention, the implementation of effective identification and treatment measures in order to prevent the increase in PU’s severity and patients becoming more prone to infections and other complications that may lead to hospitalization and thus increase substantially the costs of treatments. Conclusion: At a time marked by a deep economic crisis, it is essential to understand the costs related to the prevention and treatment of PU’S. The results of these studies can help politicians and health services managers to identify the cost factors of prevention and treatment of PU´s and in making decisions on planning, resource allocation and prioritization of health spending to improve implementation of preventive measures.
Descrição
Palavras-chave
Cost Custo Pressure ulcer Prevenção Prevention Tratamento Treatment Úlceras de pressão
Contexto Educativo
Citação
Teixeira, S. A. F., & Neves, V. M. D. S. (2016). O custo de prevenção e tratamento de úlceras de pressão: revisão da literatura. In M. M. Vieira, J. Neves-Amado, B. Araújo, & S. Deodato (Eds.), 10th International Seminar on Nursing Research proceedings (pp. 132-133). Universidade Catolica Portuguesa.
Editora
Universidade Catolica Portuguesa
Licença CC
Sem licença CC