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Abstract(s)
A demografia de uma sociedade em envelhecimento tem um significativo impacto nos sistemas de saúde em todo o mundo, conduzindo à procura de cuidados continuados integrados. Em Portugal surgiu a Rede Nacional de Cuidados Continuados Integrados (RNCCI) como resposta às novas necessidades, constatando-se taxas de ocupação elevadas nas unidades de internamento; no entanto, nos cuidados domiciliários as taxas são consistentemente mais baixas verificando-se disponibilidade de camas apesar da existência de um número elevado de utentes a aguardar referenciação, com uma mediana de tempo de quatro a catorze dias. Neste contexto esta investigação teve como objetivo, identificar as razões da subreferenciação e avaliar os ganhos em saúde sensíveis aos cuidados de enfermagem em contexto das Equipas de Cuidados Continuados Integrados (ECCI). Foram realizados quatro estudos: Estudo I – revisão integrativa da literatura, teve como objetivo comparar os custos dos cuidados de saúde prestados a pessoas idosas funcionalmente dependentes em contexto domiciliário com os cuidados institucionais; Estudo II – qualitativo, descritivo, exploratório cuja finalidade se inscreveu em conhecer as respostas assistenciais e identificar as dificuldades e constrangimentos no processo de referenciação dos utentes para a RNCCI; Estudo III – quantitativo, retrospetivo, visando caracterizar o perfil dos utentes admitidos pelas ECCI em Portugal; e Estudo IV – estudo de caso (casos múltiplos), quantitativo e retrospetivo que pretendeu avaliar o impacto dos cuidados de enfermagem nos ganhos em saúde dos utentes admitidos numa ECCI. Os resultados revelaram que o processo de referenciação é um procedimento muito burocratizado e moroso, que condiciona e atrasa o acesso dos utentes à RNCCI, agravando o seu estado de saúde. No geral os profissionais desconhecem as ECCI. No âmbito nacional, incluindo na área de investigação efetuada, os utentes admitidos nas ECCI espelham uma população envelhecida com baixo nível de literacia, dependentes na mobilidade (andar), atividades de vida diária, atividades instrumentais e défice no estado cognitivo. Apresentam doenças crónicas com multimorbilidades, baixo potencial de reconstrução de autonomia e grande vulnerabilidade na sua condição de saúde. O número de profissionais nas ECCI é insuficiente, induzindo a procura de serviços de urgência. No entanto, apesar dos parcos recursos, os cuidados prestados pelas equipas multiprofissionais têm um impacto positivo nos ganhos em saúde. Urge uma aposta efetiva na promoção dos cuidados domiciliários, garantindo o acesso atempado e equitativo aos cuidados de saúde, sendo urgente reforçar as equipas com mais profissionais especializados adaptadas às diferentes realidades regionais com vista a uma intervenção mais direcionada e efetiva na prestação de cuidados. O Serviço Nacional de Saúde tem que ser repensado tendo em conta os cuidados de saúde centrados nas pessoas, através da integração dos serviços sociais e de saúde como parceiros no planeamento, desenvolvimento e monitorização do atendimento aos utentes. É necessário investir em políticas públicas eficazes, eficientes inclusivas e inovadoras, definidas por valores e evidências, impulsionadas pela sustentabilidade social, económica e ambiental de forma a garantir melhores resultados de saúde para as populações.
The demographics of an aging society have a significant impact on healthcare systems around the world, driving the demand for integrated long-term care. In Portugal, the National Network for Continuous Integrated Care (RNCCI) emerged as a response to new needs, with high occupancy rates in inpatient units; however, in home care, rates are consistently lower, with beds being available despite the existence of a high number of users waiting for referral, with a median time of four to fourteen days. In this context, this investigation aimed to identify the reasons for under-referencing and to assess the health gains sensitive to nursing care in the context of Integrated Continuing Care Teams (ECCI). Four studies were carried out: Study I – integrative literature review, aimed to compare the costs of health care provided to functionally dependent elderly people in a home context with institutional care; Study II – qualitative, descriptive, exploratory whose purpose was to know the assistance responses and identify the difficulties and constraints in the process of referring users to the RNCCI; Study III – quantitative, retrospective, aiming to characterize the profile of users admitted by ECCI in Portugal; and Study IV – a quantitative and retrospective case study (multiple cases) that aimed to assess the impact of nursing care on health gains in an ECCI. The results revealed that the referral process is a very bureaucratic and lengthy procedure, which conditions and delays users' access to the RNCCI, worsening their health status. In general, professionals are unaware of ECCI. At the national level, including in the area of research carried out, the users admitted to the ECCI mirror an aging population with a low level of literacy, dependent on mobility (walk), activities of daily living, instrumental activities and a deficit in cognitive status. They present chronic diseases with multimorbidities, low potential for autonomy reconstruction and great vulnerability in their health condition. The number of professionals in ECCI is insufficient, inducing the demand for emergency services. However, despite limited resources, the care provided by multidisciplinary teams has a positive impact on health gains. There is an urgent need for an effective commitment to the promotion of home care, ensuring timely and equitable access to health care, and it is urgent to reinforce the teams with more specialized professionals adapted to the different regional realities with a view to a more targeted and effective intervention in the provision of care. The National Health Service needs to be rethought taking into account people centred health care, through the integration of social and health services as partners in the planning, development and monitoring of patient care. It is necessary to invest in effective, efficient, inclusive and innovative public policies, defined by values and evidence, driven by social, economic and environmental sustainability in order to guarantee better health outcomes for populations.
The demographics of an aging society have a significant impact on healthcare systems around the world, driving the demand for integrated long-term care. In Portugal, the National Network for Continuous Integrated Care (RNCCI) emerged as a response to new needs, with high occupancy rates in inpatient units; however, in home care, rates are consistently lower, with beds being available despite the existence of a high number of users waiting for referral, with a median time of four to fourteen days. In this context, this investigation aimed to identify the reasons for under-referencing and to assess the health gains sensitive to nursing care in the context of Integrated Continuing Care Teams (ECCI). Four studies were carried out: Study I – integrative literature review, aimed to compare the costs of health care provided to functionally dependent elderly people in a home context with institutional care; Study II – qualitative, descriptive, exploratory whose purpose was to know the assistance responses and identify the difficulties and constraints in the process of referring users to the RNCCI; Study III – quantitative, retrospective, aiming to characterize the profile of users admitted by ECCI in Portugal; and Study IV – a quantitative and retrospective case study (multiple cases) that aimed to assess the impact of nursing care on health gains in an ECCI. The results revealed that the referral process is a very bureaucratic and lengthy procedure, which conditions and delays users' access to the RNCCI, worsening their health status. In general, professionals are unaware of ECCI. At the national level, including in the area of research carried out, the users admitted to the ECCI mirror an aging population with a low level of literacy, dependent on mobility (walk), activities of daily living, instrumental activities and a deficit in cognitive status. They present chronic diseases with multimorbidities, low potential for autonomy reconstruction and great vulnerability in their health condition. The number of professionals in ECCI is insufficient, inducing the demand for emergency services. However, despite limited resources, the care provided by multidisciplinary teams has a positive impact on health gains. There is an urgent need for an effective commitment to the promotion of home care, ensuring timely and equitable access to health care, and it is urgent to reinforce the teams with more specialized professionals adapted to the different regional realities with a view to a more targeted and effective intervention in the provision of care. The National Health Service needs to be rethought taking into account people centred health care, through the integration of social and health services as partners in the planning, development and monitoring of patient care. It is necessary to invest in effective, efficient, inclusive and innovative public policies, defined by values and evidence, driven by social, economic and environmental sustainability in order to guarantee better health outcomes for populations.
Description
Keywords
Equipas de cuidados continuados integrados Ganhos em saúde Enfermeiros Cuidados de enfermagem Domicílio Integrated continuing care teams Health gains Nurses Nursing care Residence