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Abstract(s)
A Rede Nacional de Cuidados Integrados (RNCCI) é um projecto recente, tendo como objectivo geral a prestação de cuidados continuados integrados a pessoas que, independentemente da idade, se encontrem em situação de dependência. Compreende diferentes tipologias de internamento (UC, UMDR, ULDM e UCP), mas principalmente as que se pretendem estudar, são as Unidades de Média Duração e Reabilitação. Com a implementação de um Modelo de Gestão da Doença Crónica, que é a RNCCI, envolvendo parceiros, colaboradores e uma articulação na prestação de cuidados multidisciplinares, pretende-se que contribua e concretize a resposta às reais necessidades em cuidados crónicos, visando a dignidade, o conforto e a qualidade de vida, mesmo em situações irrecuperáveis.
A compreensão do universo qualidade de vida dos utentes internados na RNCCI, constitui um campo de investigação, que só terá significado se for estudado no seu contexto histórico, social e cultural, à dimensão regional e pessoal de cada um que vive e sente.
A dimensão subjectiva da percepção do suporte social é a que proporciona maior ou menor nível de satisfação, variável que melhor explica os resultados de saúde. A saúde mental é um equilíbrio dinâmico que resulta da interacção do indivíduo com o meio envolvente, as suas características orgânicas e os seus antecedentes pessoais e familiares. O suporte social, a saúde mental e a qualidade de vida são conceitos fortemente interdependentes.
No contexto dos serviços de reabilitação, é o conceito de qualidade de vida que parece ser mais sensível às intervenções das equipas multidisciplinares. QVRS abrange mais do que ganho de saúde isoladamente, estando também implícitos a prevenção, o atraso da deterioração e a melhoria da função. É um sentimento que se partilha, e do qual emerge a questão central deste estudo: Qual a Qualidade de Vida Relacionada com a Saúde das pessoas com Doença Crónica Incapacitante e Dependente internadas nas Unidades de Média Duração e Reabilitação da Região Centro?
Objectivos: Face a esta problemática, a presente investigação pretende avaliar a Percepção da Qualidade de Vida da pessoa com Doença Crónica Incapacitante e Dependente, e identificar os factores sócio demográficos, clínicos, psicológicos e situacionais que influenciam os domínios da qualidade de vida, da saúde mental e do suporte social dos utentes internados nas UMDR da Região Centro.
Metodologia: Em termos metodológicos, o presente estudo é considerado quantitativo, não experimental, descritivo, analítico, correlacional, retrospectivo e transversal. Foram incluídos os utentes portadores de doenças crónicas, internados em nove UMDR da região Centro (45% do número total de unidades), no período de 01 de Dezembro 2009 a 28 de Fevereiro 2010, abrangendo o momento da admissão e/ou com pelo menos 60 dias de internamento. Os instrumentos de recolha de dados utilizados neste estudo foram, Questionário de caracterização sócio demográfica, Questionário do estado de saúde do Medical Outcomes Study, referido como SF-36, Escala de Satisfação com o Suporte Social (ESSS) e o Inventário de Saúde Mental, conhecido como MHI.
O Questionário foi aplicado junto de uma amostra que totalizou 46 utentes, correspondendo a 28 observações na primeira avaliação (admissão) e à segunda avaliação com 32 observações (.≥60dias).
Resultados: Através da análise dos dados destaca-se que, 57,0% dos inquiridos são do género feminino; 72,00% provém do meio rural; 67,45% tem idade acima dos 70 anos; 50,00% são casados; 50,00% vive com a esposa/marido; 36.90% residem no distrito da Guarda; 76,10% possui o 1º ciclo de escolaridade; 91,30% é reformado; 54,35% referem rendimento mensal entre 250 e 400€; 34,80% recebem visitas semanalmente; 45,60% com diagnóstico de doenças do aparelho circulatório; a média de internamento centra-se nos 49,78 dias. Relativamente à colheita de dados, verifica-se que 36,90% dos utentes são da UMDR de Gouveia; 30,45% inquiridos na admissão; 39,10% com ≥60 dias da admissão; 30,45% na condição de admissão e ≥60 dias de internamento. Constata-se que a média da qualidade de vida global varia entre os momentos avaliativos (109,93 versus 118,91); a média da qualidade de saúde mental global (139,82 versus 138,94); a média da satisfação com o suporte social global (36,25 versus 36,50).
A consistência interna do questionário foi avaliada através do alfa Cronbach (0,892), o que indica uma medida de boa fiabilidade.
Conclusões: Conclui-se ainda, que os inquiridos na admissão, valorizam a componente saúde física em 38,68 e a componente de saúde mental com 71,25. Os utentes com ≥60 dias de internamento apresentam na componente saúde física, média 41,00, e na componente saúde mental a média 77,91. Obteve-se que o distress psicológico (MHIDIST) tem 82,29 de média e o bem-estar psicológico (MHIBEST) apresenta média igual a 57,54, no momento da admissão. No segundo momento avaliativo o MHIDIST é igual a 86,22 e o MHIBEST apresenta 52,72 de média. A satisfação com o suporte social global não apresenta diferenças significativas entre os dois momentos de avaliação.
A qualidade de vida global apresenta relação com as variáveis sócio demográficas (género, proveniência, coabitação, habilitações académicas), e variável situacional (suporte social). Em relação à qualidade de saúde mental global, verifica-se que esta apresenta relação com as variáveis sócio demográficas (género e coabitação), variável situacional (frequênciade visitas) e tempo de internamento. Confirma-se que, as variáveis sócio demográficas (idade, rendimento mensal, situação profissional) influenciam a satisfação com o suporte social.
Na análise comparativa dos resultados obtidos do grupo inquirido nos dois momentos de avaliação (14 utentes), constata-se que não existe relação com a qualidade de vida global, qualidade de saúde mental e satisfação com o suporte social. Facto este, que pode estar relacionado com o número reduzido da amostra, pois se duplicasse seria muito provável que já houvesse diferenças significativas.
Embora os resultados tenham revelado alguns determinantes preditores da qualidade de vida dos utentes internados nas UMDR da Região Centro, é evidente a necessidade de mudanças por parte do poder público e das instituições prestadoras de cuidados de saúde, especialmente no que diz respeito à afectação de recursos humanos, conforto, humanização dos cuidados e valorização da rede social.
The National Network of Integrated Care (RNCCI) is a recent project, aimed at the integrated long-term care to people, that regardless of age, are in a situation of dependency. There are various types of hospital admissions (UC, UMDR, ULDM and UCP), but the Units of Medium-Term and Rehabilitation will be the ones researched. With the implementation of a Management Model of Chronic Illness (RNCCI), involving partners, associates and an articulation in the provision of multidisciplinary care, it is intended to contribute and materialize the response to real needs in chronic care, seeking dignity, comfort and quality of life, even in unrecoverable situations. The understanding of the universe: quality of life of admitted patients in RNCCI, is a field of inquiry that will only be meaningful if studied in its historical, social and cultural context, on a regional and personal level, according to ones’ lives and feelings. The subjective dimension of social support perception is one that provides a greater or lesser degree of satisfaction, a variable that best explains the results of health. Mental health is a dynamic equilibrium resulting from the interaction of the individual with their surroundings, their organic features and their personal and family history. Social support, mental health and quality of life are highly interdependent concepts. This concept arises a shared feeling, from which the central question of this study emerges: How is the Quality of Life Related to the Health of dependent people with disabling chronic diseases and hospitalized in Medium-Term and Rehabilitation Units of the Central Region? Purposes: In view of this problem, this research intends to assess the perception of the quality of life of dependent people with disabling chronic diseases, and identify the sociodemographic, clinical, psychological and situational factors influencing the domains of quality of life, mental health and social support for UMDR hospitalized users in the Central Region. Methodology: In terms of methodology, this is a quantitative, non experimental, descriptive, analytic, co relational, retrospective and transversal study. Patients with chronic diseases, admitted to nine UMDR the Central region (45% of the total number of units) from the 1st of December, 2009 to the 28th of February, 2010 were included, covering the time of admission and / or at least 60 days of hospitalization. The instruments for collecting data used in this study were a socio demographic questionnaire; a health status questionnaire from the Medical Outcomes Study, referred to as SF-36; the Satisfaction with Social Support Scale (ESSS); and the Mental Health Inventory, known as MHI. The questionnaire was applied with a sample totaling 46 users, corresponding to 28 observations on a first assessment (admission) and a second assessment of 32 observations (≥ 60 days). Results: By analyzing the data we highlight that 57.0% of respondents are female; 72.00% come from rural areas; 67.45% are 70 years old and over; 50.00% are married; 50.00% live with the wife / husband; 36.90% live in the district of Guarda; 76.10% attended only the first cycle of schooling; 91.30% are retired; 54.35% reported a monthly income between € 250-400; 34.80% are visited weekly; 45.60% have a cardiovascular diseases diagnosis; the average hospitalization consists on 49.78 days. For the collection of data, 36.90% of users are from UMDR de Gouveia; 30.45% responded at admission; 39.10% with ≥ 60 days of admission; 30.45% on condition of admission and ≥ 60 days of hospitalization. The overall quality of life average seems to vary between the times of evaluation (109.93 versus 118.91), the overall quality of mental health average (139.82 versus 138.94), and the average satisfaction with global social support (36.25 versus 36.50). The internal consistency of the questionnaire was assessed by Alpha Cronbach (.892), indicating a measure of good reliability. Conclusions: It is further concluded that the patients at admission value the physical health component in 38.68 and the mental health component with 71.25. Users with ≥ 60 days of hospitalization present on the physical health component an average of 41.00, and on the mental health component an average of 77.91. It was found that the psychological distress (MHIDIST) has a 82.29 average and psychological well-being (MHIBEST) presents an average of 57.54 at the time of admission. In the second evaluation stage, MHIDIST is equal to 86.22 and MHIBEST presents an average of 52.72. Satisfaction with the overall social support did not differ significantly between the two periods. The overall quality of life is correlated with the social demographic variables (gender, origin, cohabitation, educational qualifications), and situational variable (social support). Regarding the quality of the overall mental health, it appears that this is correlated with the social demographic variables (gender and cohabitation), situational variable (frequency of visits) and time of admission. It is confirmed that the social demographic variables (age, monthly income, employment status) influence satisfaction with social support. In the results’ comparative analysis of the surveyed group in both periods (14 users), it appears that there is no relation to the overall quality of life, quality of mental health and satisfaction with social support. This may be related to the small sample size, since if we doubled the result, we would very likely be able to see significant differences among them. Although the results have revealed some crucial quality of life predictors of UMDR users, hospitalized in the Central Region, there is a clear that the public authorities and institutions providing health care need to undergo some changes, especially what concerns the allocation of human resources, comfort, care humanization and the appreciation of the social network.
The National Network of Integrated Care (RNCCI) is a recent project, aimed at the integrated long-term care to people, that regardless of age, are in a situation of dependency. There are various types of hospital admissions (UC, UMDR, ULDM and UCP), but the Units of Medium-Term and Rehabilitation will be the ones researched. With the implementation of a Management Model of Chronic Illness (RNCCI), involving partners, associates and an articulation in the provision of multidisciplinary care, it is intended to contribute and materialize the response to real needs in chronic care, seeking dignity, comfort and quality of life, even in unrecoverable situations. The understanding of the universe: quality of life of admitted patients in RNCCI, is a field of inquiry that will only be meaningful if studied in its historical, social and cultural context, on a regional and personal level, according to ones’ lives and feelings. The subjective dimension of social support perception is one that provides a greater or lesser degree of satisfaction, a variable that best explains the results of health. Mental health is a dynamic equilibrium resulting from the interaction of the individual with their surroundings, their organic features and their personal and family history. Social support, mental health and quality of life are highly interdependent concepts. This concept arises a shared feeling, from which the central question of this study emerges: How is the Quality of Life Related to the Health of dependent people with disabling chronic diseases and hospitalized in Medium-Term and Rehabilitation Units of the Central Region? Purposes: In view of this problem, this research intends to assess the perception of the quality of life of dependent people with disabling chronic diseases, and identify the sociodemographic, clinical, psychological and situational factors influencing the domains of quality of life, mental health and social support for UMDR hospitalized users in the Central Region. Methodology: In terms of methodology, this is a quantitative, non experimental, descriptive, analytic, co relational, retrospective and transversal study. Patients with chronic diseases, admitted to nine UMDR the Central region (45% of the total number of units) from the 1st of December, 2009 to the 28th of February, 2010 were included, covering the time of admission and / or at least 60 days of hospitalization. The instruments for collecting data used in this study were a socio demographic questionnaire; a health status questionnaire from the Medical Outcomes Study, referred to as SF-36; the Satisfaction with Social Support Scale (ESSS); and the Mental Health Inventory, known as MHI. The questionnaire was applied with a sample totaling 46 users, corresponding to 28 observations on a first assessment (admission) and a second assessment of 32 observations (≥ 60 days). Results: By analyzing the data we highlight that 57.0% of respondents are female; 72.00% come from rural areas; 67.45% are 70 years old and over; 50.00% are married; 50.00% live with the wife / husband; 36.90% live in the district of Guarda; 76.10% attended only the first cycle of schooling; 91.30% are retired; 54.35% reported a monthly income between € 250-400; 34.80% are visited weekly; 45.60% have a cardiovascular diseases diagnosis; the average hospitalization consists on 49.78 days. For the collection of data, 36.90% of users are from UMDR de Gouveia; 30.45% responded at admission; 39.10% with ≥ 60 days of admission; 30.45% on condition of admission and ≥ 60 days of hospitalization. The overall quality of life average seems to vary between the times of evaluation (109.93 versus 118.91), the overall quality of mental health average (139.82 versus 138.94), and the average satisfaction with global social support (36.25 versus 36.50). The internal consistency of the questionnaire was assessed by Alpha Cronbach (.892), indicating a measure of good reliability. Conclusions: It is further concluded that the patients at admission value the physical health component in 38.68 and the mental health component with 71.25. Users with ≥ 60 days of hospitalization present on the physical health component an average of 41.00, and on the mental health component an average of 77.91. It was found that the psychological distress (MHIDIST) has a 82.29 average and psychological well-being (MHIBEST) presents an average of 57.54 at the time of admission. In the second evaluation stage, MHIDIST is equal to 86.22 and MHIBEST presents an average of 52.72. Satisfaction with the overall social support did not differ significantly between the two periods. The overall quality of life is correlated with the social demographic variables (gender, origin, cohabitation, educational qualifications), and situational variable (social support). Regarding the quality of the overall mental health, it appears that this is correlated with the social demographic variables (gender and cohabitation), situational variable (frequency of visits) and time of admission. It is confirmed that the social demographic variables (age, monthly income, employment status) influence satisfaction with social support. In the results’ comparative analysis of the surveyed group in both periods (14 users), it appears that there is no relation to the overall quality of life, quality of mental health and satisfaction with social support. This may be related to the small sample size, since if we doubled the result, we would very likely be able to see significant differences among them. Although the results have revealed some crucial quality of life predictors of UMDR users, hospitalized in the Central Region, there is a clear that the public authorities and institutions providing health care need to undergo some changes, especially what concerns the allocation of human resources, comfort, care humanization and the appreciation of the social network.
Description
Keywords
Rede Nacional de Cuidados Continuados Integrados (RNCCI) Qualidade de vida - Saúde