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Abstract(s)
Introdução: O Serviço de UrgĂȘncias vem sendo cada vez mais utilizado, e, muitas vezes, como principal fonte de acesso ao Sistema de SaĂșde. O recurso a este serviço de forma inapropriada Ă© um problema comum, que se traduz pela sobrelotação do mesmo, com consequente diminuição na qualidade dos serviços prestados e aumento dos gastos em saĂșde. SĂŁo considerados utilizadores inapropriados os que recorrem ao serviço de urgĂȘncias 4 ou mais vezes num ano, os hiperutilizadores, e os pacientes que o fazem por queixas que poderiam ser seguidas pelo profissional de cuidados de saĂșde primĂĄrios. O objectivo deste estudo Ă© identificar o padrĂŁo de utilização dos utentes do Serviço de UrgĂȘncia Geral do Centro Hospitalar Cova da Beira, particularmente dos hiperutilizadores e dos pacientes com queixas nĂŁo urgentes, conhecer as suas caracterĂsticas sociodemogrĂĄficas com o intuito de estabelecer o perfil do utilizador desta instituição.
Metodologia: Trata-se de um estudo retrospectivo que incide sobre os utentes que se dirigiram ao Serviço de UrgĂȘncia Geral do Centro Hospitalar Cova da Beira durante os anos de 2009 e 2010. Foram analisadas variĂĄveis demogrĂĄficas (sexo e idade), o local de residĂȘncia, a data de admissĂŁo (mĂȘs, dia da semana e hora), classificação do Sistema de Triagem de Manchester (fluxograma e discriminador), o destino de alta e a medicação.
Resultados: Os hiperutilizadores corresponderam a cerca de 10% dos utentes, sendo responsĂĄveis por aproximadamente 31% das visitas, durante o perĂodo em que decorreu o estudo. Por outro lado, 56,9% e 54,7% dos utentes recorreram ao serviço de urgĂȘncias, pelo menos uma vez, por queixas nĂŁo urgentes, em 2009 e 2010, respectivamente. Os hiperutilizadores pertenciam, mais frequentemente, ao sexo feminino (58,1% em 2009 e 57,2% em 2010), idade superior a 65 anos (46,5% em 2009 e 46,7% em 2010) e residiam, predominantemente, na CovilhĂŁ (40,4% em 2009 e 38,5% em 2010), tendo-se dirigido ao SU maioritariamente por queixas urgentes (61,6% em 2009 e 64,1% em 2010). Por sua vez, os pacientes nĂŁo urgentes pertenciam, mais frequentemente ao sexo feminino (56,3% em 2009 e 55,8% em 2010), tinham entre os 35 e os 64 anos (41,1% em 2009 e 41,8% em 2010) e, novamente, o local de residĂȘncia mais observado foi a CovilhĂŁ com cerca de 32%. O padrĂŁo de utilização do serviço de urgĂȘncia foi semelhante nos hiperutilizadores e nos pacientes nĂŁo urgentes, sendo a âSegundaâ e o horĂĄrio diurno (das 06:00 Ă s 18:00) os que tiveram maior afluĂȘncia. Verificou-se ainda, que a maioria dos pacientes nĂŁo foi encaminhada apĂłs o episĂłdio da urgĂȘncia, incluindo os hiperutilizadores e os utentes nĂŁo urgentes.
ConclusĂŁo: Conclui-se que as mulheres e pacientes residentes na CovilhĂŁ tĂȘm maior probabilidade de serem consideradas inapropriados. Os indivĂduos mais idosos tĂȘm um risco acrescido de serem considerados hiperfrequentadores, jĂĄ o grupo dos pacientes nĂŁo urgentes encontra-se mais entre os 35 e os 64 anos. Ă aconselhĂĄvel orientar os pacientes sobre as situaçÔes que devem ser seguidas pelos cuidados de saĂșde primĂĄrios ou pelo serviço de urgĂȘncia, assim como, garantir o seguimento do paciente apĂłs o episĂłdio, uma vez que, estas medidas se mostraram eficazes na redução da utilização inapropriada. Inferiu-se, tambĂ©m, que os hiperutilizadores, de um modo geral, nĂŁo devem ser considerados inapropriados, uma vez que se dirigem ao serviço de urgĂȘncia por motivos urgentes, na maioria dos episĂłdios.
Introduction: The emergency department has been increasingly used, and, often, as the main route of access to the health care system. The inappropriate use of this service is a common problem that results in overcrowding with consequent decreased quality of care and increased health care costs. Inappropriate users are considered to be those who attend the emergency department 4 or more times during a year, the frequent users, and those who present to this department with complaints that could be followed by the primary care physician. This study aims to identify the utilization pattern of emergency room of Centro Hospitalar Cova da Beira, particularly of the frequent users and non-urgent patients, acknowledge their sociodemographic characteristics trying to establish a profile of the user of this hospital. Methods: A retrospective study conducted on the users of the emergency department of CHCB in 2009 and 2010. Statistic analysis was performed on sociodemographic variables (gender and age), residence, admission time, Manchester Triage System classification, discharge and medication. Results: Frequent users represent 10% of emergency department patients, and accounts for 31% of visits during the study period. On the other hand, 56,9% and 54,7% of the users went to the emergency department, at least once, with non-urgent complaints. Frequent users were, mainly, female (58,1% in 2009 and 57,2% in 2010), above 65 years old (46,5% in 2009 and 46,7% in 2010), lived in CovilhĂŁ (40,4% in 2009 and 38,5% in 2010) and went to the department mostly due to urgent complaints (61,6% in 2009 e 64,1% in 2010). Non-urgent patients were for the most part female (56, 3% in 2009 e 55,8% in 2010), between 35 and 64 years old (41,1% in 2009 and 41,8% in 2010) and from CovilhĂŁ (32%). The utilization pattern was similar in the frequent users and non-urgent patients, with Monday and day shifts (from 6 am to 6 pm) being the most attended. Most patients were not forwarded after the emergency episode, including frequent users and non-urgent patients. Conclusion: Women and patient with residence in CovilhĂŁ are most likely to be inappropriate users. The elderly had higher risk of being frequent users, however, non-urgent patients were between 35 and 64 years old. Patients should be counseled on which situations they should go to emergency department or primary care physician and ensure the patientsâ follow-up by the primary care physician. These measures have been proved to be effective in decreasing the inappropriate use of the department. It was also concluded that frequent users should, no longer, be considered inappropriate users.
Introduction: The emergency department has been increasingly used, and, often, as the main route of access to the health care system. The inappropriate use of this service is a common problem that results in overcrowding with consequent decreased quality of care and increased health care costs. Inappropriate users are considered to be those who attend the emergency department 4 or more times during a year, the frequent users, and those who present to this department with complaints that could be followed by the primary care physician. This study aims to identify the utilization pattern of emergency room of Centro Hospitalar Cova da Beira, particularly of the frequent users and non-urgent patients, acknowledge their sociodemographic characteristics trying to establish a profile of the user of this hospital. Methods: A retrospective study conducted on the users of the emergency department of CHCB in 2009 and 2010. Statistic analysis was performed on sociodemographic variables (gender and age), residence, admission time, Manchester Triage System classification, discharge and medication. Results: Frequent users represent 10% of emergency department patients, and accounts for 31% of visits during the study period. On the other hand, 56,9% and 54,7% of the users went to the emergency department, at least once, with non-urgent complaints. Frequent users were, mainly, female (58,1% in 2009 and 57,2% in 2010), above 65 years old (46,5% in 2009 and 46,7% in 2010), lived in CovilhĂŁ (40,4% in 2009 and 38,5% in 2010) and went to the department mostly due to urgent complaints (61,6% in 2009 e 64,1% in 2010). Non-urgent patients were for the most part female (56, 3% in 2009 e 55,8% in 2010), between 35 and 64 years old (41,1% in 2009 and 41,8% in 2010) and from CovilhĂŁ (32%). The utilization pattern was similar in the frequent users and non-urgent patients, with Monday and day shifts (from 6 am to 6 pm) being the most attended. Most patients were not forwarded after the emergency episode, including frequent users and non-urgent patients. Conclusion: Women and patient with residence in CovilhĂŁ are most likely to be inappropriate users. The elderly had higher risk of being frequent users, however, non-urgent patients were between 35 and 64 years old. Patients should be counseled on which situations they should go to emergency department or primary care physician and ensure the patientsâ follow-up by the primary care physician. These measures have been proved to be effective in decreasing the inappropriate use of the department. It was also concluded that frequent users should, no longer, be considered inappropriate users.
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Keywords
Hospital - Serviço de urgĂȘncias - Perfil do utilizador Hospital - Serviço de urgĂȘncias - Triagem Hospital - Serviço de urgĂȘncias - Hiperutilizadores
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Publisher
Universidade da Beira Interior