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Abstract(s)
Introdução: Em resposta à situação económica desfavorável vivida em Portugal, foi firmado, em 2011, o Memorando de Entendimento entre o Governo Português e a Comissão Tripartida - Fundo Monetário Internacional, Comissão Europeia e Banco Central Europeu. Deste resultaram diversas medidas no setor da saúde, nomeadamente, a atualização das taxas moderadoras. Assim, em janeiro de 2012, com a entrada em vigor do Decreto-Lei n.º 113/2011, de 29 de novembro, verificaram-se aumentos de mais de 100% no valor das taxas moderadoras. Com este projeto pretende-se avaliar se a revisão do regime de taxas moderadoras em 2012 provocou alterações na utilização efetiva do Serviço de Urgência Geral do Centro Hospitalar Cova da Beira.
Materiais e métodos: Estudo retrospetivo e observacional, de caráter descritivo e analítico que se focou sobre os utentes com idade igual ou superior a 18 anos, que recorreram ao Serviço de Urgência Geral do Centro Hospitalar Cova da Beira, no período de 01 de janeiro de 2011 a 31 de dezembro de 2012. Sobre cada episódio de urgência foi recolhida informação acerca da data a que ocorreu o mesmo, idade e sexo do utente, prioridade atribuída segundo a triagem de Manchester, estado de isenção de taxa moderadora (isento vs não isento) e número identificativo único para cada utente. A análise estatística, bem como o tratamento de dados e a apresentação dos mesmos, foram realizados recorrendo ao programa Microsoft Office Excel 2007TM.
Resultados: Entre 2011 e 2012, verificou-se uma redução de 9,9% no número total de episódios no Serviço de Urgência Geral do Centro Hospitalar Cova da Beira. A taxa de variação é significativa apenas para os “Não isentos” (-21,2%). Em relação ao número médio de episódios por utente, este diminuiu, tanto nos episódios “Urgentes” (-0,8% nos “Isentos” e -5,4% nos “Não isentos”), como nos “Não urgentes” (-4,9% nos “Isentos” e -7,2% nos “Não isentos”). Na análise da prioridade atribuída na triagem de Manchester, as diferenças entre o grupo “Urgente” e o grupo “Não urgente” são significativas a um nível de 1%, no entanto, são independentes do estado de isenção (p-value=0,282).
Conclusão: Ao aumento das taxas moderadoras, ocorrido em janeiro de 2012, estiveram associadas reduções significativas no número total de episódios e no número médio de episódios por utente, principalmente nos não urgentes, no Serviço de Urgência Geral do Centro Hospitalar Cova da Beira. No entanto, a medida em estudo não explica as alterações verificadas nas proporções das prioridades atribuídas na triagem de Manchester durante o mesmo período. Sugerem-se estudos similares em outras unidades hospitalares, bem como a análise das alterações que ocorreram em simultâneo na utilização dos cuidados de saúde primários. Aconselha-se também a realização de um inquérito junto dos cidadãos para melhor avaliar as situações em que o recurso ao serviço de urgência foi evitado.
Introduction: In response to the unfavorable economic situation experienced in Portugal, the Memorandum of Understanding between the Portuguese Government and the Tripartite Commission - International Monetary Fund, European Commission and European Central Bank was signed in 2011. This resulted in several measures in the health sector, in particular, the update of user fees. Thus, in January 2012, with the entry into force of Decree-Law n. º 113/2011 of 29 November, there were increases of over 100% in the amount of user fees. This project aims to assess whether the review of the system of user fees in 2012 led to changes in the effective use of the Service Emergency Department of Cova da Beira Hospital Centre. Materials and methods: retrospective and observational, descriptive and analytical approach which focused on clients aged over 18 years who assisted in the Emergency Department of the Cova da Beira Hospital, between January 1, 2011 to December 31, 2012. Upon each episode, the emergency information was gathered regarding the date that occurred, as well as, the age and gender of the user, according to the priority screening Manchester, state of exemption from prescription charges (exempt vs. non-exempt) and unique identification number for each user. Statistical analysis, data handling and presentation of the results, was performed using the Microsoft Office Excel 2007TM program. Results: Between 2011 and 2012, there was a 9.9% decrease in the total number of episodes in the Department of General Urgency of Cova da Beira Hospital Centre. The rate of change was significant only for the "not free" (-21.2%). Regarding the average number of episodes per user, it decreased in both episodes "urgent" (-0.8% in the "exempt" and -5.4% in the "not free"), as in "not urgent" (- 4.9% in the "exempt" and -7.2% in the "not free"). In analyzing the priority Manchester triage, the differences between the "urgent" group and the "Not Urgent" group are significant at the 1% level, however, they are independent of the state exemption (p-value = 0.282). Conclusion: The increase of user fees, which occurred in January 2012, was associated with significant reductions in the total number of episodes and the average number of episodes per user, especially in non-emergency, in the Department of General Urgency of Cova da Beira Hospital Centre. However, the study does not explain the changes in the proportions of the colors assigned to screen Manchester during the same period. We suggest similar studies in other hospital units, as well as analysis of the changes that occurred simultaneously in the use of primary care. It is also advisable to conduct a survey of citizens to better assess situations in which the use of the emergency service was avoided.
Introduction: In response to the unfavorable economic situation experienced in Portugal, the Memorandum of Understanding between the Portuguese Government and the Tripartite Commission - International Monetary Fund, European Commission and European Central Bank was signed in 2011. This resulted in several measures in the health sector, in particular, the update of user fees. Thus, in January 2012, with the entry into force of Decree-Law n. º 113/2011 of 29 November, there were increases of over 100% in the amount of user fees. This project aims to assess whether the review of the system of user fees in 2012 led to changes in the effective use of the Service Emergency Department of Cova da Beira Hospital Centre. Materials and methods: retrospective and observational, descriptive and analytical approach which focused on clients aged over 18 years who assisted in the Emergency Department of the Cova da Beira Hospital, between January 1, 2011 to December 31, 2012. Upon each episode, the emergency information was gathered regarding the date that occurred, as well as, the age and gender of the user, according to the priority screening Manchester, state of exemption from prescription charges (exempt vs. non-exempt) and unique identification number for each user. Statistical analysis, data handling and presentation of the results, was performed using the Microsoft Office Excel 2007TM program. Results: Between 2011 and 2012, there was a 9.9% decrease in the total number of episodes in the Department of General Urgency of Cova da Beira Hospital Centre. The rate of change was significant only for the "not free" (-21.2%). Regarding the average number of episodes per user, it decreased in both episodes "urgent" (-0.8% in the "exempt" and -5.4% in the "not free"), as in "not urgent" (- 4.9% in the "exempt" and -7.2% in the "not free"). In analyzing the priority Manchester triage, the differences between the "urgent" group and the "Not Urgent" group are significant at the 1% level, however, they are independent of the state exemption (p-value = 0.282). Conclusion: The increase of user fees, which occurred in January 2012, was associated with significant reductions in the total number of episodes and the average number of episodes per user, especially in non-emergency, in the Department of General Urgency of Cova da Beira Hospital Centre. However, the study does not explain the changes in the proportions of the colors assigned to screen Manchester during the same period. We suggest similar studies in other hospital units, as well as analysis of the changes that occurred simultaneously in the use of primary care. It is also advisable to conduct a survey of citizens to better assess situations in which the use of the emergency service was avoided.
Description
Keywords
Hospital Memorando de Entendimento Serviço de Urgência Taxas Moderadoras