Detalhes bibliográficos
| Ano de defesa: |
2010 |
| Autor(a) principal: |
Thumé, Elaine |
| Orientador(a): |
Facchini, Luiz Augusto |
| Banca de defesa: |
Não Informado pela instituição |
| Tipo de documento: |
Tese
|
| Tipo de acesso: |
Acesso aberto |
| Idioma: |
por |
| Instituição de defesa: |
Universidade Federal de Pelotas
|
| Programa de Pós-Graduação: |
Programa de Pós-Graduação em Epidemiologia
|
| Departamento: |
Medicina
|
| País: |
BR
|
| Palavras-chave em Português: |
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| Palavras-chave em Inglês: |
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| Área do conhecimento CNPq: |
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| Link de acesso: |
https://guaiaca.ufpel.edu.br/handle/123456789/1983
|
Resumo: |
In the first article we assessed the utilization of home care by the elderly in Brazil after implementation of the Family Health Strategy (FHS). Data were derived from a crosssectional study in a southern city in Brazil. Using the Chi-square test and a logistic regression with different levels of determination, we tested the hypothesis that the FHS increased the utilization of home care compared with utilization under the Traditional Primary Health Care (TPHC) system. We interviewed 1593 residents aged 60 years and older. Home care utilization under the FHS was 2.7 times the rate of utilization under the TPHC (95% confidence interval=1.5, 4.7; P=.001), and utilization increased among the older group, the less educated, those with history of hospitalization, and those with functional limitations. Improvement in access to care resulted in greater utilization of home care. Our findings have policy implications that include expanding the coverage of the FHS throughout big cities where coverage is limited. These findings are important because the population is aging and the family strategy operates in poorer areas; thus, it can promote equity in access to home health care among the elderly. In the second article the objective was to assess factors associated with home health care for the elderly and its characteristics based on different care models, the Family Health Strategy and Traditional primary care. It also describes the forms of access, the professionals who provide the care, the elderly satisfaction and health status after receiving care. Poisson regression model was used for estimating crude and adjusted prevalence ratios, their related 95% confidence intervals and p-values (Wald test). Home health care was statistically associated with prior history of stroke, signs of dementia and disability in activities of daily living. The family was requested 75% of home care visits. Medical doctors provided most of the care in Traditional primary care settings while nursing staff provided most care within the Family Health strategy. Approximately 78% of the elderly received care within 24 hours after the request and 95% of them positively evaluated the care received. Two thirds of the elderly reported improved health status after receiving home care. The variables associated with home health care were consistent with vulnerability indicators included in the Brazilian National Health Policy for the Elderly, reinforcing the role of this strategy for promoting equitable health care to elderly population. Users satisfaction and the positive impact on their health status support home as a setting for providing care. The objective of the third article was to review the literature in search for tools and indicators proposed for the study of quality assessment of care for the elderly at home. Nineteen articles were selected for inclusion in the analysis. Two instruments are highlighted in the study of quality home care: the Outcome and Assessment Information Set and the Minimum Data Set - Home Care. The hospitalization rate, functional capacity and pain control indicators were used in both instruments to assess quality. This review may help the discussion about the relevance in the development of specific instruments and appropriate indicators to assess home care provided in primary health care, mainly due to the expansion and consolidation of family health strategy. |
