Hiperutilizadores de baixo risco clínico em pronto socorro de um hospital universitário: usuários produzidos ou produtores de cuidado?

• Ano de defesa: 2019
• Autor(a) principal: Sacoman, Thiago Marchi [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP); Brasil
• Palavras-chave em Português: excessive use of health products and services; emergency hospital service; frequent user; triage; inapropriete access to urgency and emergency; uso excessivo de produtos e serviços de saúde; serviço hospitalar de emergência; hiperutilizador; classificação de risco; acesso inapropriado na urgência e emergência; Saúde Coletiva
• Link de acesso: http://repositorio.unifesp.br/handle/11600/50939

Introduction: Overcrowding of the Hospital Emergency Services (HES) has become an increasingly complex challenge for health systems. The interventions advocated by the current public policies tend to give priority to investments in infrastructure and in the organization of environment-centered management processes / technologies, involving the internal processes and outputs of the HES, but leaving out the power of demand analysis of frequent users. The user who attends HES 4 or more times a year is considered frequent user. Several studies highlight frequent users due to the high demand (28%) and associated costs on the HES. However, there are no studies addressing frequent user with low clinical risk in HES. Objective: to describe the pattern of use and to understand the reasons and strategies developed by frequent user of low clinical risk seen in HES. Methodology: the identification of the frequent user was performed through the analysis of the consultations carried out in 2016 by the department emergency of a university hospital (HU) from the information contained in the institution's database. The top 10 low risk frequent users were selected for a more detailed analysis of the HES care, as well as the other services in the HU were tracked through their medical records. The results were systematized and presented to the service managers to collect their perceptions about the service utilization and subsequently analyzed critically. Results and Discussion: In 2016, 8% of the total number of users seen in the HES could be considered frequent users, who demanded 1/3 of the visits. The frequent users classified as low clinical risk represented 3% of users and demanded 10% of the total number of visits. Considering the 10 main frequent users with low clinical risk, the majority of these users are from the health region in which the HES is inserted, have a mean age of 49 years, 70% are male, 60% were in outpatient care and only 1 presented an episode of hospitalization in the year of analysis. In the perception of the managers, the reasons that influence in the utilization of the HES by users of low clinical risk are: user loyalty due to the institutional linkage to specialized clinics; inefficient access to the service network; the professional regulation carried out by the HES workers themselves who control the "door secrets"; the low capacity of APS to produce care and bonding; among others. No strategies of the HES were identified for a differentiated look at the frequent user of the service. The lack of articulation actions along the other points of the emergency SUS and emergency network is a critical point. Conclusion: The analysis of the profile of users seeking urgent care is presented as an instrument to better understand the phenomenon of overcrowding in the RUE. The analysis of the demand of low-risk frequent users in clinical settings in the HES can provide an opportunity to intervene in urgent care processes, reduce expenses associated with emergency services, and articulate care among other points of attention of the network urgency in the quest for the integral care and quality of life of these users. The study raises questions about the production of these frequent users by the university hospital complex itself. It remains open the strategies used by the users in the frequent use of the HES in the search for care, as well as other challenges in the other points of attention of the network that influence the user in this search for recurrent care in the HES. Deepening the understanding of these strategies from the users' own voice can bring new logics on the paths of access to services.