Ganhos em saúde sensíveis aos cuidados de enfermagem em contexto das equipas de cuidados continuados integrados

Abstract

The demographics of an aging society have a significant impact on healthcare systems around the world, driving the demand for integrated long-term care. In Portugal, the National Network for Continuous Integrated Care (RNCCI) emerged as a response to new needs, with high occupancy rates in inpatient units; however, in home care, rates are consistently lower, with beds being available despite the existence of a high number of users waiting for referral, with a median time of four to fourteen days. In this context, this investigation aimed to identify the reasons for under-referencing and to assess the health gains sensitive to nursing care in the context of Integrated Continuing Care Teams (ECCI). Four studies were carried out: Study I – integrative literature review, aimed to compare the costs of health care provided to functionally dependent elderly people in a home context with institutional care; Study II – qualitative, descriptive, exploratory whose purpose was to know the assistance responses and identify the difficulties and constraints in the process of referring users to the RNCCI; Study III – quantitative, retrospective, aiming to characterize the profile of users admitted by ECCI in Portugal; and Study IV – a quantitative and retrospective case study (multiple cases) that aimed to assess the impact of nursing care on health gains in an ECCI. The results revealed that the referral process is a very bureaucratic and lengthy procedure, which conditions and delays users' access to the RNCCI, worsening their health status. In general, professionals are unaware of ECCI. At the national level, including in the area of research carried out, the users admitted to the ECCI mirror an aging population with a low level of literacy, dependent on mobility (walk), activities of daily living, instrumental activities and a deficit in cognitive status. They present chronic diseases with multimorbidities, low potential for autonomy reconstruction and great vulnerability in their health condition. The number of professionals in ECCI is insufficient, inducing the demand for emergency services. However, despite limited resources, the care provided by multidisciplinary teams has a positive impact on health gains. There is an urgent need for an effective commitment to the promotion of home care, ensuring timely and equitable access to health care, and it is urgent to reinforce the teams with more specialized professionals adapted to the different regional realities with a view to a more targeted and effective intervention in the provision of care. The National Health Service needs to be rethought taking into account people centred health care, through the integration of social and health services as partners in the planning, development and monitoring of patient care. It is necessary to invest in effective, efficient, inclusive and innovative public policies, defined by values and evidence, driven by social, economic and environmental sustainability in order to guarantee better health outcomes for populations.

Date of Award	13 May 2024
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Supervisor	João Costa Amado (Supervisor) & Pedro Miguel Santos Dinis Parreira (Co-Supervisor)