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Impacto no número de referenciações para Cuidados Paliativos relacionado com capacitação em Cuidados de Saúde Primários – Um estudo Pre-Post
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| 11.94 MB | Adobe PDF |
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Abstract(s)
Estima-se que, globalmente, apenas uma exígua percentagem de pessoas com necessidades paliativas recebam Cuidados Paliativos, sendo este acesso condicionado, entre outros, por fatores organizacionais, políticos e educacionais. Tal facto, tem expressão nacional com impacto real a nível das Unidades Locais de Saúde do país. Desta forma, ao nível dos Cuidados de Saúde Primários de uma Unidade Local de Saúde, colocou-se a hipótese da existência de um subdiagnóstico de doentes com necessidades paliativas, e como tal, uma sub-referenciação para Cuidados Paliativos. Concomitantemente, existem diversas recomendações por parte do Governo e de outras entidades acerca da formação dos profissionais, nesta área. Assim, surgiu a necessidade de realizar este estudo, tendo como objetivo avaliar o impacto de uma formação de 8h, nos profissionais de saúde de uma Unidade de Cuidados na Comunidade, no número de referenciações de doentes com necessidades paliativas para Cuidados Paliativos e avaliar a qualidade de vida desses doentes, através do Questionário de Qualidade de Vida McGill, pré e pós integração em equipas especializadas de Cuidados Paliativos. Tratou-se de um Estudo Pre-Post, do tipo intervencional, prospetivo e comparativo, com implementação de 1 de março de 2023 a 26 de junho de 2023. A população-alvo foram os profissionais de saúde da Unidade de Cuidados na Comunidade, tendo sido intervencionados 11 deles. Os dados recolhidos foram tratados pelo método de comparação de resultados, tendo mostrado que, desde a data de criação desta unidade (1 de março de 2023) até à data de 26 de junho de 2023 (pré e pós intervenção), quantitativamente houve zero registos de referenciações. Qualitativamente, percecionou-se, através da análise do grupo focal em reuniões de serviço, maior predisposição dos profissionais para o tema, proporcionando uma abordagem mais dirigida em prol da qualidade de vida do doente e suas famílias. O Questionário de McGill, não foi possível aplicar-se, dado não ter havido referenciações, contudo vimos vertido o mesmo num estudo de caso realizado durante a prática clínica, com ganhos na qualidade de vida do doente. Os resultados pré intervenção podem ser justificados pela falta de conhecimento acerca da identificação de necessidades paliativas e das formas de referenciação, e pela frágil predisposição para esta temática. Os resultados pós intervenção podem ser explicados pela imaturidade prática e/ou destreza na identificação deste grupo específico de doentes, ou pelo facto dos doentes integrados na UCC, no período de análise, não apresentarem efetivamente critérios de referenciação para equipas especializadas. Também, o tempo de intervenção e o período de maturidade da unidade intervencionada poderão ter sido fatores de sub-referenciação. As limitações deste estudo relacionam-se com a possibilidade de não terem sido registadas possíveis referenciações da UCC em análise para CP e possíveis falhas na recolha de informação dos dados informáticos. Espera-se que o estudo apresentado possa dar origem a novas linhas de pesquisa, nomeadamente ao nível da capacitação dos profissionais de todas as unidades dos Cuidados de Saúde Primários do concelho onde decorreu o estudo e da sua predisposição para o tema, e ao nível do reconhecimento das formas de referenciação para Cuidados Paliativos.
Abstract: Globally, it is estimated that only a small percentage of people with palliative care needs receive palliative care, and this access is conditioned by various organizational, political, and educational factors. This fact has national expression with real impact at the level of the Local Health Units of the country. In this context, it was hypothesized that there might be an underdiagnosis of patients with palliative care needs within the Primary Healthcare of a Local Health Unit, leading to a sub-referral to palliative care. Simultaneously, there are several recommendations from the Government and other entities regarding professional training in this area. Thus, the need arose to conduct this study with the objective of evaluating the impact of an 8-hour training program on healthcare professionals within a Community Care Unit, in terms of the number of referrals of patients with palliative care needs to palliative care and assessing the quality of life of these patients using the McGill Quality of Life Questionnaire, before and after integration into specialized palliative care teams. This was a Pre-Post study, of interventional, prospective, and comparative nature. The target population was the healthcare professionals of the Community Care Unit, and a total of 11 professionals were intervened upon. The collected data were analysed using the results comparison method, which showed that from the date of the creation of this unit (March 1, 2023) until June 26, 2023 (pre- and post-intervention), there were zero records of referrals in quantitative terms. Qualitatively, it was perceived, through the analysis of the focal group in service meetings, a greater predisposition of professionals towards the topic, providing a more targeted approach in favour of the quality of life of the patients and their families. The McGill Questionnaire could not be applied due to the lack of referrals. However, it was applied in a case study conducted during clinical practice, which showed improvements in the patient's quality of life. The pre-intervention results can be justified by the lack of knowledge about identifying palliative care needs and the forms of referral, as well as the fragile disposition towards this subject. The post-intervention results can be explained by the practical immaturity and/or lack of skill in identifying this specific group of patients, or by the fact that the patients integrated into the Community Care Unit during the analysis period did not effectively meet the referral criteria for specialized teams. Additionally, the intervention duration and the maturity period of the intervened unit may have contributed to under-referral. The limitations of this study are related to the possibility of not recording potential referrals from the analysed Community Care Unit to palliative care and possible failures in the collection of data from computerized systems. XII It is expected that the presented study may lead to new lines of research, particularly in terms of empowering professionals from all Primary Healthcare Units in the municipality where the study took place and their disposition towards the subject, as well as recognizing the forms of referral to palliative care
Abstract: Globally, it is estimated that only a small percentage of people with palliative care needs receive palliative care, and this access is conditioned by various organizational, political, and educational factors. This fact has national expression with real impact at the level of the Local Health Units of the country. In this context, it was hypothesized that there might be an underdiagnosis of patients with palliative care needs within the Primary Healthcare of a Local Health Unit, leading to a sub-referral to palliative care. Simultaneously, there are several recommendations from the Government and other entities regarding professional training in this area. Thus, the need arose to conduct this study with the objective of evaluating the impact of an 8-hour training program on healthcare professionals within a Community Care Unit, in terms of the number of referrals of patients with palliative care needs to palliative care and assessing the quality of life of these patients using the McGill Quality of Life Questionnaire, before and after integration into specialized palliative care teams. This was a Pre-Post study, of interventional, prospective, and comparative nature. The target population was the healthcare professionals of the Community Care Unit, and a total of 11 professionals were intervened upon. The collected data were analysed using the results comparison method, which showed that from the date of the creation of this unit (March 1, 2023) until June 26, 2023 (pre- and post-intervention), there were zero records of referrals in quantitative terms. Qualitatively, it was perceived, through the analysis of the focal group in service meetings, a greater predisposition of professionals towards the topic, providing a more targeted approach in favour of the quality of life of the patients and their families. The McGill Questionnaire could not be applied due to the lack of referrals. However, it was applied in a case study conducted during clinical practice, which showed improvements in the patient's quality of life. The pre-intervention results can be justified by the lack of knowledge about identifying palliative care needs and the forms of referral, as well as the fragile disposition towards this subject. The post-intervention results can be explained by the practical immaturity and/or lack of skill in identifying this specific group of patients, or by the fact that the patients integrated into the Community Care Unit during the analysis period did not effectively meet the referral criteria for specialized teams. Additionally, the intervention duration and the maturity period of the intervened unit may have contributed to under-referral. The limitations of this study are related to the possibility of not recording potential referrals from the analysed Community Care Unit to palliative care and possible failures in the collection of data from computerized systems. XII It is expected that the presented study may lead to new lines of research, particularly in terms of empowering professionals from all Primary Healthcare Units in the municipality where the study took place and their disposition towards the subject, as well as recognizing the forms of referral to palliative care
Description
Relatório de Prática Clínica apresentado à Escola Superior de Saúde Dr. Lopes Dias do Instituto Politécnico de Castelo Branco para obtenção do Grau de Mestre em Cuidados Paliativos.
Keywords
Cuidados paliativos Cuidados de saúde primários Referenciação Formação Palliative care Primary healthcare Referral Training