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Advisor(s)
Abstract(s)
Com o aumento da esperança média de vida, os cuidados dispensados ao doente crónico tornaram-se numa área importante no contexto dos serviços de saúde. Ou seja, os serviços de saúde que até então, estavam centrados em tratar a doença, passam a estar cada vez mais voltados para a necessidade de oferecer cuidados paliativos, ao invés de curativos. Com a criação da Rede Nacional de Cuidados Continuados Integrados (RNCCI), são as Unidades de Longa Duração e Manutenção (ULDM) que recebem mais doentes dependentes, com necessidade de cuidados de conforto e ações paliativas. Existem estudos que garantem que a implementação de um modelo paliativo reduz os custos e torna mais eficiente a gestão e a
utilização de recursos humanos e materiais. É um estudo quantitativo e descritivo, de caráter retrospetivo, cujos objetivos gerais foram: desenvolver um estudo comparativo entre as práticas em uso na Instituição, desde a sua abertura (de Agosto de 2015 a Agosto de 2018); uniformizar estratégias de monitorização; propor um modelo de gestão em saúde que tenha em consideração a diminuição do sofrimento e a eficiência dos recursos. Como objetivos específicos pretendeu-se: identificar as práticas em uso na Instituição; identificar
as necessidades e ajustar o plano terapêutico, de forma a melhorar a qualidade de vida e a minimizar o seu sofrimento, e, desta forma economizar recursos financeiros; apresentar um estudo acerca de todos os custos inerentes ao objeto de estudo; apresentar uma proposta estratégica de gestão dos casos considerados em fim de vida inseridos em ULDM. A população foi constituída por 249 utentes. Da amostra, constaram os utentes que faleceram, sendo analisados os últimos 30 dias de vida, em termos de recursos utilizados (humanos, materiais, em fornecimentos externos e valores de amortização do edifício). Correspondeu a um total de 57 utentes e permitiu um apuramento do valor diário de comparticipação pelo seu internamento, que se demonstrou ser superior ao valor comparticipado. Foi possível concluir que o financiamento devido na RNCCI às ULDM, não tem em conta as reais necessidades desta tipologia de utentes, exigindo das Instituições a alocação de recursos humanos e materiais superiores ao comparticipado. No final do período analisado obtevese um saldo negativo, no entanto as práticas e procedimentos utilizados demonstram que existe uma orientação para o utente, apresentando-se um modelo com base nos cuidados paliativos que promova o envolvimento e a eficiência de recursos.
With the increase in life expectancy, the care provided to chronic ill became a major area in the context of health services. In other words, the health services that until then were focused on treating the disease, were focused on treating the disease, are increasingly facing the need to offer palliative care, instead of curative care. With the creation of the Nacional Continuing Care System (NCCS), are the Long Term Care and Maintenance (LTCM), receiving more patients dependent on, in need of comfort care and palliative actions. There are studies to ensure that the implementation of a palliative model reduces costs and makes more efficient management and use of human and material resources. It is a retrospective quantitative and descriptive study, whose general objectives were: to develop a comparative study between the practices in use in the Institution, since its opening (from August 2015 to August 2018); standardize monitoring strategies; propose a health management model that takes into account the reduction of suffering and the efficiency of resources. Specific objectives were: to identify the practices in use in the Institution; identify needs and adjust the therapeutic plan in order to improve the quality of life and minimize their suffering, thus saving financial resources; present a study about all the costs inherent to the object of study; present a strategic proposal for the management of the cases considered at the end of life inserted in LTCM. The population was constituted by 249 users. The sample consisted of users who have died, being analyzed the last 30 days, in terms of resources employed (human, material, and supplies depreciation values of the building). It corresponded to a total of 57 users and allowed a calculation of the daily value of reimbursement for their hospitalization, which was shown to be higher than the reimbursed amount. It was possible to conclude that the NCCS funding due to the LTCM does not take into account the real needs of this typology of patient, requiring the Institutions to allocate human and material resources superior to the reimbursed. At the end of the analysis period was obtained a negative balance, however, the practices and procedures demonstrate there is an orientation to the patient, presenting a model based on palliative care that promotes involvement and resource efficiency.
With the increase in life expectancy, the care provided to chronic ill became a major area in the context of health services. In other words, the health services that until then were focused on treating the disease, were focused on treating the disease, are increasingly facing the need to offer palliative care, instead of curative care. With the creation of the Nacional Continuing Care System (NCCS), are the Long Term Care and Maintenance (LTCM), receiving more patients dependent on, in need of comfort care and palliative actions. There are studies to ensure that the implementation of a palliative model reduces costs and makes more efficient management and use of human and material resources. It is a retrospective quantitative and descriptive study, whose general objectives were: to develop a comparative study between the practices in use in the Institution, since its opening (from August 2015 to August 2018); standardize monitoring strategies; propose a health management model that takes into account the reduction of suffering and the efficiency of resources. Specific objectives were: to identify the practices in use in the Institution; identify needs and adjust the therapeutic plan in order to improve the quality of life and minimize their suffering, thus saving financial resources; present a study about all the costs inherent to the object of study; present a strategic proposal for the management of the cases considered at the end of life inserted in LTCM. The population was constituted by 249 users. The sample consisted of users who have died, being analyzed the last 30 days, in terms of resources employed (human, material, and supplies depreciation values of the building). It corresponded to a total of 57 users and allowed a calculation of the daily value of reimbursement for their hospitalization, which was shown to be higher than the reimbursed amount. It was possible to conclude that the NCCS funding due to the LTCM does not take into account the real needs of this typology of patient, requiring the Institutions to allocate human and material resources superior to the reimbursed. At the end of the analysis period was obtained a negative balance, however, the practices and procedures demonstrate there is an orientation to the patient, presenting a model based on palliative care that promotes involvement and resource efficiency.
Description
Keywords
Cuidados Paliativos Custos em fim de vida Gestão em saúde Cuidados Continuados Longa duração e Manutenção Palliative care End-of-life costs Health management Continuing care Long term care and Maintenance