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Impacto da pandemia COVID-19 no perfil de utilização de um Serviço de Urgência Pediátrica de um hospital de nível III
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Introdução: A pandemia de COVID-19 introduziu mudanças abruptas nos cuidados de saúde a nível global. O fenómeno de sobreutilização dos serviços de saúde coloca em risco a sua sustentabilidade e qualidade. Sendo o Serviço de Urgência Pediátrica (SUPed) sede habitual deste fenómeno, foi objetivo do presente estudo analisar o impacto da pandemia no perfil de utilização do SUPed.
Métodos: Análise retrospetiva dos episódios de urgência ocorridos no período em que se atingiu o pico de incidência de COVID-19 durante a primeira vaga da doença em Portugal (30/03/2020 a 12/04/2020), em comparação com os registados no período homólogo de 2019, num hospital pediátrico de nível III.
Resultados: Foram analisados 3.413 episódios de urgência, 690 no período estudado de 2020 versus 2.723 no período de referência de 2019. No período pandémico verificou-se um aumento da proporção de utentes triados como pouco urgentes ou não urgentes (51,0% versus 45,6%; valor p = 0,01), sem diferença significativa quanto à proporção de visitas classificáveis como evitáveis. Em paralelo, assistiu-se a um aumento da referenciação por parte do Centro de Contacto do Serviço Nacional de Saúde – SNS 24 (24,2% versus 5,9%; valor p <0,001) e da taxa de internamento (12,0% versus 5,6%; valor p <0,001). Constatou-se ainda uma redução do tempo até ao primeiro atendimento médico (19 minutos versus 36 minutos; valor p = 0,001) e, em sentido inverso, um aumento do tempo até à alta (85 minutos versus 69 minutos; valor p = 0,001).
Conclusão: Os resultados deste estudo mostraram um decréscimo de 75% da afluência ao SUPed e sugerem uma redução do fenómeno de sobreutilização. Este padrão, possivelmente atribuível às medidas de Saúde Pública instituídas e ao receio da população em recorrer ao SUPed durante a pandemia, poderá, no entanto, ter afastado doentes com situações clínicas graves dos cuidados de que necessitavam.
Introduction: The COVID-19 pandemic caused a sudden change in global healthcare. Overuse of healthcare services is a phenomenon that challenges its sustainability and quality. As Paediatric Emergency Department (PED) overuse is a well-recognized issue, the aim of this study was to analyse the impact of the pandemic on the PED utilization pattern. Methods: Retrospective analysis of PED visits that occurred from March 30th to April 12th 2020 in a level III paediatric hospital. This was the period in which the peak incidence of COVID-19 was reached, during the first wave of the disease in Portugal. These visits were compared to those recorded in the same period of 2019. Results: A total of 3,413 visits were analysed, 690 in the study period of 2020 versus 2,723 in the reference period of 2019. During the pandemic period, the proportion of users screened as nonurgent increased (51.0% versus 45.6%; p-value = 0.01), with no significant difference in the proportion of avoidable visits. In addition, there was an increase in referral by the National Health Service Contact Centre – SNS 24 (24.2% versus 5.9%; p-value <0.001) and in the hospitalization rate (12.0% versus 5.6%; p-value <0.001). While a reduction in time until the first medical observation was seen (19 minutes versus 36 minutes; p-value = 0.001), there was an increase in time until discharge (85 minutes versus 69 minutes; p-value = 0.001). Conclusion: The results of this study showed a 75% decrease in attendance to PED and suggested a reduction in the PED overuse phenomenon. While this may be attributable to the Public Health measures implemented, delayed care seeking behaviour due to fear of contamination may also have limited access of patients with serious clinical conditions to appropriate care.
Introduction: The COVID-19 pandemic caused a sudden change in global healthcare. Overuse of healthcare services is a phenomenon that challenges its sustainability and quality. As Paediatric Emergency Department (PED) overuse is a well-recognized issue, the aim of this study was to analyse the impact of the pandemic on the PED utilization pattern. Methods: Retrospective analysis of PED visits that occurred from March 30th to April 12th 2020 in a level III paediatric hospital. This was the period in which the peak incidence of COVID-19 was reached, during the first wave of the disease in Portugal. These visits were compared to those recorded in the same period of 2019. Results: A total of 3,413 visits were analysed, 690 in the study period of 2020 versus 2,723 in the reference period of 2019. During the pandemic period, the proportion of users screened as nonurgent increased (51.0% versus 45.6%; p-value = 0.01), with no significant difference in the proportion of avoidable visits. In addition, there was an increase in referral by the National Health Service Contact Centre – SNS 24 (24.2% versus 5.9%; p-value <0.001) and in the hospitalization rate (12.0% versus 5.6%; p-value <0.001). While a reduction in time until the first medical observation was seen (19 minutes versus 36 minutes; p-value = 0.001), there was an increase in time until discharge (85 minutes versus 69 minutes; p-value = 0.001). Conclusion: The results of this study showed a 75% decrease in attendance to PED and suggested a reduction in the PED overuse phenomenon. While this may be attributable to the Public Health measures implemented, delayed care seeking behaviour due to fear of contamination may also have limited access of patients with serious clinical conditions to appropriate care.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
COVID-19 Pandemia Sobreutilização Serviço de Urgência pediátrica