Continuidade do cuidado ao paciente após a alta hospitalar

Abstract

To analyze how the articulation between hospital and primary health care (PHC) occurs, in relation to the patient discharge and continuity of caring after hospitalization; to investigate the practice and the time dedicated by PHC nurses to the actions concerning this process. Methods: Mixed sequential exploratory strategy was developed in three stages. Stage 1 - had as settings a Basic Health Unit, 10 Family Health Strategies and a private teaching hospital in the state of São Paulo. Four focus group sessions were accomplished with the participation of 21 nurses. The discussions about responsible discharge were analyzed, according to the content in the thematic modality. Stage 2 - the activities to be performed by PHC nurses were outlined through two focus groups with the same 11 PHC participants from the previous stage; the Delphi technique was adopted for content validation by 11 experts with consensus pre-established at 0.80 and calculation of the content validity index (CVI). Stage 3 - web survey with 51 PHC nurses from two municipalities in the interior of the State of São Paulo. A questionnaire containing frequency, moment, professionals involved, complicating factors, quality of the process, and time dedicated to each of the activities was built from a list of activities. Data collection has occurred between December 2019 and April 2020 (S1); September to March 2022 (S2); and March to August 2022 (S3). Results: Five thematic categories have emerged: Patient inclusion flow in the Responsible Discharge Plan; Patient/family/caregiver participation; Care planning for Responsible Discharge; Communication between hospital and primary health care; and Challenges in the responsible discharge process (S1). Two rounds of the Delphi Technique have occurred: in the first, the CVI ranged from 0.73 to 1.0 and, in the next, from 0.90 (S2). Fifty-one nurses participated and, from the 17 activities listed, 14 are frequently performed by PHC nurses; 7/17 occur on the first day, after receiving the plan, and 80.3% are accomplished collaboratively. The average time reported for conducting the 17 activities together ranged from Md 30(25) - APS 2 to 42.5(40) PHC1 (p≤0.05 and p≤0.01). The participants of PHC have noticed the quality of the developed actions as good and very good (PHC 1) and good (PHC2). Only 12.7% reported experiencing difficulties in conducting the activities - PHC 1<PHC 2, p≤ 0.01 (S3). Conclusion: For continuing care, PHC nurses dedicate themselves mainly to organizing services, coordinating care, and educating users; these activities are mostly performed until the first day after receiving the discharge plan and in a collaborative manner. The process requires skills and time from nurses and, above all, articulation of actions between the hospital and primary care with effective communication and coordination of caring in a network. This study advances knowledge about continuity of caring in the Brazilian health system and can contribute to the training of nurses, the management of PHC practices, and the strengthening of the network and a comprehensive health care.