Adequação da demanda atendida em serviço de urgência de média complexidade em Londrina, Paraná, Brasil

AUTOR(ES)
DATA DE PUBLICAÇÃO

2008

RESUMO

Hierarchy in health care follows a bottom-up flow that starts at the level of lower complex services. Nevertheless, studies have shown that this is a system with frail organization and flow deviations. Thus, emergency services are highly demanded and lead to long waiting lines and a high percentage assistance of inadequate cases. Due to the scarce research on the theme of urgency in this country, this present study is meant to describe and classify the demand for assistance in PAM - the Municipal Emergency Ward in the city of Londrina, State of Paraná, following the adequacy of the cases to the role of the service. This study involved 394 subjects who were selected by systematic sampling and who had come to PAM within the period of two weeks in July 2007. The data were collected after consultation by trained interviewers and the information was entered in a databank through software Epi Info version 3.4 for Windows. The classification of data as to their adequacy followed explicit criteria (situations objectively defined) and implicit criteria (at the physician’s discretion). The analysis of association between the independent variables and the adequacy of service was performed upon the classification with explicit criteria by means of the chi-square test (χ2). Among the main results, it was verified that there is a discrete predominance of female subjects (55,6%), aged 20 to 39 years old (45,9%) with elementary degree school education (51,7%), currently working but not holding a health care insurance plan. Most subjects had come to PAM at their own choice (77,1%), and those who were referred to it, were mostly referred by the UBS – the State Unit of Basic Health Care (76,0%). Public transportation was most used by subjects (46,7%), and 79% of them were discharged after consultation at PAM. Out of the cases analyzed, 54,3% were considered adequate according to the explicit classifying criteria. The factors significantly associated (p<0,05) to the adequacy of services were: age equal or above 60 years old, currently working, use of the state units of basic health, and previous demand of services for the same problem at PAM. When compared to different criteria of demand classification, it was noted a concordance of 81,4% (Kappa statistics= 0,62), which was considered as substantially concordant. Despite the predominance of spontaneous demand (77,1%), the context of PAM in Londrina evidenced a reasonable adequacy of the demand in relation to the nature of the service, a fact hardly observed in other similar studies.

ASSUNTO(S)

national health services saúde pública saúde pública - administração serviços de saúde pública public health

ACESSO AO ARTIGO

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