Análise comparativa da efetividade do cuidado domiciliar versus hospitalar

Abstract

Introduction: Demographic and epidemiological transition represents a challenge for current health systems. Home care, as an alternative to hospital assistance, represents a potential reordering of health service; therefore it is necessary to evaluate the effectiveness of home care in order to justify greater investments. Objective: To compare the effectiveness of home care service with hospital assistance, both offered by the same tertiary and large size university hospital. Methods: This was a cross-sectional study, accomplished through medical records analysis, between January 2012 and December 2016. Two groups of 65 patients in chronic situations were compared: Home Care Group (n = 48): patients assisted by the Home Care Service; Hospital Assistance Group (n = 17): patients who remained hospitalized even with indication of clinical discharge for home assistance. For the comparative analysis of the effectiveness of the care provided by the different services, the number of hospital readmissions, infection rate, number of procedures and outcomes (discharge, death, permanence) were evaluated. Findings: Patients in home assistance presented higher survival, lower death rate and low occurrence of hospital readmissions (χ² = 37.72; p = <0.001; Φ = 0.72). They also used less laboratorial and imaging resources (H = 18.30, p <0.001), had lower infection rates and less antimicrobial use compared to hospital patients (χ² = 11.20, p = 0.001). Conclusion: Home care service was effective, using less resources and better results.