Custos de atendimento domiciliar em nível hospitalar vs intra-hospitalar em infecção complicada do trato urinário
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Objetivo: Avaliar a diferença dos custos assistenciais em pacientes com infecção urinária complicada entre um serviço de atenção domiciliar de nível hospitalar e a internação intramural.
Métodos: Estudo de coorte retrospectivo, utilizando os prontuários de pacientes com infecção complicada do trato urinário atendidos em um hospital de quarto nível, no período de janeiro de 2017 a maio de 2020. Obteve-se um modelo de regressão linear para avaliar os determinantes de custo./creche.
Resultados: 239 pacientes foram incluídos no grupo de atendimento hospitalar e 68 no grupo de atendimento domiciliar. A coorte hospitalar era mais velha (mediana 71 vs 59 anos, p=0,002). Não houve diferenças na taxa de mortalidade em 30 dias (2,1% vs 5,9%, p=0,114) ou custos totais de atendimento (COP 8767141 vs 9558334, p= 0,112). Maior tempo total de atendimento (mediana 17 vs 12 dias, p<0,001) e menor custo/dia foram encontrados em pacientes tratados em casa (COP 756100 vs 554685, p<0,001). Foram evidenciados fatores associados ao custo/dia: atendimento domiciliar (COP –209155, p=0,01), índice de Charlson ≥6 (COP 26250, p=0,001), procedimentos cirúrgicos (COP 368157, p<0,001), necessidade de Unidade de Terapia Intensiva ( COP 373927, p<0,001), regime subsidiado (COP 209156, p=0,013), isolamento de estafilococos (COP 1252473, p<0,001) e germes produtores de carbapenemases (COP 629319, p<0,001).
Conclusões: Este estudo sugere que o custo por dia de atendimento para pacientes com infecção urinária complicada é menor no atendimento domiciliar. No entanto, os custos totais são semelhantes. Além disso, o atendimento domiciliar é seguro.
Urinary tract infections, cost and cost analysis, Home care services, Health Care Economics and Organizations, ColombiaInfecções Urinárias, Custos e Análise de Custo, Serviços de Assistência Domiciliar, Economia e Organizações de Saúde, ColombiaInfecciones urinarias, costo y análisis de costo, Servicios de Atención de Salud a Domicilio, Economía en Atención de Salud y Organizaciones, Colombia
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