Factors associated with failure to discharge in the context of home care

This was a cross-sectional study conducted at the home care service of the metropolitan region in the state of Minas Gerais, Brazil. Data from the records of 157 users assisted by the home care teams in 2016, including those that remained throughout 2017, were collected. The socio-demographic, economic, health, and behavioral data were analyzed, in addition to data regarding access to the home care service and the socio-demographic variables of the caregivers. Poisson regression was used to determine the factors associated with failure to discharge from the home care service to primary healthcare, considering p < 0.05 as significant.

Results:

The percentage of failure to discharge to primary healthcare was 22.29%. The increase in age and frequency of home visits were associated with failure to discharge. Income of >$780.00 increased by 2.55 times the percentage of failure to discharge from the home care service to primary healthcare compared with users whose income was <$260.00.

Being referred from the emergency care unit decreased the percentage of failure to discharge when controlling for the remaining variables of the model.

Conclusion:

The results demonstrated the existence of users for whom the home care service has difficulties in discharging to primary healthcare; discharge was also associated with the type of access to the service. This study presented contributions to the subject.

Keywords
Home nursing; Comprehensive health care; Home care services; Health services; Epidemiology

Characteristics of users		n (%)
Socio-demographic and economic factors
Age		n = 157		66.86^c c median;
Sex		n = 157
	Male		81 (51.59)
	Female			76 (48.4)
Marital status		n = 110
	With a partner^a a married + stable union;		65 (59.09)
	Without a partner^b b single + widow + separated + divorced;			45 (40.9)
Income		n = 157
	Less than USD 260.00			14 (8.91)
	USD 260.00-USD 780.00		139 (88.53)
	Greater than USD 780.00			4 (2.54)
Health Insurance		n = 84
	Yes			4 (4.76)
	No		80 (95.23)
Reason for admission to the HCS		n = 154
	Dressing		49 (31.81)
	Antibiotic therapy		53 (34.41)
	Clinical support		47 (30.51)
	Home rehabilitation			5 (3.24)
Number of visits received		n = 157		10^c c median;
Health and behavioral factors		n = 127
Systemic hypertension
	No		37 (29.13)
	Yes		90 (70.86)
Diabetes mellitus		n = 125
	No		70 (56)
	Yes		55(44)
Hospitalization in the last 12 months		n = 132
	No	7
	Yes		125 (5.30)
Access to HCS		n = 155		94,69
Referred from
	BHU + FHS		38 (24.51)
	Hospital		42 (27.09)
	ECU		75 (48.38)
Characteristics of caregivers			n (%)
Socio-demographic factors
Age		n = 148		48,65^d d mean.
Sex		n = 155
	Male		36 (23.22)
	Female		119 (76.77)
Relationship with user		n = 155
	Spouse/partner		38 (24.51)
	Children/stepchildren		65 (41.93)
	Father/mother		13 (8.38)
	Brother/sister		15 (9.67)
	Nephew/niece		9 (5.8)
	Others		15 (9.67)

Socio-demographic factors		PR	95% CI	p-value^* * Poisson univariate regression model with robust variances;
Age (continuous)		1.00	0.99−1.01	0.854
Sex				0.433
	Male	1.00
	Female	1.26	0.70−2.28
Marital status				0.476
	With a partner	1.00
	Without a partner	0.79	0.42−1.49
Income
	Less than USD 260.00	1.00
	USD 260.00-USD 780.00	0.54	0.25−1.19	0.127^ p-value less than 20% (p < 0.20)
	Greater than USD 780.00	2.1	0.85−5.19	0.108^ p-value less than 20% (p < 0.20)
Health insurance				0.199^ p-value less than 20% (p < 0.20)
	Yes	1.00
	No	0.5	0.17−1.44
Reason for admission to the HCS
	Dressing	1.00
	Antibiotic therapy	0.15	0.05−0.49	0.002^ p-value less than 20% (p < 0.20)
	Clinical support	0.69	0.38−1.28	0.245
	Home rehabilitation	0.54	0.09−3.28	0.507
	Frequency of visits	1.01	1.01−1.03	0.000^ p-value less than 20% (p < 0.20)
Health and behavioral factors
Systemic hypertension				0.159^ p-value less than 20% (p < 0.20)
	No	1.00
	Yes	1.78	0.80−3.98
Diabetes mellitus				0.222
	No	1.00
	Yes	1.43	0.80−2.55
Stroke				0.601
	No	1.00
	Yes	1.24	0.56−2.74
Hospitalization (last 12 months)				0.125^ p-value less than 20% (p < 0.20)
	No	1.00
	Yes	0.48	0.19−1.22
Access to HCS
Referred from
	BHU + FHS	1.00
	Hospital	0.72	0.39−1.35	0.308
	ECU	0.27	0.12−0.58	0.001^ p-value less than 20% (p < 0.20)

Factors		PR	p-value^ Model adjusted for marital status and reason for admission in the HCS;
Age		1.02	0.024^* * significant p-value (p-value < 0.05);
Income
	Less than USD 260.00	1
	USD 260.00-USD 780.00	0.85	0.685
	Greater than USD 780.00	2.55	0.027^* * significant p-value (p-value < 0.05);
Referred from
	BHU + FHS	1
	Hospital	0.84	0.582
	ECU	0.36	0.025^* * significant p-value (p-value < 0.05);
Frequency of visits		1.01	0.002^* * significant p-value (p-value < 0.05);

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author Vânia de Souza, Email: vaniaxsouza@yahoo.com.br