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Master's Dissertation
DOI
Document
Author
Full name
Lígia Maria Silva de Oliveira
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2018
Supervisor
Committee
Santana, Rodrigo de Carvalho (President)
Fonseca, Benedito Antonio Lopes da
Lourenço, Edvania Angela de Souza
Pazin Filho, Antonio
Title in Portuguese
Fatores preditores de reinternação precoce em unidade de internação para pacientes com infecção pelo HIV
Keywords in Portuguese
AIDS
HIV
Reinternação hospitalar
Serviço social
Abstract in Portuguese
Desde a descrição inicial dos primeiros casos da síndrome da imunodeficiência adquirida, em 1981, a doença se expandiu por todo o mundo tornando-se grave problema de saúde pública mundial. Com o advento da terapia antirretroviral (TARV) altamente potente em meados da década de 1990 houve considerável declínio da mortalidade por causas relacionadas à AIDS. No entanto, as doenças oportunistas ainda respondem por consideráveis taxas de mortalidade em pessoas vivendo com HIV em diferentes regiões do mundo. Associado a isto, neste grupo de pacientes são frequentes fatores que prejudicam a adesão ao tratamento e o adequado controle da doença, como uso de drogas ilícitas, vulnerabilidade social e transtornos psiquiátricos. Tais fatores se refletem em elevadas taxas de internação hospitalar em pacientes infectados pelo HIV. Por outro lado, as elevadas taxas de internação elevam custos às instituições de saúde e potenciais risco à saúde dos pacientes. As taxas de reinternação hospitalar em 30 dias tem sido utilizada como marcador de qualidade da assistência á saúde e auxilia da definição de estratégia de prevenção de reinternacões . Neste contexto o presente trabalho buscou avaliar fatores preditores de reinternação hospitalar em pacientes infectados pelo HIV. O estudo realizado foi do tipo prospectivo sendo realizado em enfermaria especializada no tratamento deste grupo de pacientes. Foram avaliados fatores clínicos, contagem de células CD4 + e da carga viral do HIV, indicadores sociais, uso de drogas ilícitas e adesão à terapia antirretroviral, na tentativa de identificar preditores de reinternação hospitalar precoce. A identificação destes potenciais preditores poderão auxiliar no desenvolvimento de estratégias para prevenir readmissões hospitalares evitáveis. Foram convidados a participar do estudo 71 pacientes que passaram por internação no período de agosto de 2016 a agosto de 2018. O estudo buscou apontar através de entrevistas os fatores que levaram a reinternação precoce. Entre os 71 pacientes incluídos no estudo 16 apresentaram reinternação precoce no período de 30 dias. Vale ressaltar que as internações foram consideradas preveníveis diante dos critérios estabelecidos e através dos resultados foi possível concluir que os pacientes que reinternaram na UETDI precocemente apresentam dificuldades de adesão ao tratamento ocasionadas pelo contexto social em que vivem, onde enfrentam o preconceito, abandono, rompimento e fragilização dos vínculos familiares, além dos vícios, que é um grande fator para a não adesão ao tratamento nos pós alta hospitalar
Title in English
Predictors of early rehospitalization in hospitalization unit for patients with HIV infection
Keywords in English
AIDS
HIV
Hospital rehospitalization
Social service
Abstract in English
Since the initial description of the first cases of acquired immunodeficiency syndrome in 1981, the disease has spread worldwide becoming a serious public health problem worldwide. With the advent of highly potent antiretroviral therapy (HAART) in the mid-1990s there was a considerable decline in mortality from AIDS-related causes. However, opportunistic diseases still account for considerable mortality rates in people living with HIV in different regions of the world. Associated to this, in this group of patients, frequent factors that impair adherence to treatment and adequate control of the disease, such as illicit drug use, social vulnerability and psychiatric disorders are frequent. These factors are reflected in high hospital admission rates in HIV-infected patients. On the other hand, high hospitalization rates raise costs for health institutions and potential health risks for patients. Hospital readmission rates in 30 days have been used as a marker of health care quality and help to define a strategy to prevent rehospitalization. In this context, the present study aimed to evaluate predictive factors of hospital readmission in patients infected by HIV. The prospective study was performed in a specialized ward in the treatment of this group of patients. Clinical factors, CD4 + cell count and HIV viral load, social indicators, use of illicit drugs and adherence to antiretroviral therapy were evaluated in an attempt to identify predictors of early hospital readmission. The identification of these potential predictors may assist in the development of strategies to prevent preventable hospital readmissions. We were invited to participate in the study 71 patients who were hospitalized in the period from August 2016 to August 2018. The study sought to indicate through interviews the factors that led to early rehospitalization. Among the 71 patients included in the study 16, they presented early readmission within 30 days. It is worth mentioning that hospitalizations were considered preventable in view of the established criteria and, through the results, it was possible to conclude that the patients who returned to the UETDI at an early stage presented difficulties in adhering to the treatment caused by the social context in which they live, where they face prejudice, abandonment, disruption and weakening of family ties, as well as addictions, which is a great factor for non adherence to treatment after hospital discharge
 
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Publishing Date
2019-05-03
 
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