Egressos da Unidade de Acidente Vascular Cerebral: acesso aos serviços de saúde e seus preditores sociodemográficos e clínico-funcionais

Abstract

After a stroke, access to health services for continuity of care is essential and must be provided in a comprehensive and multi-professional manner, according to individual needs. In Brazil, there are public policies and structured care recommendations for post-stroke individuals. However, information on access to health services for this population is scarce. The objectives of this study were to characterize access to health services, to compare “real access” to “expected access,” and to determine their sociodemographic and clinical-functional predictors in the first month (T1) after hospital discharge from an stroke unit. For six months (September/2019-February/2020), individuals aged ≥20 years, identified in a stroke unit in Belo Horizonte/MG with stroke for the first time and without previous disabilities, were included and evaluated at the time hospital discharge (T0) for characteristics sociodemographic (gender, age, education, and socioeconomic level) and clinical-functional (severity of stroke and level of disability). In T1, they were contacted by telephone to collect information about access to health services (“real access”). Descriptive statistics and Wilcoxon test were used to compare the “expected access” (referrals from stroke unit professionals), and binary logistic regression (α = 5%) was conducted to identify predictors. Therefore, 260 individuals were identified, including 116 and 78 assessed at T1: most were female (53%), with an average age of 60 ± 16 years, with less than four years of study (50%), with mild disability (53%) and severity level of mild stroke (50%) the most common. All received at least one referral. Access to health services in T1 was obtained by most individuals (77%;60/78), however, partially (70%;42/60) comparing to what was expected, with the amount of “real access” (n=122) significantly lower than the "expected access" (n=249) (p<0.001). Public services (88%;53/60) and doctors (93%;56/60) were the most accessed. Considering the proportional relationship between “real access” and “expected access”, medical services (56/78;72%), speech therapy (15/21;71%), and physical therapy (26/43;61%) obtained better results. Occupational therapy was, proportionally, the one with the lowest frequency of access (17/74;23%), and no access to psychology and social services was observed, despite the referrals made (five and three, respectively). Sex (OR=18.92;p=0.01) and education (OR=1.48;p=0.04) were the only significant predictors of access. The fact that most individuals obtained access to health services after just one month of hospital discharge positively characterizes the functioning of the public health system in Belo Horizonte/MG. Nevertheless, this access was primarily to medical services and significantly lower than expected, demonstrating that the needs for comprehensive and multi-professional health care and functionality of most of these individuals are not being met within a month of hospital discharge. Being female and having a low level of education favored access, which in parts indicates the care for vulnerable groups. It is noteworthy that post-stroke health care must be performed as early as possible to obtain the best results, hence the need to analyze access to health services in first month after stroke. However, this period may have been insufficient for the expected access to all health services to be obtained. It is recommended further studies with Brazilian individuals from other regions a deeper investigation for a longer period.