Análise da busca por serviços de emergência e da reinternação de idosos em até 30 dias após a alta hospitalar na perspectiva da farmacoterapia

Abstract

Because of the populations aging, there are an increase of the burden of chronic diseases and the demand for more hospital beds, consultations, exams and medications. The presence of one or more chronic diseases among the elderly is associated to the use of multiple medications and a medication regimen complexity. The first 30 days after discharge, the elderly people have difficulties to return to basic activities and monitoring their health conditions and drug therapy. Consequently, in the transition care period can occur a return to the emergency department and hospital readmissions. The objective of the study is to analyze the frequency of the return to emergency medical services and readmissions of elderly within 30 days after discharge and to determine their associated factors. This is an observational, analytical and prospective study, performed in a general public hospital with elderly people aged 60 years or older. The socio-demographic, clinical and pharmacotherapy data were collected by interviewing and documentary analysis of the medical record. The medication complexity was determined by the Brazilian version of the Medication Regimen Complexity Index. Polypharmacy was defined as the use of five or more drugs concomitant. Potentially inappropriate medications for elderly were determined according to the American Geriatric Society/ Beers 2015 criteria. Two outcomes were evaluated: emergency department visit and readmission, both within 30 days after discharge from the hospitalization index. The association between each outcome and the independent variables was determined by multiple logistic regression. The risk of elderly readmission in 30 days was determined by using the Readmission Risk Score. The total of 255 patients aged 60 years or older were included in the study. Of these, 67 (26.3%) returned to an emergency service and 32 (12.5%) had to be rehospitalized. The 30-day readmission risk calculated for the elderly according to the Readmission Risk Score had a median of 20%. The Readmission Risk Score demonstrated to be a feasible and practical tool. It was able to be applied in the investigated hospital and had a linear gradient effect. The heart failure diagnosis and the high value of Medication Regimen Complexity Index (> 16.5) were positively associated to the return to the emergency room in 30 days (OR = 2.3, 95% CI 1.04-4.94, p= 0.048 and OR = 2.1, 95% CI 1.11-4.02, p= 0.021). Furthermore, the diagnosis of Diabetes Mellitus and chronic kidney disease obtained an inverse association with the outcome (OR = 0.4, 95% CI 0.20-0.73, p = 0.004 and OR = 0.3, 95% CI 0.13-0.86, p = 0.023). Only the cancer diagnosis was positively associated to the occurrence of elderly 30-day readmission (OR = 2.9, 95% CI, 1.11-7.70, p = 0.031). The study demonstrated that the heart failure diagnosis and the high value of MRCI are associated to the occurrence of return to emergency services within 30 days after discharge. The cancer diagnosis is associated to elderly readmission within 30 days after discharge from the hospitalization index.