Análise da evasão em programa de acompanhamento do desenvolvimento de crianças nascidas pré-termo

Abstract

Preterm birth entails high costs for the health care system because it needs specialized procedures, and bring burden for families who may have to deal with the consequences resulting from prematurity. It is known that children born prematurely are more likely to have neurological and sensory deficits, with impact on motor, cognitive and social development. Taking into account the cumulative risks in the development of preterm children, follow-up programs are recommended, to assess the development regularly, identifying in time possible delays and allowing referral for intervention, prevention of further complications; to identify emotional problems in the child or the family and offer parental guidance as they face possible difficulties in child care during early childhood. Despite being highly recommended, one issue faced by follow up programs is to ensure the adhesion of families who benefit from the follow up. High dropout rates in follow-up programs are found both in Brazil and internationally, which have brought concerns from health professionals who work with this population, leading to research into the causes of evasion as well as the profile of children and families involved in this process. Thus, this study addresses the issue of evasion in developmental follow-up programs for preterm newborns, focusing on the Ambulatório da Criança de Risco (ACRIAR), from Hospital das Clínicas, Universidade Federal de Minas Gerais (HC / UFMG), since it has been observed an increase in evasion and missed appointments in recent years, being extremely important to this program and others alike to understand the reasons for the abandonment of these kind of programs. Since this is not a specific problem of ACRIAR, characterizing evasion may help to seek more efficient strategies to maintain adherence of families in services dedicated to the developmental follow-up of preterm infants. This study investigate the evasion in the past seven years in the preterm developmental follow up offered by the Physio and Occupational Therapy team at ACRIAR, seeking out to know the reasons for evasion, to map the trajectory of preterm babies born at Hospital das Clinicas/UFMG from January 2014 to June 2015, since the discharge from the hospital to the first visit in the Physiotherapy and Occupational Therapy service, to investigate the mothers' perception about the care needs of the preterm baby and verify their knowledge prior to discharge about the follow up program offered at ACRIAR. This is a descriptive study, with a quanti-qualitative approach, divided into two stages. In the first stage it was done a survey of the evasions occurred between January 2009 and December 2013, Parents pf the children who dropout were interviewed about the reasons for dropout. In the second stage of the study, it was mapped the trajectory and the identification of the moment when there was discontinuity in the follow up of the preterm neonates born from January 2014 to June 2015, and the ones who were forwarded to the first appointment with the pediatricians and others specialties at ACRIAR. Mothers admitted in the maternity ward of the hospital were interviewed about their perceptions of prematurity, their notions about the preterm baby caretaking needs and their knowledge about the follow-up program. In the first stage, significant differences between children in the follow up and drop outs were found in regards to mothers´ age and educational level, while the interviews identified reasons for evasion related to socioeconomic factors and the health service organization. In the second stage, the results showed that the majority of newborns who survived after hospital discharge were not scheduled or dropped out before the first pediatric appointment in the follow up. No significant differences between children who dropped out and those who remained in the program were found in gestational age, however children who remained in the program had a birth weight superior than the ones who dropped out. There were no significant differences between groups in regard to the region where they lived. The mothers´ interviews were organized into two themes: care and impact on development and the importance of the preterm babies follow-up. It was concluded that the multidisciplinary health care team should recognize the existence of social and family problems experienced by the families assisted in follow-up programs and should develop constant efforts to increase the awareness of the parents about the need for follow-up programs. Good practices such as better organization of the health services, the establishment of routines and objectives shared by the whole team, can help to maintain the adherence to the follow-up. Furthermore, it is important to adopt approaches of bringing awareness to the families about the preterm baby and the possible consequences of prematurity, since the hospital, evolving the whole health team, which can help mobilize parents about the importance of the follow up for preterm babies.