Factors associated with the care of elderly persons with Primary Health Care sensitive conditions

Rêgo, Anderson da Silva; Rissardo, Leidyani Karina; Scolari, Giovana Aparecida de Souza; Sanches, Rafaely de Cássia Nogueira; Carreira, Lígia; Radovanovic, Cremilde Aparecida Trindade

doi:10.1590/1981-22562017020.170120

Abstract

Objective:

to analyze factors associated with the care of the elderly for Primary Health Care sensitive conditions in an Emergency Care Unit.

Method:

a cross-sectional study was carried out in a municipal district located in the northwest of the state of Paraná, Brazil, between May and November of 2015. A semi-structured instrument was used, consisting of three distinct blocks that addressed sociodemographic profile, characterization of care and the reasons that led the elderly to seek care in the unit. The data were submitted to descriptive analysis and logistic regression for the treatment of variables.

Results:

A total of 191 elderly persons, who were female (56%), had less than eight years of schooling (85.3%) and were retirees (78.5%) were interviewed. The results showed that people with chronic morbidities were 1.42 times more likely (CI: 1.08 - 5.42) to seek the Emergency Care Unit prior to the Basic Health Unit and were 1.65 times more likely (IC: 1.01 - 6.82) to be referred by the unit for care. The lack of a doctor in Basic Health Units was also a factor responsible for the 1.36 times greater chance (CI: 1.03 - 5.38) of the elderly being referred to the Emergency Care Unit for primary care sensitive conditions.

Conclusion:

the lack of human resources in the first level of care of the health service, together with the need for treatment of morbidities, were factors associated with the elderly seeking treatment for primary care sensitive conditions, with diseases of the osteomuscular and connective tissue systems the main reasons for seeking such care (47.6%).

Keywords:
Elderly; Emergency Medical Services; Primary Health Care; Geriatric Nursing

[1] Correspondence Anderson da Silva Rêgo E-mail: Anderson.dsre@hotmail.com

Variables	n	%
Age (years)
60 to 70	95	49.7
71 to 80	50	26.2
>81	46	24.1
Gender
Female	107	56.0
Male	84	44.0
Marital Status
With Partner	113	59.1
Without Partner	78	40.9
Schooling (years)
<8	163	85.3
>8	28	14.7
Economic situation
Retired	150	78.5
Employed	30	15.7
Unemployed	11	5.8
Health Plan
Yes	56	29.3
No	135	70.7

Main complaint*	CID-10**	N	%
Osteomuscular and connective tissue diseases	M00-M99	91	47.6
Diseases of the respiratory tract	J00-J99	58	30.3
Diseases of the circulatory system	I00-I99	13	6.8
Diseases of the genitourinary system	N00-N99	06	3.1
Diseases of the digestive system	K00-K93	21	10.9
Diseases of the nervous system	G00-G99	17	8.9
Symptoms, signs, and abnormal findings from clinical and laboratory tests, not classified elsewhere	R00-R99	08	4.1

Variables	Sought BHU before ECU			Univariate Analysis			Referred by BHU		Univariate Analysis
Variables	Yes	No	OR	CI95%	p	Yes	No	OR	CI95%	p
Perception of care at BHU
Negative	27	114	1	0.52-2.95	0.621	22	119	1	0.82-10.13	0.084*
Positive	8	42	1.24	0.52-2.95	0.621	3	47	1.89	0.82-10.13	0.084*
Presence of Morbidities
No	21	100	1	1.26-5.67	0.009*	8	106	1	1.52-9.21	0.002*
Yes	14	56	2.67	1.26-5.67	0.009*	17	60	2.75	1.52-9.21	0.002*
Geographic Location of BHU
Close	29	110	1	0.19-1.27	0.138*	19	120	1	0.31-2.19	0.698
Far	6	46	0.49	0.19-1.27	0.138*	6	46	0.82	0.31-2.19	0.698
Lack of Doctors at BHU
No	27	91	1	0.17-0.97	0.038*	8	108	1	1.71-9.69	0.004*
Yes	8	65	0.41	0.17-0.97	0.038*	17	58	2.81	1.71-9.69	0.004*
Lack of confidence in care at BHU
No	34	128	1	0.01-1.02	0.025*	24	138	1	0.02-1.58	0.095*
Yes	1	28	0.13	0.01-1.02	0.025*	1	28	0.2	0.02-1.58	0.095*
Better care at ECU
No	30	116	1	0.17-1.33	0.153*	21	125	1	0.18-1.79	0.339
Yes	5	40	0.48	0.17-1.33	0.153*	4	41	0.58	0.18-1.79	0.339
Better Resources at ECU
No	30	101	1	0.14 - 0.97	0.038*	22	108	1	0.07-0.88	0.022*
Yes	5	55	0.38	0.14 - 0.97	0.038*	3	58	0.25	0.07-0.88	0.022*
Long wait for care at BHU
No	28	117	1	0.30-1.85	0.532	17	128	1	0.63-3.95	0.312
Yes	7	39	0.75	0.30-1.85	0.532	8	38	1.58	0.63-3.95	0.312
Considered ECU case
No	30	92	1	0.08-0.65	0.003*	21	101	1	0.09-0.90	0.025*
Yes	5	64	0.24	0.08-0.65	0.003*	4	65	0.29	0.09-0.90	0.025*
Faster service at ECU
No	12	34	1	0.24-1.18	0.118*	8	128	1	0.25-1.57	0.321
Yes	23	122	0.53	0.24-1.18	0.118*	17	38	0.63	0.25-1.57	0.321
Possibility of undergoing exams at ECU
No	22	96	1	0.44-2.01	0.885	16	102	1	0.37-2.14	0.806
Yes	13	60	0.94	0.44-2.01	0.885	9	64	0.89	0.37-2.14	0.806
No need to schedule an appointment at ECU
No	26	71	1	0.12-0.65	0.002*	20	77	1	0.07-0.60	0.002*
Yes	9	85	0.28	0.12-0.65	0.002*	5	89	0.21	0.07-0.60	0.002*

Variables	Sought care at BHU before ECU		Multivariate Analysis
Variables	Yes	No	OR	CI95%	p
Presence of Morbidities
No	14	100	1	1.08 - 5.42	0.032
Yes	21	56	1.42	1.08 - 5.42	0.032
Lack of Doctors at BHU
No	27	91	1	0.15 - 0.96	0.041
Yes	8	65	0.38	0.15 - 0.96	0.041
Considered ECU Case
No	30	92	1	0.07 - 0.59	0.003
Yes	5	64	0.20	0.07 - 0.59	0.003
No need to schedule an appointment at ECU
No	26	71	1	0.12 - 0.72	0.007
Yes	9	85	0.31	0.12 - 0.72	0.007
	Referred by BHU		Multivariate Analysis
Variables	Yes	No	OR	CI95%	p
Presence of Morbidities
No	8	106	1	1.01 - 6.82	0.043
Yes	17	60	1.65	1.01 - 6.82	0.043
Lack of Doctors at BHU
No	8	108	1	1.03 - 5.38	0.032
Yes	17	58	1.36	1.03 - 5.38	0.032