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Ano da Graça de 2003-2004: Morrer com Cancro no Hospital do Espírito Santo de Évora

Madalena Feio
Revista Portuguesa de Filosofia
T. 66, Fasc. 2, Morrer em Portugal (2010), pp. 461-485
Stable URL: http://www.jstor.org/stable/41354801
Page Count: 25
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Since scans are not currently available to screen readers, please contact JSTOR User Support for access. We'll provide a PDF copy for your screen reader.
Ano da Graça de 2003-2004: Morrer com Cancro no Hospital do Espírito Santo de Évora
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Abstract

Os gastos em Saúde concentram-se na fase final da vida. Hoje, a maior parte das mortes por doença ocorrem em internamento. Em estados internacionais tem sido reconhecido que doentes com doenças progressivas e ayançadas falecem com descontrolo sintomático. Para obter elementos sobre a situação no nosso país foi efectuado um estudo retrospectivo, em que se investigaram os óbitos no Concelho de Évora entre Março de 2003 e Fevereiro de 2004 por doença oncológica avançada e progressiva, diagnosticada há mais de 30 dias e o recurso em fim de vida ao Hospital do Espínto Santo de Évora limitado ao período do último mês. Quantificaram-se: os dias de internamento, as consultas externas, as idas à urgência e os exames complementares. Foram também pesquisados os síntomas presentes. Através dos dados obtidos por contabilidade analítica do HES -Évora calcularam-se os cusios dos cuidados hospitalares desta população com doença terminal. Foram identificados 235 pessoas falecidas com doença oncológica. Destes 118 obedeciam aos critérios definidos. Idade média 69,1 ± 10,7 anos, 69,5% eram do sexo masculino, 55% residiam no Concelho de Évora. As topografias mais comuns foram o aparelho digestivo, 31% e o pulmão 20,3%. Os síntomas mais frequentes foram a sonoléncia, a dor, a dispneia e a astenia. Em internamento faleceram 82,2%, no Serviço de Urgência 11% e 4% no domicilio. Estiveram internados 84,7%, foram a consultas externas 40,6% e recorreram à Urgencia 60,7% dos doentes. Todos os doentes fizeram pelo menos um exame complementar. O total de cusios calculado foi de 379.761,35 €. O internamento e as Urgências corresponderam as maioresparcelas. Os cusios médios por doente, neste último mês de vida, foram 3218,32 €. As principais respostas oferecidas a estes doentes foram o internamento e a Urgência. Verificou-se um custo grande associado ao uso do Hospital por doentes com doença oncológica avançada e progressiva, no último mes de vida, associado a indicadores de menor qualidade nos cuidados. Healthcare costs concentrate in life last months. Today most patient die in a hospital ward. Several studies demonstrate that patients with advanced and progressive diseases have uncontrolled symptoms close to death. Trying to clarify what happens in our country we decided to evaluate the usage and hospital costs at Hospital do Espirito Santo -Évora (HES -Évora), within the penod of a year, regarding the last month of life of the patients who died in Évora from progressive and advanced cancer. We made a retrospective study: patient identification through Death Certificates, followed by research in the Hospital clinical data and informatics registrations. The calculation of costs was made with the Analytical Accountability data of the HES-Évora. The inclusion entena were advanced and progressive cancer diagnosed for more than a month and death due to cancer progression. Two hundred and thirty five persons that died from cancer were identified and 118 obeyed the inclusion criteria. Age 69.1 ± 10.7 years, 69.5% were male, 55% lived in the county of Évora. Most common primary topographies were digestive system, 31% and lung, 20,3%. Most common identified symptoms were drowsiness, pain, dyspnoea and asthenia. Died in a hospital ward 82.2%, in the Emergency Room (ER) 11%, and at home 4%. In their last month of life 84.7%, were in a hospital ward, 40,6% were seen at an External Consultation and 62.7% at the ER. All were submitted, at least, to one complementary exam. The calculated total cost was 379.761,35 €. The biggest fractions were due to in-hospital stays and visits to the ER. The medium cost per patient in the last month of life was 3218,32 €. Main care offered to these patients in their last month of life was provided by in-hospital wards and ER though associated with great costs and indicators of less quality care.

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