Estimated economic impact of implementing exclusive palliative care in an intensive care unit / Impacto económico estimado da implementação de cuidados paliativos exclusivos numa unidade de cuidados intensivos

Ana Paula Niespodzinski, Patrícia Andréa Simplício, Paulo Victor Zattar Ribeiro, Felipe Pfuetzenreiter, Álvaro Koenig, Eduardo Manoel Pereira

Abstract


Palliative care (PC) is a modality of care for patients with no possibility of cure for a disease or terminally ill. The objective of this care model is to provide integral care to the patient and their family, involving the multidisciplinary team in caring, in addition to pursuing strategies so that the interventions conducted promote comfort and well-being for those involved. This is a retrospective cross-sectional study in which the total expenses and per day of hospitalization with exams and medications of patients before and after being included in the PC protocol of the institution were evaluated. All patients who met the inclusion criteria in the PC protocol and were likely to change the therapeutic focus to exclusive PC, oncologic and non-oncologic, were included. The study proved to be extremely relevant in the quantitative comparison of costs in adult ICU before and after PC, showing a reduction regarding cost/day with exams and medications of 95% and 44% respectively, and mean hospital stay was reduced from 14 to 6 days. It is noteworthy that 16% of those patients did not die in the ICU environment, representing a possible humanization of care and improvement in the quality of visits and family interaction. The results of this study indicate a significant decrease in costs with the correct implementation of exclusive PC, supporting the need for introduction of protocols and earlier and more comprehensive insertion of patients in PC.


Keywords


palliative care, costs and cost analysis, hospital, intensive care unit, end-of-life care.

Full Text:

PDF

References


Meneguin S, Ribeiro R. Dificuldades de cuidadores de pacientes em cuidados paliativos na estratégia da saúde da família. Texto contexto - enferm. [Internet]. 2016 [cited 13 october 2020]; 25(1):e3360014. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S010407072016000100312&lng=en.6.(1)

Lourençato FM, Santos AFJ, Ficher AMFT, Santos JC, Zoppi D, Giardini MH et al. Implantação de serviço de cuidados paliativos no setor de emergência de um hospital público universitário. Revista Qualidade HC. 2016; 1: 127-133 (2)

Lima SF, Lamy ZC, Motta VBR, Roma TM, Gomes CMRP, Souza TP. Dinâmica da oferta de cuidados paliativos pediátricos: estudo de casos múltiplos. Cadernos de Saúde Pública [internet]. 2020. [cited 5 march 2021]; 36 (9): e00164319. Available from: https://www.scielosp.org/article/csp/2020.v36n9/e00164319/pt/# (3)

Ribeiro SZRS, Vidal SA, Oliveira AG, Silva MIC, Vicente CD, Lopes LGF. Custos e qualidade de vida de paciente em cuidados paliativos. Revista de Enfermagem UFPE on line [internet]. 2018 [cited 5 march 2021]; 12 (6): 1688-95. Available from: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/234832/29213 (4)

May P, Garrido MM, Cassel JB, Kelley AS, Meier DE, Normand C, et al. Prospective cohort study of hospital palliative care teams for in patients with advanced cancer: earlier consultation is associated with larger cost-saving effect. J Clin Oncol [internet]. 2015 [citado 19 april 2020]; 33 (25): 2745–2752. Available from: https://ascopubs.org/doi/full/10.1200/JCO.2014.60.2334 (5)

Brinkman-Stoppelenburg A, Polinder S, Olij BF, Berg B, Gunnink N, Hendriks MP et al. The association between palliative care team consultation and hospital costs for patients with advanced cancer: an observational study in 12 Dutch hospitals. Eur J Cancer Care (Engl) [internet], 2020 [cited 13 october 2020];29(3): 1-11. Available from: https://onlinelibrary.wiley.com/doi/10.1111/ecc.13198 (6)

Cano CWA, Silva ALC, Barboza AF, Bazzo BF, MartinsCPa, Iandoli Júnior D et al. Finitude da vida: compreensão conceitual da eutanásia, distanásia e ortotanásia. Rev. Bioét. [Internet]. 2020 [cited 13 december 2020]; 28 (2): 376-383. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S198380422020000200376&lng=en (7)

Rozman LM, Campolina AG, Lopez RM, Chiba T, Soárez PC. Palliative cancer care: costs in a Brazilian quaternary hospital. BMJ Supportive & Palliative Care [internet] 2019 [cited 13 december 2020]; 0: 1-8. Available from: https://spcare.bmj.com/content/early/2019/10/15/bmjspcare-2019-001809 (8)

Burlá C, Py L. Cuidados Paliativos: ciência e proteção ao fim da vida. Cadernos de Saúde Pública [internet]. 2014 [cited 5 march 2021]; 30 (6): 1-3. Available from:https://www.scielo.br/scielo.php?pid=S0102311X2014000601139&script=sci_arttext&tlng=pt (9).

Câstor KS, Moura ECR, Pereira EC, Alves DC, Ribeiro TS, Leal PC. Palliative care: epidemiological profile with a biopsychosocial look on oncologicalpatients. Revista BrJP [Internet]. 2019 [cited 5 march 2021]; 2(1): 49-54. Available from: https://www.scielo.br/scielo.php?pid=S2595-31922019000100049&script=sci_abstract (10)

Carneiro LAF, Campino ACC, Leite F, Rodrigues CG, Santos GMM, Silva ARA. Envelhecimento populacional e os desafios para o sistema de saúde brasileiro. [E-book on the Internet] São Paulo: Instituto de Estudos de Saúde Suplementar; 2013 [cited 25 march 2021]. 6-107p. Available from: https://www.ibedess.org.br/imagens/biblioteca/939_envelhecimentopop2013.pdf (11)

Rodrigues JSM, Ferreira NMLA. Caracterização do perfil epidemiológico do câncer em uma cidade do interior paulista: conhecer para intervir. Rev Bras Cancerol [Internet]. 2010 [cited 5 march 2021]; 56(4): 431-4. Available from: https://rbc.inca.gov.br/revista/index.php/revista/article/view/1464 (12)

Souza RS, Simão DAS, Lima EDRP. Perfil sociodemográfico e clínico de pacientes atendidos em um serviço ambulatorial de quimioterapia paliativa em Belo Horizonte. REME Rev Min Enferm [Internet]. 2012 [cited 5 march 2021]; 16(1): 38-47. Available from: http://www.reme.org.br/artigo/detalhes/498 (13).

Bastos BR, Pereira AKS, Castro CC, Carvalho MMC. Perfil sociodemográfico dos pacientes em cuidados paliativos em um hospital de referência em oncologia do estado do Pará, Brasil. Rev Pan-Amaz Saude [Internet]. 2018 [cited 5 march 2021]; 9(2): 31-36. Available from: http://scielo.iec.gov.br/scielo.php?script=sci_arttext&pid=S2176-62232018000200031 (14)

Kyeremanteng K, Gadnon LP, Thavorn K, Heyland D, D’Egidio G. The impact of palliative care consultation in the icu on length of stay: a systematic review and cost evaluation. J Int Care Medicine. 2016; 33 (6): 346-353. (15)

El-Jawahri A, Greer JA, Temel JS. Does palliative care improve outcomes for patients within curable illness? A review of the evidence. J Support Oncol. 2011; 9(3):87-94 (16)

Khandelwal N, Kross EK, Engelberg RA, Coe NB, Long AC, Curtis JR. Estimating the effect of palliative care interventions and advance care planning on ICU utilization: a systematic review. Crit Care Med. 2015; 43(5): 1102-1111 (17)

Campbell ML, Guzman JA. A proactive approach to improve end-of-lifecare in a medical intensive care unit for patients with terminal dementia. Crit Care Med. 2004; 32(9):

-1843 (18).

Okon TR, Vats HS, Dart RA. Palliative medicine referral in patients undergoing continuous renal replacement therapy for acute kidney injury. Ren Fail. 2011; 33(7):707-717 (19).

Mazutti SRG, Nascimento AF, Fumis RRL. Limitação de Suporte Avançado de Vida em pacientes admitidos em unidade de terapia intensiva com cuidados paliativos. Rev Bras Ter Intensiva. 2016; 28 (3): 294-300 (20).

Pessini L, Bertachini L. Cuidados Paliativos: ética geriatria gerontologia comunicação e espiritualidade. O mundo da saúde. 2005; 9 (4): 491-509. (21)

Siman A, Rauch CS. A finitude humana: morte e existência sob um olhar fenomenológico-existencial. Faculdade Sant’Ana em Revista. 2017; 1 (2): 106-122(22).

Hermes HR, Lamarca ICA. Cuidados paliativos: uma abordagem a partir das categorias profissionais de saúde. Ciênc e Saúde Colet. 2013; 18 (9): 2577-2588(23).




DOI: https://doi.org/10.34117/bjdv8n5-329