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Previous issue date: 2015-09-29 === O envelhecimento populacional no Brasil ressalta a necessidade de discutir o gerenciamento adequado do or?amento destinado ? sa?de, em especial nos setores de alta complexidade, onde coexistem procedimentos onerosos, recursos limitados e necessidade de conten??o de despesas, mesmo diante de uma demanda crescente e diretamente proporcional ao aumento do n?mero de idosos. Objetivo: Desta forma, esta pesquisa tem como objetivo geral analisar os gastos decorrentes da interna??o de idosos em Unidades de Terapia Intensiva (UTI) e seus fatores associados. M?todos: Trata-se de um estudo seccional, de abordagem quantitativa e com car?ter descritivo-explorat?rio. Os dados foram coletados em prontu?rios de idosos internados em UTI em Natal-RN, entre primeiro de novembro de 2013 e 31 de janeiro de 2014. As vari?veis coletadas relacionam-se ao perfil s?cio demogr?fico, quadro de morbidade e caracteriza??o da interna??o. A vari?vel dependente foi categorizada pelo quartil 75, em alto e baixo gasto de interna??o e submetida ao teste de Qui-quadrado com as vari?veis independentes da pesquisa. As associa??es que apresentaram p<0,20 na an?lise bivariada foram submetidas ? t?cnica da regress?o log?stica m?ltipla. Optou-se pela constru??o de tr?s modelos de regress?o a partir do algoritmo supracitado: um chamado de modelo de regress?o geral, composto por todas as 493 interna??es do estudo, outro somente para os 181 indiv?duos internados no Sistema ?nico de Sa?de (SUS) e um terceiro referente aos 312 casos provenientes da rede de assist?ncia privada. Resultados: No modelo de regress?o geral, as vari?veis doen?as respirat?ria, institui??o privada, paciente desorientado e acidente vascular cerebral pr?vio foram associadas ? maior probabilidade de alto gasto na interna??o em UTI. Por sua vez, nas interna??es do SUS, essa probabilidade foi associada ? paciente desorientado, com 80 anos ou mais, com Sepse e Interna??o por motivo cl?nico. J? nos casos provenientes da rede privada, o alto gasto foi associado ? doen?a respirat?ria, ventila??o mec?nica, interna??o por motivo cl?nico e aos pacientes desorientados. Conclus?o: O aumento dos gastos com a interna??o de idosos em terapia intensiva depende das condi??es clinicas dos indiv?duos. Isso evid?ncia a import?ncia de evitar interna??es decorrentes de agravos sens?veis ? aten??o prim?ria, por meio da preven??o a sa?de e garantia de assist?ncia integral ao idoso. Al?m disso, a obten??o de modelos explicativos distintos, segundo a esfera administrativa do hospital, demonstra a import?ncia da organiza??o dos servi?os de sa?de na composi??o dos gastos da interna??o de idosos. Outro destaque foi a necessidade de melhorar o financiamento em sa?de em termos quantitativos e qualitativos, usando de maneira racional os recursos dispon?veis e evitando interna??es desnecess?rias de idosos inseridos nos extremos de gravidade. Diante da car?ncia de toda ordem de recursos, internar em UTI um idoso em condi??es n?o cr?ticas ou em estado terminal pode comprometer a qualidade dos servi?os prestados ?queles que realmente necessitam de cuidado intensivo. === Introduction: Population aging in Brazil underscores the need to discuss the proper management of the budget allocated in health field, especially in the sectors of high complexity, where coexist costly procedures, limited resources and the need for cost containment. In the other hand, demand is growing in a way directly proportional to the increase in the number of elderly in country. Objective: In this way, this research had as main objective to analyze the costs resulting from the admission of elderly in intensive care units (ICU) and its associated factors. Methods: This is a cross-sectional study with a quantitative approach and featured as a descriptive and exploratory research. Data were collected from medical records of elderly hospitalized in ICU from a brazilian city called Natal-RN, between november first, 2013 and january, 31 of 2014. The variables collected relate to the socio demographic profile, morbidity framework and characterization of hospitalization. The dependent variable was categorized by quartile 75 in high and low expense of hospitalization and submitted to chi-square test with the independent variables of the survey. Associations with p value <0.20 in the bivariate analysis were submitted to the technique of multiple logistic regression. We opted for the construction of three regression models from the above algorithm: general regression model, composed by all 493 hospitalizations in the study, other made with 181 individuals admitted in health public system (SUS) and a third one related to 312 cases from private service in health area. Results: In the general regression model, the variables respiratory diseases, hospitalizations in the private system, disoriented patient and previous stroke were associated with greater probability of high spending in the ICU. In the other hand, in SUS kind of hospitalizations, this probability was associated with disoriented patient, 80 years old or more, sepsis and admission for clinical reason. In the cases from the private network health, the high expenditure was associated with respiratory disease, mechanical ventilation, hospitalization for clinical reason and disoriented patients. Conclusion: The increased expenditure on hospitalization of elderly in intensive care depends on the clinical conditions of individuals. This highlights the importance of avoiding hospitalizations due to diseases sensitive to primary care by health preventive actions and providing comprehensive care to the elderly. In addition, obtaining different explanatory models, according to kind hospital funding, demonstrates the importance of the organization in health services related to composition of costs of hospitalization among the elderly. Another question founded was the need that to improve the funding, we must use rationally the available resources by avoiding unnecessary hospitalizations of elderly people in the extremes of severity. On this kind of precarious funding, ICU hospitalization of elderly non-critical or in a terminal state can compromise the quality of services provided to those who really need intensive care.
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