Itinerário terapêutico de trabalhadores com intoxicação alcoólica crônica

• Ano de defesa: 2017
• Autor(a) principal: Silva, Lais Fernanda Ferreira da
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Estadual de Maringá; Brasil; Programa de Pós-Graduação em Enfermagem; UEM; Maringá, PR; Centro de Ciências da Saúde
• Palavras-chave em Português: Enfermagem; Saúde pública; Alcoolismo; Serviço de saúde; Doença crônica; Família; Brasil.; Health services accessibility; Family; Chronic disease; Public health nursing; Brazil.; Ciências da Saúde
• Link de acesso: http://repositorio.uem.br:8080/jspui/handle/1/2392

The objective of this study was to recognize the therapeutic itinerary of workers with chronic alcohol intoxication and to identify the different health services accessed by workers and the fragilities of access based on the narratives of the relatives. It is a descriptive and longitudinal study of a qualitative nature, using the theoretical reference of the Therapeutic Itinerary and the Narrative as methodological resource. It was carried out in the municipality of Maringá-PR, with an intentional sample of nine chronic alcohol users, admitted to the Regional University Hospital of Maringá and enrolled in the Poison Control Center of the Hospital, from January to June 2016, having the worker as key informant. The data sources were the Monthly List of Intoxicated Patients in the PCC/UHM; the Toxicological Occurrence Form/Alcoholic Poisoning and/or Other Abuse Drugs and the hospital records of the workers; and the instruments of data collection were four scripts - Guide for Data Collection of Hospital Documents; Home Interview script for narrative interview; Charlson Comorbidity Index Chart; and Guide for Non-Participating Home Observation, with a research journal type. From the hospital documents, sociodemographic data were compiled from the worker and his family, data regarding the hospitalization and contextualization of chronic alcohol use, which were analyzed descriptively. The Charlson Index was applied to each user through the records in the hospital chart and the scores were obtained through the sum of the comorbidities recorded. The interviews were carried out with five informant relatives, from October to November, 2016, in the workers' homes, conducted by the researcher in a single meeting. Interviews lasted approximately 70 minutes and were recorded in full on digital audio media. Data analysis used the principles of narrative analysis (BURY, 2001). All the established ethical precepts were established under Opinion 1,606,056. Four users were men, with an average age of 54.5 years old, and three had no marital relationship. Only one of them was still working; Two were receiving Social Security illness assistance and two were unemployed. The main reasons for hospitalization were chronic gastrointestinal diseases, mainly pancreatitis, portal hypertension, esophageal varices, chronic hepathopaties, liver cirrhosis, and alcoholic hepatitis; chronic infectious diseases - hepatitis C, HIV infection, repeated community pneumonias; and neoplasms. All of them started using alcoholic beverages early, and the average time of use was of 35.5 years, stressed by withdrawal phases, during a period of no more than one year, and relapses. Four users had a Charlson Comorbidity Index greater than 4 indicating the severity of the chronic disease/comorbidity and the high risk of mortality. It was observed constant access of the families to the services of the Emergency Care Network and hospitals, low access and bond to the devices of the Primary Health Care Network and the Community-Based Health Psychosocial Care Network, with difficulties of inclusion into treatment, early access and continuity of care in health care services noted by discontinuity, fragmentation and lack of access to the secondary and tertiary levels of care. The therapeutic itineraries allowed the visualization of the trajectory of the worker and family by the health system, besides its social and cultural aspects, in view of the disease situation. The study corroborated several authors who work with the therapeutic itinerary theme and the multiple logics that govern patients' options and pathways in search for treatment, when there are individual aspects, sociocultural representations related to the disease and healing systems, socioeconomic and structural conditions and related to easy or not easy access. Although the present analysis presents limitations inherent to the intentionality of the interviewees' choice, it is a specific group of alcoholics and families with effects of chronic drinking for a long period, and the results may contribute to a better knowledge about the access to public health services and, concerning the gaps in taking care of alcoholics in the health care network, to guide the actions of managers and health professionals.