Scoping review do gerenciamento de casos na transição do cuidado de pessoas com necessidades complexas nos serviços de emergência

Abstract

Case management is a key strategy to promote adequate care transition in the emergency services. It is an integrated, holistic, comprehensive and interdisciplinary approach to promote better outcomes and ensure continuity of care throughout health services. The purpose of this scoping review was to map and synthesize scientific evidence regarding the characteristics, key strategies, outcomes, and potentialities of implementing case management interventions in care transitions in the emergency services. The methodological assumptions of the Joanna Briggs Institute were adopted in line with the recommendations of Levac, Colquhoun and O'Brien. A systematized search was carried out in the following databases: MEDLINE via PubMed, Web of Science via CAPES Periodicals, CINAHL, EMBASE via OVID, and LILACS via VHL. The gray literature was accessed through Google scholar and the reference lists of the studies were evaluated. The synthesis of the interventions was described considering the target population; professionals and central actions; strategies employed; characteristics and potentialities of the case management. Of the 25 studies included, the majority were published in the United States (16 articles) and Canada (4 articles). Case management intervention has played a central role in coordinating high complexity care, especially for frequent users who have complex psychosocial and clinical needs, and in some cases has included family members. Interventions models carried out by multidisciplinary teams were prevalent, which, in collaboration with care providers at different levels of the health system, should promote a holistic and integrative approach to the care. The case manager assumes the central role of communicating with the patient via telephone and promoting the connection with the primary care physician in order to ensure the transmission of all information necessary for the continuity and follow-up of the care after discharge from the emergency service. It was found that screening strategies with risk assessment, individualized and progressive care planning, and coordination of care by establishing effective communication among the multidisciplinary teams in the different care settings were critical for favorable outcomes of the interventions implemented. The main concern was identified with the optimization of the care process for the prevention or reduction of the need of the clients to access the emergency service. The potentialities identified were: promotion of communication between the multidisciplinary team and other health care providers; promotion of the connection with the primary care physician; improved quality of care; patient satisfaction; reduction of costs; and reduction of inappropriate visits and admissions to the emergency department. When used in the emergency services case management resulted in: reduction of overcrowding; improvement of the service and the satisfaction of the team with the work provided; need for training the team; and increased outpatient visits. Case management favors coordination and continuity of care and is critical for the promotion of the optimal care transition for patients with complex needs, seeking to overcome the limits of traditional care in the emergency services