Fatores associados ao tempo de decisão para procura de serviços de saúde por pessoas com acidente vascular cerebral isquêmico

Abstract

The neurological deficits resulting from ischemic stroke (CVA) have an important impact on human life and the early decision to seek health services by people with acute stroke has the potential to reduce morbidity and mortality, enabling therapies time-dependent. Objectives:1. Estimate the decision time of people with stroke to seek a health service after the onset of symptoms or wake up stroke; 2.Verify the association between sociodemographic, clinical, environmental, cognitive and emotional factors and the decision time for seeking a health service after the onset of symptoms or Wake up stroke in people with ischemic stroke. Methods: A cross-sectional study, carried out with 304 people with acute stroke treated at a Public Hospital of reference for treatment, in Salvador-BA. Data were collected through interviews and medical records from March to October 2019 and analyzed using descriptive and inferential statistics. In the bivariate analyses, to investigate the association between the independent variables and the DT, robust linear regression was used, with the DT analyzed as a geometric mean due to its asymmetric distribution.The variables whose associations showed p-value ≤ 0.20 were taken to the multivariate analysis, initially performed in blocks (sociodemographic, clinical, environmental, cognitive and emotional). Subsequently, the analysis of the complete model was carried out with all the independent variables of the referred blocks, using the Multiple Linear Regression. The goodness of fit of the model was evaluated by the Akaike Information Criterion, selecting the one with the lowest value as the final model. The adopted statistical significance was 5%. Multicollinearity was evaluated in the adjustment of the model by the variance inflation factor and STATA version 12 was used. Results: The minimum value of the TD was 0.02 h (1.5 min) and the maximum value of 118 h (7,080 min). The geometric mean of the DT was 0.30 h (95% CI 0.23-0.39), which corresponded to a mean of 18 min for participants to decide to seek care after the onset of stroke or wake up stroke symptoms. The final model explained DT in 41%, showing an increase in DT in 0.5 min for participants with arterial hypertension, in 10.8 min for those who waited for symptoms to improve, in 1.4 min for those who were alone. at the onset of symptoms, in 2.1 min for those on the street/public road, in 3.2 min at work and in 3.9 min at home. Conclusions: Participants took an average of 18 min to decide to seek care at a health service and DT was influenced by variables of a clinical nature (having arterial hypertension), environmental (being alone or in an environment other than a health service) and cognitive and emotional (expect the improvement of symptoms). It is important to consider, in health education activities aimed at people with risk factors for stroke and aimed at the community in general, the variables that contributed to greater TD.