Proposta de aprimoramento do modelo assistencial de um Centro de Referência para pessoas idosas com base na Classificação Internacional de Funcionalidade, Incapacidade e saúde

Abstract

Contextualization: The care model of the State Reference Center for Elderly Health Care (CREASI) is based on two main pillars understood by the biopsychosocial model and structuring of the elderly health care network (RASPI) of the Unified Health System (SUS) in Bahia. However, it is observed that the screening instrument used is based on frailty, not functionality, as recommended by the World Health Organization’s (WHO) biopsychosocial model. In addition, the comprehensive geriatric assessment (AGA) is very extensive, making communication between the various points of RASPI difficult. General objective: To propose the improvement of the care model of a reference center for elderly people based on the International Classification of Functioning Disability and Health (CIF). Specific objectives: To describe the development of a collaborative, multiprofessional and person-centered care model for elderly people; to link the AGA performed at CREASI with CIF; to identify the distribution of CIF domains in AGA performed at CREASI; to investigate the degree of agreement among experts regarding the importance of CIF categories in AGA. Methodology: Initially, a documentary rescue and interviews were carried out to record the participatory action research with a co-creation approach to the elderly health care model that was developed between 2013 and 2014 and implemented at CREASI in January 2015. Aiming at aligning AGA with the biopsychosocial model, the comprehensive geriatric assessment (AGA) performed at CREASI was linked to the International Classification of Functioning, Disability and Health (CIF) proposed by WHO. For this purpose, a validated checklist with 11 rules was used to link an instrument with CIF. To facilitate interaction between CREASI and other points of RASPI, ensuring focus on health problems with greater impact on functionality, avoiding rework and unnecessary costs to public health, it was proposed to use essential CIF categories to describe functionality and disability in frail elderly people. Thus, a qualitative-quantitative research was developed, with continuing education in functionality and Delphi method survey. Results and Discussion: The CREASI care model was systematized through the rescue of its creation stages and reaffirmation of its components. Functionality gained prominence through the linkage between AGA and CIF, which was performed by two independent specialists and their agreement was considered perfect for each CIF domain (k=0.91; p<0.00; agreement = 93.32%), demonstrating that CIF can have its use favored in specific contexts through linkage with forms elaborated by health services themselves. Of the 313 itens from AGA linked to CIF, 83 were considered extremely important for functional evaluation in the first round of Delphi Study and confirmed in the second round when substantial or almost perfect agreement was verified among specialists, allowing definition of 83 essential CIF categories to describe functionality in frail elderly people. Conclusion: This research improves communication between various points of RASPI by defining essential CIF categories for functional evaluation of frail elderly people, indicating main problems to be evaluated and favoring longitudinal monitoring of impacts of health professionals’ actions on elderly people’s functionality.