Factors associated with the discontinuance of outpatient follow-up in neonatal units

Duarte, Elysangela Dittz; Tavares, Tatiana Silva; Cardoso, Isadora Virgínia Leopoldino; Vieira, Carolina Santiago; Guimarães, Bárbara Radieddine; Bueno, Mariana

doi:10.1590/0034-7167-2018-0793

Brasil

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (3) • 2020 • https://doi.org/10.1590/0034-7167-2018-0793 linkcopy

Factors associated with the discontinuance of outpatient follow-up in neonatal units

Factores asociados con la interrupción del seguimiento ambulatorio de recién nacidos tras el alta de unidades neonatales

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives: to identify predisposing and enabling factors as well as the health needs associated with the discontinuance of outpatient follow-up of newborns who were hospitalized at neonatal intensive care unit.

Methods: cross-sectional study, using the behavioral model of health services use. The study was composed of 358 mothers and newborns referred to the outpatient follow-up after discharge. Characterization, perception of social support, postnatal depression, and attendance to appointments data were collected, analyzed by the R software (3.3.1).

Results: outpatient follow-up was discontinued by 31.28% of children in the first year after discharge. In multiple regression analysis, the chance of discontinuance was higher for newborns who used mechanical ventilation (OR = 1.68; 95%CI 1.04-2.72) and depended on technology (OR = 3.54; 95%CI 1.32-9.5).

Conclusions: predisposing factors were associated with the discontinuance of follow-up; enabling factors and health needs did not present a significant association. Children with more complex health conditions require additional support to participate in follow-up programs, thus ensuring the continuity of care.

Descriptors: Continuity of Patient Care; Ambulatory Care; Intensive Care Units, Neonatal; Pediatric Nursing; Needs Assessment

Variables		Discontinued		Odds Ratio	p value
Variables		n^* * the value of n changes according with the total number of records of the variable;	%	Odds Ratio	p value
Sex of the child^‡ ‡ Events observed at the time of hospital discharge; ^ǂ ǂ Variable selected for the multivariate model	Female	44	26.3	1.00	-
	Male	61	35.5	1.54	0.070
Gestational age at birth^‡ ‡ Events observed at the time of hospital discharge;	< 37 weeks	86	31.0	1.00	-
	≥ 37 weeks	20	32.8	1.08	0.791
Weight at birth^‡ ‡ Events observed at the time of hospital discharge;	< 2500 g ≥ 2500 g	92 14	32.6 25.0	1.00 0.69	- 0.263
Mechanical ventilation^‡ ‡ Events observed at the time of hospital discharge; ^ǂ ǂ Variable selected for the multivariate model	No Yes	45 56	26.5 38.1	1.00 1.71	- 0.027
Technology dependence^‡ ‡ Events observed at the time of hospital discharge; ^ǂ ǂ Variable selected for the multivariate model	No Yes	101 11	29.7 61.1	1.00 3.72	- 0.008
Age Legal guardian^§ § Events observed in the first outpatient appointment ǂ	< 18 years	9	42.9	1.00	-
	Aged from 18 to 30 years	57	29.1	0.55	0.197
	≥ 30 years	42	31.6	0.62	0.311
Previous children^§ § Events observed in the first outpatient appointment	No	56	29.5	1.00	-
	Yes	52	32.7	1.16	0.516
Mother's educational level^§ § Events observed in the first outpatient appointment ^ǂ ǂ Variable selected for the multivariate model	Illiterate/Some elementary school Elementary school/Some high school High school/Some higher education Higher education	12	38.7	1.00	-
		38 55 5	31.1 30.9 22.7	0.72 0.71 0.47	0.424 0.391 0.224
Declared ethnicity^§ § Events observed in the first outpatient appointment	White Black Mixed Other	19 22 68 1	28.8 29.3 32.5 25.0	1.00 1.03 0.82 1.19	- 0.943 0.568 0.871
Marital status^§ § Events observed in the first outpatient appointment	Without partner With partner	37 73	30.6 31.5	1.00 1.04	- 0.864
Smoker^§ § Events observed in the first outpatient appointment	No Yes	99 10	30.6 32.3	1.00 1.08	- 0.844
Use of drugs^§ § Events observed in the first outpatient appointment	No Yes	107 1	31.1 20.0	1.00 0.55	- 0.599
Edinburgh Scale^§ § Events observed in the first outpatient appointment	< 12 ≥ 12	79 27	30.3 32.9	1.00 1.13	- 0.650

Variables		Discontinued		Odds Ratio	p value
Variables		n^* * the value of n changes according with the total number of records of the variable;	%	Odds Ratio	p value
Social class^§ § Events observed in the first outpatient appointment;	D/E C A/B	18 81 11	28.1 32.5 26.2	1.00 1.23 0.91	- 0.500 0.827
Referral for follow-up after discharge^‡ ‡ Events observed at the time of hospital discharge; ^ǂ ǂ Variable selected for the multivariate model	No Yes	5 107	71.4 30.5	1.00 0.18	- 0.039
Has the Benefício de Prestação Continuada (BPC) [Continuous Provision Benefit]^§ § Events observed in the first outpatient appointment;	No Yes	96 10	30.9 32.3	1.00 1.07	- 0.873
Has another benefit for the child^§ § Events observed in the first outpatient appointment;	No Yes	94 10	30.3 31.2	1.00 1.04	- 0.914
Difficulty to go to the outpatient service^§ § Events observed in the first outpatient appointment; ^ǂ ǂ Variable selected for the multivariate model	No Yes	58 51	27.4 36.7	1.00 1.54	- 0.065
Own car^§ § Events observed in the first outpatient appointment;	No Yes	72 37	30.6 31.9	1.00 1.06	- 0.811
Bus^§ § Events observed in the first outpatient appointment;	No Yes	62 47	29.8 32.9	1.00 1.15	- 0.543
TFD (vehicle provided by the city hall)^§ § Events observed in the first outpatient appointment; ^ǂ ǂ Variable selected for the multivariate model	No Yes	93 16	32.9 23.5	1.00 0.63	- 0.138
Distance^§ § Events observed in the first outpatient appointment;	< 100 km ≥ 100 km and < 200 km ≥ 200 km	91 15 3	31.9 34.1 18.8	1.00 1.10 0.49	- 0.775 0.277
City^§ § Events observed in the first outpatient appointment;	Belo Horizonte Other	40 68	32.5 30.6	1.00 0.92	- 0.717
Overall score - social support scale^§ § Events observed in the first outpatient appointment;	Mean (SD)	106	85(1.6)	1.16	0.844

Variables		Discontinued		Odds Ratio	p value
Variables		n	%	Odds Ratio	p value
Classification of the child's health^ǂ ǂ Variable selected for the multivariate model	Very good	73	33.5	1.00	-
	Good	34	27.4	0.75	0.245
	Average/Very poor	1	11.1	0.25	0.193
Chance of the baby having development problems due to the condition at birth	High/Very high	2	28.6	1.00	-
	Average	12	27.3	0.94	0.943
	Low/Very low	94	31.8	1.16	0.858
Influence of your care for your child's development	High/Very high	101	30.9	1.00	-
	Average	3	33.3	1.12	0.876
	Low/Very low	4	28.6	0.90	0.854
Your child's need for outpatient care^ǂ ǂ Variable selected for the multivariate model	High/Very high	86	34.5	1.00	-
	Average	14	20.0	0.47	0.022
	Low/Very low	9	29.0	0.78	0.542

Variables		Discontinued		Odds Ratio (IC 95%)	p value
Variables		n	%	Odds Ratio (IC 95%)	p value
Mechanical ventilation	No	45	26.50	1.00
Mechanical ventilation	Yes	56	38.10	1.68(1.04-2.72)	0.035
Technology dependence	No	101	29.70	1.00
Technology dependence	Yes	11	61.10	3.54(1.32-9.5)	0.012

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[TF1X] Note:

[TFN2] ^*
the value of n changes according with the total number of records of the variable;

[TFN3] ^‡
Events observed at the time of hospital discharge;

[TFN4] ^§
Events observed in the first outpatient appointment

[TFN5] ^ǂ
Variable selected for the multivariate model