Efetividade e análise de impacto orçamentário para implementação de um programa de teleatendimento para prevenção de quedas baseado em gestão de casos para pessoas idosas na Atenção Primária à Saúde

Abstract

To assess the effectiveness and budgetary impact of a case management-based fall prevention program for community-dwelling elderly individuals with a history of falls in order to estimate the impact of its implementation in the SUS. Methodology: To achieve this objective, this dissertation will be presented in two studies. Study 1 evaluated the effectiveness of a protocol for fall prevention based on case management, adopting as primary outcome the number of self-reported falls and as secondary outcome the quality of life (utility), assessed using the EuroQol-5D-3L instrument. All analyses were performed following the intention-to-treat principle. The Shapiro-Wilk test was used to verify normality. To analyze the usefulness, the Linear Mixed Model (SPSS software version 29) was used. Study 2 evaluated, through a budget impact analysis, whether this same protocol has the potential to be implemented in primary health care (PHC). To determine the eligible population, the projections of the Brazilian Institute of Geography and Statistics (IBGE) were used, assuming the age groups: 60 to 90 years or older, in a time horizon of 5 years. To perform the Budget Impact Analysis, 2 different scenarios were constructed. In scenario 1, it was considered that the program should be made available to 100% of the elderly population with recurrent falls in the first year. Then, the 40% effectiveness of the protocol was used to reduce falls. Thus, in the following 4 years, 60% of the previous year was considered, added to the population growth. In scenario 2, no reduction was applied. A sensitivity analysis with best and worst scenario was performed, in addition, a third scenario that did not take into account extra costs was also verified. Results: In study 1, 32 participants were allocated to the IG and 30 to the CG. No differences were found regarding the number of falls between the groups. However, the comparison between the times of the 52-week measurements with the baseline indicated a significant difference in the reduction in the number of falls. For utility, no difference in overall effect was found when comparing GC and GI (p=0.21), which makes it impossible to analyze it in greater detail between reassessments. In study 2, approximately 7.5 million older adults became the target audience for this treatment between years 1 and 5. Both scenarios show a decrease in long-term costs. However, the sensitivity analysis indicates an increase in extra costs, perceived in the pessimistic version of both scenarios. However, when verified, the optimistic scenario and the scenario that did not consider extra costs demonstrated more immediate positive results with regard to cost reduction. Conclusion: Although the analyzed protocol was not effective in reducing the number of falls between groups or in improving quality of life, it has the potential to generate cost savings in the long term. However, studies with more robust sampling and more realistic cost estimates need to be carried out, taking into account the adaptations necessary for its operation within PHC. Still, it is observed that close and systematic monitoring for fall prevention can reduce the number of these accidents, which is very important for maintaining the health of the elderly population. Furthermore, the study contributes to the scenario of multifactorial research and its repercussions in the literature.