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Monitoring of high-risk children in health services: A geospatial mixed-methods study
Bianca Machado Cruz Shibukawa1, Roberta Tognollo Borota Uema1, Natan Nascimento de Oliveira1
1Universidade Estadual de Maringá, Maringá, PR, Brazil.
Insights
Adherence to high-risk child monitoring is declining, with increasing non-adherence and abandonment rates, particularly in remote areas. Failures in transportation and patient follow-up contribute to this trend.
Area of Science:
- Pediatrics
- Public Health
- Healthcare Management
Background:
- Monitoring high-risk children is crucial for early intervention and improved outcomes.
- Rede Mãe Paranaense's high-risk centers face challenges in ensuring continuous patient engagement.
- Understanding adherence patterns is vital for optimizing healthcare delivery.
Purpose of the Study:
- To analyze adherence, non-adherence, and abandonment rates in the monitoring of high-risk children.
- To identify factors contributing to deviations from scheduled monitoring within Rede Mãe Paranaense.
- To evaluate the effectiveness of current monitoring protocols for vulnerable pediatric populations.
Main Methods:
- A parallel and convergent mixed-methods study integrating quantitative and qualitative data.
- Analysis of 3,107 medical charts for quantitative assessment and spatial distribution.
- Content analysis of interviews with 29 health professionals and 34 family members for qualitative insights.
Main Results:
- Adherence rates to monitoring are decreasing, especially in municipalities distant from high-risk outpatient services.
- Non-adherence and abandonment rates are increasing, indicating a growing gap in care continuity.
- Identified a failure in the coordination between transportation services and the active search for absent patients.
Conclusions:
- Adherence to monitoring for high-risk children is declining.
- Non-adherence and abandonment rates have significantly increased, posing a risk to patient care.
- Systemic issues in logistics and patient follow-up require urgent attention to improve monitoring adherence.
Objective:
to analyze adherence, non-adherence and abandonment of the monitoring of children referred to the high-risk reference centers of Rede Mãe Paranaense.
Method:
a parallel and convergent mixed-methods study, in which both approaches have the same weight. The study loci were two high-risk outpatient services from the South of the country. In the quantitative part, 3,107 medical charts of high-risk children were analyzed and the spatial distribution was performed. In the qualitative part, interviews were conducted with 29 health professionals, in addition to 34 family members, and content analysis was performed. Two databases were produced, which were analyzed separately and eventually integrated.
Results:
the rates regarding adherence to monitoring are decreasing, mainly in the municipalities that are far away from the high-risk outpatient services, and the non-adherence and abandonment rates are increasing. In the reports by the representatives and the manager, a failure was observed between the transportation offer and the active search flow of the absent patients, which contributes to the increase in the non-adherence and abandonment rates and to the consequent decrease in adherence.
Conclusion:
in high-risk children, adherence is decreasing and the non-adherence and abandonment rates increased.
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