[Discharge Plan: A Care Tool - Chronic Disease DyadPlano de saída: ferramenta de cuidados - diade com doença crónica]

The WHO reports an increase in chronic non-communicable diseases. Given the complexity of these diseases, patients are constantly hospitalized; therefore, it is necessary to strengthen the competence of both patients and caregivers at home to take care of the disease using the program "discharge plan."

To determine the change in care competency following the implementation of the tool "discharge plan" in a second-level care facility for in-home care of the chronically ill person and family caregiver dyad.

Quantitative, quasi-experimental study, with pre-test and post-test design, using the "Characterization of the patient-caregiver dyad" form and the "CUIDAR" instrument. The population consisted of 62 dyads. Non-probabilistic convenience sampling was used. Pre- and post-delta was calculated, and paired Student t-test was used for comparison.

The "discharge plan" program increased the patients' dimensions of Knowledge by a delta of 3.2, Uniqueness by 3.0, and total care competency by 10.3. Family caregivers'competencies improved in the dimensions of Knowledge by a delta of 3.34, Uniqueness by 1.5, Enjoyment by 1.7, and Reciprocity relationship by 1.61, for a total competency score of 9.2.

These findings suggest that the discharge plan program must be strengthened during hospitalization and discharge to improve the homecare competency of chronically ill patients and their family caregivers.