Care trajectories of COVID-19 patients: from preventive measures to rehabilitation

This study aims to analyze the care trajectories of patients diagnosed with COVID-19 who were hospitalized and are currently undergoing rehabilitation regarding their use of and access to the healthcare network (HN). An evaluative, qualitative study was carried out based on interviews with patients in the city of Niterói, Rio de Janeiro State, Brazil. The care trajectories were reconstructed at three different occasions that express their experiences with the healthcare and support network during the pandemic: prevention, support and diagnosis measures; hospitalization; post-COVID-19 care, rehabilitation and support. The results indicate that the main source of information about COVID-19 was TV newscasts. Preventive hygiene measures were the most widely adopted. The family was the main support network. There was no waiting time for admission to the municipal referral hospital. Hospitalization was very well evaluated in terms of user embracement, multidisciplinary care, virtual visits and daily contact between doctor and family members. A post-discharge “care vacuum” was identified, with no follow-up by primary health care (PHC) and other public services. Low-cost health insurance plans and private specialized post-COVID-19 services were frequently and spontaneously sought until the implementation of the rehabilitation service. In summary, solitary and discontinuous care trajectories of individuals and families shed light on several challenges to the health system, including guaranteed access to coordinated PHC and expanded offer of specialized public services and rehabilitation, aligned with the principles of humanized care, in addition to the maintenance of social support measures.

本研究旨在分析确诊感染新冠病毒（COVID-19）、曾住院且目前正接受康复治疗的患者，在医疗保健网络（Healthcare Network，HN）中的使用情况与可及性，并梳理其照护轨迹。
本研究为评价性质性研究，基于巴西里约热内卢州尼特罗伊市的患者访谈资料开展。
研究在三个不同阶段重构了患者的照护轨迹，以呈现其在新冠疫情期间依托医疗与支持网络的经历：防控、支持与诊断措施阶段；住院治疗阶段；新冠后遗症照护、康复与支持阶段。
研究结果显示，新冠病毒相关信息的主要来源为电视新闻节目。预防型卫生措施被广泛采用，家庭是患者最主要的支持网络。患者前往市级转诊医院时无需等待入院时长。住院治疗环节在患者认可度、多学科照护、虚拟探视以及医生与家属的日常沟通方面均获得了极高评价。
研究发现存在出院后“照护真空”现象，基层医疗卫生服务（Primary Health Care，PHC）及其他公共服务未提供后续随访服务。
在康复服务落地实施前，患者常自发寻求低成本健康保险计划与私人专业新冠后遗症诊疗服务。
综上，个体与家庭分散且不连贯的照护轨迹，凸显了当前医疗体系面临的多项挑战：需保障患者可获取协调一致的基层医疗卫生服务，扩大符合人性化照护原则的公共专业服务与康复服务供给，同时持续落实社会支持措施。