Metas internacionais de segurança do paciente na atenção primária à saúde: uma revisão integrativa  <span class="so-article-trans-title" dir="auto"> Translated title: International patient safety goals in the Primary Health Care: an integrative review </span>

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Abstract

Resumo A atenção primária em saúde (APS) representa o primeiro contato dos indivíduos com a porta de entrada dos siste- mas de saúde. A implementação de estratégias como as Metas Internacionais de Segurança do Paciente (MISP) neste nível de atenção em saúde surge como alternativa para qualificação do cuidado. O presente estudo tem como objetivo investigar na literatura, estudos relacionados às MISP no âmbito da APS. Tratase de uma revisão de literatura integrativa com busca nas bases de dados Scopus, MEDLINE/Pubmed, LILACS e Scielo, de 2012 a 2019. Dos 43 artigos selecionados, 20,9% apresentaram origem na Espanha, seguidos de Brasil e Reino Unido com sete (16,3%) estudos cada. A MISP 3, sobre o uso seguro de medicamentos, foi a mais prevalente, 65,4% dos estudos, e envolveu estudos com as temáticas de polifarmácia, medicamentos potencialmente inapropriados, revisão de medicamentos e conciliação medicamentosa. A presente revisão integrativa contribuiu para ampliar o conhecimento sobre a segurança do paciente no âmbito da APS e para ressaltar a necessidade da realização de mais estudos referentes às seis MISP, muitas delas, já bem descritas e debatidas no ambiente hospitalar, mas com discreta abordagem mesmo com igual relevância, no âmbito da APS.

Translated abstract

Abstract The Primary Health Care (PHC) characterizes the first contact of citizens with the health systems. The implementation of strategies such as the International Patient Safety Goals (IPSG) in this level of healthy attention appears as an alternative to qualify care. The study aims to investigate, thought science literature, studies related to IGPS in the field of PHC. It is an integrative review based on data from Scopus, MEDLINE/Pubmed, LILACS and Scielo, from 2012 to 2019. Out of 43 selected studies, the majority has analyzed data from the Spain (20.9%), followed by Brazil and United Kingdom, seven (16.4%) studies each. The MISP 3, regarding the improve the safety of medications was the most prevalent, 65.4% of the studies, sustaining themes as polypharmacy, potentially inappropriate medication, medication review and medication reconciliation. This integrative review contributes to increase the knowledge about the patient's safety in the field of PHC and emphasizes the need for further studies related to the six IGPS. Although most of them has already been described and debated in the hospital environment, the PHC remains an overlooked field of study.

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Multimorbidity, polypharmacy, referrals, and adverse drug events: are we doing things well?

Amaia Calderón-Larrañaga, Alexandra Prados-Torres, Francisca González-Rubio … (2012)

The consequences of multimorbidity include polypharmacy and repeated referrals for specialised care, which may increase the risk of adverse drug events (ADEs). The objective of this study was to analyse the influence of multimorbidity, polypharmacy, and multiple referrals on the frequency of ADEs, as an indicator of therapeutic safety, in the context of a national healthcare system. This was a multicentre, retrospective, observational study of 79 089 adult patients treated during 2008 in primary care centres. The explanatory patient variables sex, age, level of multimorbidity, polypharmacy, number of primary care physician visits, and number of different specialties attended were analysed. The response variable was the occurrence of ADEs. Logistic regression models were used to identify associations among the analysed variables. The prevalence of individuals with at least one ADE was 0.88%. Multivariate analysis identified the following variables as risk factors for the occurrence of ADE in descending order of effect size: multimorbidity level (odds ratio [OR]Veryhigh/Low = 45.26; ORHigh/Low = 17.58; ORModerate/Low = 4.25), polypharmacy (OR = 1.34), female sex (OR = 1.31), number of different specialties (OR = 1.20), and number of primary care physician visits (OR = 1.01). Age, however, did not show statistical significance (OR = 1.00; 95% confidence interval = 0.996 to 1.005). The results of this study demonstrate that multimorbidity is strongly related to the occurrence of ADEs, insofar as it requires the intervention of multiple specialties and the prescription of multiple medications. Further research should shed light on the causal pathway between multimorbidity and increased risk of adverse events.

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Avaliação da qualidade do acesso na atenção primária de uma grande cidade brasileira na perspectiva dos usuários

Rosana Campos, Ana Ferrer, Carlos Gama … (2014)

Este artigo visa compreender como usuários do sistema de saúde de uma metrópole brasileira avaliam o acesso aos serviços de atenção primária. Está é uma avaliação participativa de quarta geração, guiada pela metodologia hermenêutica Gadameriana. Foram conduzidos quatro grupos focais com usuários. Narrativas foram construídas a partir das transcrições usando o arcabouço teórico de Ricoeur. A atenção primária é reconhecida como a porta de entrada do sistema de saúde, mas o acesso é dificultado por: problemas de organização; uso do acolhimento como barreira ao acesso; falta de recursos humanos; dificuldades em dar seguimento ao tratamento. O modelo centrado na doença e a falta de análise crítica podem induzir a descrença nos resultados da atenção primária.