Reducción de daños en la atención primaria de salud: una revisión integradora de las estrategias de atención

Soares, Nayana Santos Arêa; Fernandes, Márcia Astrês; Ribeiro, Hellany Karolliny Pinho; Rocha, Daniel de Macêdo; Ribeiro, Ítalo Arão Pereira

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Sumário

Review • Rev. esc. enferm. USP 54 • 2020 • https://doi.org/10.1590/S1980-220X2018051803591 copiar

Reducción de daños en la atención primaria de salud: una revisión integradora de las estrategias de atención

Autoría SCIMAGO INSTITUTIONS RANKINGS

Resumen

Objetivo:

Analizar las evidencias disponibles en la literatura acerca de las acciones de reducción de daños desarrolladas por la atención primaria a la salud.

Método:

Revisión integrativa de la literatura realizada en las bases de datos MEDLINE, CINAHL, SCOPUS, Web of ScienceTM y LILACS.

Resultados:

Fueron incluidos 17 estudios primarios, publicados en el período de 2008 a 2017. Las estrategias asistenciales para reducción de daños comprenderán lo tratamiento de mantenimiento con metadona, la terapia con agonistas opioides, los programas de distribución de agujas y seringas, y la creación de salas para consumo asistido de drogas. Los profesionales de salud fueran esenciales para la consolidación de las estrategias de inclusión considerando las habilidades para oír sin juicio y prejuicio. Conclusión: Las estrategias asistenciales para reducción de los daños fueron difundidas en diferentes países y niveles de atención a la salud, visando la práctica segura, y cuidados con cualidad, efectividad y libre de riesgos.

Descriptores:
Reducción del Dano; Consumidores de Drogas; Enfermería de Atención Primaria; Personal de Salud; Revisión

Descriptors in Health Sciences
P	CD	Transtornos Relacionados ao Uso de Substâncias; Cocaína Crack; Alcoolismo.
P	NCD	Abuso de Drogas; Abuso de Substância; Abuso de Substâncias que Produzem Dependência; Abuso de Substâncias Psicoativas; Dependência de Agentes Químicos; Dependência Química; Dependência de Drogas; Transtornos por Uso de Drogas; Transtornos por Uso de Substâncias; Transtornos por Uso de Substâncias Psicoativas; Transtornos Relacionados ao Uso de Substâncias Psicoativas; Uso Indevido de Drogas; Uso Indevido de Substâncias; Crack; Abuso de Álcool; Intoxicação Alcoólica Crônica; Intoxicação por Álcool Crônica.
I	CD	Redução do Dano
I	NCD	Redução de Danos; Minimização do Dano; Política de Redução de Danos.
Co	CD	Atenção Primária à Saúde
Co	NCD	Atenção Primária de Saúde; Atenção Básica; Cuidados Primários; Cuidados Primários à Saúde.
MESH
P	CD	Substance-Related Disorders; Crack Cocaine; Alcoholism.
P	NCD	Drug Dependence; Dependence, Drug; Drug Addiction; Addiction, Drug; Substance Use Disorders; Disorder, Substance Use; Substance Abuse; Substance Dependence; Drug Abuse; Abuse, Drug; Drug Use Disorders; Disorder, Drug Use; Cocaine, Crack; Alcohol Dependence; Dependence, Alcohol; Chronic Alcoholic Intoxication; Alcohol Addiction; Addiction, Alcohol; Alcohol Abuse; Abuse, Alcohol.
I	CD	Harm Reduction
I	NCD	Harm Minimization
Co	CD	Primary Health Care
Co	NCD	Health Care, Primary; Primary Health care; Primary Care; Care, Primary.
P AND I AND Co
((((((((((((((((((((((((("Substance-Related Disorders"[Mesh]) OR "drug dependence") OR "dependence, drug") OR "drug addiction") OR "addiction, drug") OR "substance use disorders") OR "disorder, substance use") OR "substance abuse") OR "substance dependence") OR "drug abuse") OR "abuse, drug") OR "drug use disorders") OR "disorder, drug use") OR "cocaine, crack") OR "alcohol dependence") OR "dependence, alcohol") OR "chronic alcoholic intoxication") OR "alcohol addiction") OR "addiction, alcohol") OR "alcohol abuse") OR "abuse, alcohol") OR "crack cocaine"[MeSH Terms]) OR "alcoholism"[MeSH Terms])) AND (("harm reduction"[MeSH Terms]) OR "harm minimization")) AND ((((("primary health care"[MeSH Terms]) OR "health care, primary") OR "primary health care") OR "primary care") OR "care, primary")

Main author, and year	Design	Main HR strategies	EL
^{Wiessing L et al. 2017}11. Wiessing L, Ferri M, Belacková V, Carrieri P, Friedman SR, Folch C, et al. Monitoring quality and cover age of harm reduction services for people who use drugs: a consensus study. Harm Reduct J Internet . 2017 cited 2018 Oct 05 ;14(19):1-14. Available from: https://harmreductionjournal.biomedcentral.com/track/pdf/10.1186/s12954-017-0141-6 https://harmreductionjournal.biomedcentr... (¹¹11. Wiessing L, Ferri M, Belacková V, Carrieri P, Friedman SR, Folch C, et al. Monitoring quality and cover age of harm reduction services for people who use drugs: a consensus study. Harm Reduct J Internet . 2017 cited 2018 Oct 05 ;14(19):1-14. Available from: https://harmreductionjournal.biomedcentral.com/track/pdf/10.1186/s12954-017-0141-6 https://harmreductionjournal.biomedcentr... )	Consensus study with qualitative analysis.	Distribution of needles and syringes and therapy with opioid agonists.	2C
^{Toth EC et al. 2016}12. Toth EC, Tegner J, Lauridsen S, Kappel N. A cross-sectional national survey assessing self-reported drug in take behavior, contact with the primary sector and drug treatment among service users of Danish drug consumption rooms. Harm Reduct J. 2016;13(1):27. DOI: 10.1186/s12954-016-0115-0. https://doi.org/10.1186/s12954-016-0115-... (¹²12. Toth EC, Tegner J, Lauridsen S, Kappel N. A cross-sectional national survey assessing self-reported drug in take behavior, contact with the primary sector and drug treatment among service users of Danish drug consumption rooms. Harm Reduct J. 2016;13(1):27. DOI: 10.1186/s12954-016-0115-0. https://doi.org/10.1186/s12954-016-0115-... )	Quanti-qualitative study.	Supervised drug use.	2C
^{McNeil R et al. 2016}13. McNeil R, Kerr T, Pauly B, Wood E, Small W. Advancing patient-centered care for structurally vulnerable drug-using populations: a qualitative study of the perspectives of people who use drugs regarding the potential integration of harm reduction intervention into hospitals. Addiction. 2016;111(4):685-94. DOI:10.1111/add.13214 https://doi.org/10.1111/add.13214... (¹³13. McNeil R, Kerr T, Pauly B, Wood E, Small W. Advancing patient-centered care for structurally vulnerable drug-using populations: a qualitative study of the perspectives of people who use drugs regarding the potential integration of harm reduction intervention into hospitals. Addiction. 2016;111(4):685-94. DOI:10.1111/add.13214 https://doi.org/10.1111/add.13214... )	Qualitative, ethno-epidemiological study.	Patient-centered care prioritizing access to hospital care.	2C
^{Kwan TH et al. 2015}14. Kwan TH, Wong NS, Lee SS. Participation dynamics of a cohort of drug users in a low-threshold methadone treatment programme. Harm Reduct J. 2015;12(30):1-10. DOI: 10.1186/s12954-015-0072-z https://doi.org/10.1186/s12954-015-0072-... (¹⁴14. Kwan TH, Wong NS, Lee SS. Participation dynamics of a cohort of drug users in a low-threshold methadone treatment programme. Harm Reduct J. 2015;12(30):1-10. DOI: 10.1186/s12954-015-0072-z https://doi.org/10.1186/s12954-015-0072-... )	Cohort study.	Treatment and maintenance with low threshold methadone.	2A
^{Moradi G et al.2015}15. Moradi G, Farnia M, Shokoohi M, Shahbazi M, Moazen B, Rahmani K. Methadone maintenance treatment program in prisons from the perspective of medical and non-medical prison staff: a qualitative study in Iran. Int J Health Policy Manag Internet . 2015 cited 2018 Oct 05 ;4(9):583-9. Available from: http://www.ijhpm.com/article_2988_ef26a8eda29a296f83ae7a96a6a9ae13.pdf http://www.ijhpm.com/article_2988_ef26a8... (¹⁵15. Moradi G, Farnia M, Shokoohi M, Shahbazi M, Moazen B, Rahmani K. Methadone maintenance treatment program in prisons from the perspective of medical and non-medical prison staff: a qualitative study in Iran. Int J Health Policy Manag Internet . 2015 cited 2018 Oct 05 ;4(9):583-9. Available from: http://www.ijhpm.com/article_2988_ef26a8eda29a296f83ae7a96a6a9ae13.pdf http://www.ijhpm.com/article_2988_ef26a8... )	Qualitative study.	MMT	2C
^{Collins SE et al. 2015}16. Collins SE, Grazioli VS, Torres NI, Taylor EM, Jones CB, Hoffman GE, et al. Qualitatively and quantitatively evaluating harm-reduction goal setting among chronically homeless individuals with alcohol dependence. Addict Behav. 2015;45:184-90. DOI: 10.1016/ j.addbeh.2015.02.001 https://doi.org/10.1016/j.addbeh.2015.02... (¹⁶16. Collins SE, Grazioli VS, Torres NI, Taylor EM, Jones CB, Hoffman GE, et al. Qualitatively and quantitatively evaluating harm-reduction goal setting among chronically homeless individuals with alcohol dependence. Addict Behav. 2015;45:184-90. DOI: 10.1016/ j.addbeh.2015.02.001 https://doi.org/10.1016/j.addbeh.2015.02... )	Quanti-qualitative study.	Treatment with naltrexone and behavioral intervention.	2C
^{Ayres R et al. 2014}17. Ayres R, Ingram J, Rees A, Neale J, Beattie A, Telfer M. Enhancing motivation within a rapid opioid substitution treatment feasibility RCT: a nested qualitative study. Subst Abuse Treat Prev Policy. 2014;9:44. DOI:10.1186/1747-597X-9-44. https://doi.org/10.1186/1747-597X-9-44... (¹⁷17. Ayres R, Ingram J, Rees A, Neale J, Beattie A, Telfer M. Enhancing motivation within a rapid opioid substitution treatment feasibility RCT: a nested qualitative study. Subst Abuse Treat Prev Policy. 2014;9:44. DOI:10.1186/1747-597X-9-44. https://doi.org/10.1186/1747-597X-9-44... )	Qualitative study.	Opioid substitution treatment.	2C
^{MacNeil J et al. 2011}18. MacNeil J, Pauly B. Needle exchange as a safe haven in an unsafe world. Drug Alcohol Rev. 2011;30(1):26-32. DOI: 10.1111/j.1465-3362.2010.00188.x https://doi.org/10.1111/j.1465-3362.2010... (¹⁸18. MacNeil J, Pauly B. Needle exchange as a safe haven in an unsafe world. Drug Alcohol Rev. 2011;30(1):26-32. DOI: 10.1111/j.1465-3362.2010.00188.x https://doi.org/10.1111/j.1465-3362.2010... )	Qualitative study.	Syringe exchange and establishing trust with the Health Team.	2C
^{Larance B et al. 2008}19. Larance B, Degenhardt L, Copeland J, Dillon P. Injecting risk behavior and related harm among men who use performance and image enhancing drugs. 2008;27(6):679-86. DOI: 10.1080/09595230802392568. https://doi.org/10.1080/0959523080239256... (¹⁹19. Larance B, Degenhardt L, Copeland J, Dillon P. Injecting risk behavior and related harm among men who use performance and image enhancing drugs. 2008;27(6):679-86. DOI: 10.1080/09595230802392568. https://doi.org/10.1080/0959523080239256... )	Quantitative study.	Information about the risks associated with sharing vials, safe application techniques and medical monitoring.	2C
^{Engstrom EM et al. 2016}20. Engstrom EM, Teixeira MB. Manguinhos, Rio de Janeiro, Brazil, "Street Clinic" team: care and health promotion practice in a vulnerable territory. Ciênc Saúde Coletiva Internet . 2016 cited 2018 Oct 05 ;21(6):1839-48. Available from: http://www.scielo.br/pdf/csc/v21n6/1413-8123-csc-21-06-1839.pdf http://www.scielo.br/pdf/csc/v21n6/1413-... (²⁰20. Engstrom EM, Teixeira MB. Manguinhos, Rio de Janeiro, Brazil, "Street Clinic" team: care and health promotion practice in a vulnerable territory. Ciênc Saúde Coletiva Internet . 2016 cited 2018 Oct 05 ;21(6):1839-48. Available from: http://www.scielo.br/pdf/csc/v21n6/1413-8123-csc-21-06-1839.pdf http://www.scielo.br/pdf/csc/v21n6/1413-... )	Qualitative study.	A multidisciplinary team developed the reception and inclusion of homeless people to citizenship and health services. It promoted educational and informative actions, in addition to make possible artistic and recreational activities.	2C
^{Muniz MP et al. 2015}21. Muniz MP, Abrahão AL, Souza AC, Tavares CMM, Cedro LF, Storani M. Expanding the network: when the drug user accesses psychosocial care through primary care services. Rev Pesq Cuid Fundam Internet . 2015 cited 2018 Oct 05 ;7(4):3442-53. Available from: http://www.seer.unirio.br/index.php/cuidadofundamental/article/view/4951/0 http://www.seer.unirio.br/index.php/cuid... (²¹21. Muniz MP, Abrahão AL, Souza AC, Tavares CMM, Cedro LF, Storani M. Expanding the network: when the drug user accesses psychosocial care through primary care services. Rev Pesq Cuid Fundam Internet . 2015 cited 2018 Oct 05 ;7(4):3442-53. Available from: http://www.seer.unirio.br/index.php/cuidadofundamental/article/view/4951/0 http://www.seer.unirio.br/index.php/cuid... )	Qualitative study.	Reception actions and referral to specialized mental health services.	2C
^{Junqueira MAD et al. 2015}22. Junqueira MA, Rassool GH, Santos MA, Pillon SC. The impact of an educational program in brief interventions for alcohol problems on undergraduate nursing students: a Brazilian context. J Addict Nurs. 2015;26(3):129-35. DOI: 10.1097/JAN.0000000000000086. https://doi.org/10.1097/JAN.000000000000... (²²22. Junqueira MA, Rassool GH, Santos MA, Pillon SC. The impact of an educational program in brief interventions for alcohol problems on undergraduate nursing students: a Brazilian context. J Addict Nurs. 2015;26(3):129-35. DOI: 10.1097/JAN.0000000000000086. https://doi.org/10.1097/JAN.000000000000... )	Quantitative study.	Nursing students as drivers in HR through a technical approach to health counseling, with a focus on changing behaviors.	2C
^{Jack HE et al. 2017}23. Jack HE, Oller D, Kelly J, Magidson JF, Wakeman SE. Addressing substance use disorder in primary care: the role, integration, and impact of recovery coaches. Subst Abus. 2017;39(3):307-14. DOI: 10.1080/08897077.2017.1389802 https://doi.org/10.1080/08897077.2017.13... (²³23. Jack HE, Oller D, Kelly J, Magidson JF, Wakeman SE. Addressing substance use disorder in primary care: the role, integration, and impact of recovery coaches. Subst Abus. 2017;39(3):307-14. DOI: 10.1080/08897077.2017.1389802 https://doi.org/10.1080/08897077.2017.13... )	Qualitative study.	“Recovery coaches”	2C
^{Zafarghandi MB et al. 2017}24. Zafarghandi MBS, Tabasi Y, Bolhari J, Baghbanian A, Yazdani S, Adibfar MA, et al. The integration program of prevention and treatments of substance use and HIV/AIDS in the rural primary health care (PHC) system of Iran. Int J High Risk Behav Addict. 2017;6(1):e29173. DOI: 10.5812/ijhrba.29173 https://doi.org/10.5812/ijhrba.29173... (²⁴24. Zafarghandi MBS, Tabasi Y, Bolhari J, Baghbanian A, Yazdani S, Adibfar MA, et al. The integration program of prevention and treatments of substance use and HIV/AIDS in the rural primary health care (PHC) system of Iran. Int J High Risk Behav Addict. 2017;6(1):e29173. DOI: 10.5812/ijhrba.29173 https://doi.org/10.5812/ijhrba.29173... )	Cross-sectional descriptive/qualitative study.	Referrals to specialists or other professional centers of higher education.	2C
^{Souza LGS et al. 2015}25. Souza LGS, Menandro MCS, Menandro PRM. Alcoholism its causes and treatment in the social representations constructed by Brazilian family health professionals. Physis Internet . 2015 cited 2018 Oct 05 ;25(4):1335-60. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S010373312015000401335&lng=en http://www.scielo.br/scielo.php?script=s... (²⁵25. Souza LGS, Menandro MCS, Menandro PRM. Alcoholism its causes and treatment in the social representations constructed by Brazilian family health professionals. Physis Internet . 2015 cited 2018 Oct 05 ;25(4):1335-60. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S010373312015000401335&lng=en http://www.scielo.br/scielo.php?script=s... )	Qualitative study.	Abstinence was described as the only method of healthcare.	2C
^{Green CA et al. 2014}26. Green CA, McCarty D, Mertens J, Lynch FL, Hilde A, Firemark A, et al. A qualitative study of the adoption of buprenorphine for opioid addiction treatment. J Subst Abuse Treat. 2014;46(3):390-401. (²⁶26. Green CA, McCarty D, Mertens J, Lynch FL, Hilde A, Firemark A, et al. A qualitative study of the adoption of buprenorphine for opioid addiction treatment. J Subst Abuse Treat. 2014;46(3):390-401.)	Qualitative study.	Therapeutic use of buprenorphine.	2C
^{Smye V et al. 2011}27. Smye V, Browne AJ, Varcoe C, Josewski V. Harm reduction, methadone maintenance treatment and the root causes of health and social inequities: an intersectional lens in the Canadian context. Harm Reduct J. 2011;8(17). DOI: http://dx.doi.org/10.14288/1.0224095. https://doi.org/10.14288/1.0224095... (²⁷27. Smye V, Browne AJ, Varcoe C, Josewski V. Harm reduction, methadone maintenance treatment and the root causes of health and social inequities: an intersectional lens in the Canadian context. Harm Reduct J. 2011;8(17). DOI: http://dx.doi.org/10.14288/1.0224095. https://doi.org/10.14288/1.0224095... )	Qualitative study.	MMT	2C

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[1] Corresponding author:
Nayana Santos Arêa Soares Quadra H, Casa 29, Bela Vista III CEP 64030-840 - Teresina, PI, Brazil nayanandrey@gmail.com