Desafíos de la seguridad del paciente en atención primaria de salud: revisión exploratoria

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REVIEW • Rev. Bras. Enferm. 73 (5) • 2020 • https://doi.org/10.1590/0034-7167-2019-0209 copiar

Desafíos de la seguridad del paciente en atención primaria de salud: revisión exploratoria

About the SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

identificar los desafíos de la seguridad del paciente descriptos por profesionales de salud en atención primaria de salud.

Métodos:

se realizó revisión exploratoria en bases LILACS, MEDLINE, IBECS, BDENF y CINAHL, y en bibliotecas Cochrane, SciELO, PubMed y Web of Science en enero de 2019. Se incluyeron artículos originales, realizados con profesionales de salud sobre seguridad del paciente en ámbito de atención primaria.

Resultados:

la revisión incluyó 26 estudios publicados entre 2002 y 2019. El análisis determinó cuatro categorías: desafíos de los profesionales de salud; desafíos de la gestión de servicios de salud; desafíos con los usuarios y familia; y recursos potenciadores de la seguridad del paciente.

Conclusiones:

los desafíos de la seguridad del paciente son, para los profesionales de atención primaria, múltiples y complejos. Este estudio brinda conocimiento sobre recursos para mejorar la seguridad del paciente para profesionales de salud, pacientes, gestores, formuladores de políticas, educadores e investigadores.

Descriptores:
Seguridad del Paciente; Atención Primaria de Salud; Enfermería; Grupo de Atención al Paciente; Revisión

Author	Year/ county	Journal	Participants	Approach	Level of evidence/degree of recommendation
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Bodur S, Filiz E.⁽²⁵25 Bodur S, Filiz E. A survey on patient safety culture in primary healthcare services in Turkey. Int J Qual Heal Care[Internet]. 2009 [cited 2019 Feb 6];21(5):348-55. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19700779 https://www.ncbi.nlm.nih.gov/pubmed/1970... ⁾	2009 Turkey	Int J Qual Heal Care	54 general practitioners, 48 nurses, 51 midwives, 27 health workers	quantitative cross-sectional study	IV
Manwell LB, et al⁽³⁴34 Manwell LB, Williams ES, Babbott S, Rabatin JS, Linzer M. Physician Perspectives on Quality and Error in the Outpatient Setting. Wis Med J[Internet]. 2009 [cited 2019 Feb 6];108(3):139-44. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19552351 https://www.ncbi.nlm.nih.gov/pubmed/1955... ⁾	2009 United States	Wis Med J	32 doctors	qualitative study	VII
Sequeira AM, Martins L, Pereira VH⁽²⁹29 Sequeira AM, Martins L, Pereira VH. Natureza e frequência dos erros na actividade de Medicina Geral e Familiar Geral num ACES- Estudo descritivo. Rev Port Clin Geral [Internet]. 2010 [cited 2019 Apr 6];572-88. Available from: http://rpmgf.pt/ojs/index.php/rpmgf/article/download/10800/10536 http://rpmgf.pt/ojs/index.php/rpmgf/arti... ⁾	2010 Portugal	Rev Port Clin Geral	8 doctors specializing in general and family medicine	prospective, quantitative cross-sectional study	IV
Paese F, Sasso G⁽³⁷37 Paese F, Teresinha Marcon Dal Sasso G. patient safety culture in primary health care. Texto e Contexto Enferm [Internet]. 2013 [cited 2019 Feb 6];22(2):302-12. Available from: http://www.scielo.br/pdf/tce/v22n2/v22n2a05 http://www.scielo.br/pdf/tce/v22n2/v22n2... ⁾	2013 Brazil	Texto Context Enferm	52 community health workers, 30 nursing technicians and 14 nurses	cross-sectional, quantitative study	IV
Gehring K, et al.⁽²⁶26 Gehring K, Schwappach DLB, Battaglia M, Buff R, Huber F, Sauter P, et al. Safety climate and its association with office type and team involvement in primary care. Int J Qual Heal Care [Internet]. 2013[cited 2019 Feb 6];25(4):394-402 Available from: https://www.ncbi.nlm.nih.gov/pubmed/23667155 https://www.ncbi.nlm.nih.gov/pubmed/2366... ⁾	2013 Switzerland	Int J Qual Heal Care	630 health professionals (314 nurses and 316 doctors)	cross-sectional, quantitative study	IV
Torijano-Casalengua ML, et al.⁽³¹31 Torijano-Casalengua ML, Olivera-Cañadas G, Astier-Peña MP, Maderuelo-Fernández JÁ, Silvestre-Busto C. Validation of a questionnaire to assess patient safety culture in Spanish Primary Health Care professionals. Aten Primaria [Internet]. 2013 [cited 2019 Feb 6];45(1):22-37. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22981282 https://www.ncbi.nlm.nih.gov/pubmed/2298... ⁾	2013 Spain	Aten Primaria	185 health professionals (doctors, nurses and management staff)	qualitative study	VII
Verbakel NJ, et al.⁽¹⁰10 Verbakel NJ, Van Melle M, Langelaan M, Verheij TJM, Wagner C, Zwart ADLM. Exploring patient safety culture in primary care. Int J Qual Heal Care [Internet]. 2014 [cited 2019 Out 10];26 (6):585-91. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25085256 https://www.ncbi.nlm.nih.gov/pubmed/2508... ⁾	2014 Holland	Int J Qual Heal Care	625 workers (150 physical therapists, 125 midwives, 99 from anticoagulation clinics, 70 from speech therapy, 61 from dental care, 36 physiotherapist, 39 occupational therapists, 26 from skin therapy, 19 from dietetics	quantitative cross-sectional study	IV
Bondevik GT, et al.⁽²²22 Bondevik GT, Hofoss D, Hansen EH, Deilkas ECT. Patient safety culture in Norwegian primary care: A study in out-of-hours casualty clinics and GP practices. Scand J Prim Health Care [Internet] 2014 [cited 2019 Feb 6];32(3):132-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25263763 https://www.ncbi.nlm.nih.gov/pubmed/2526... ⁾	2014 Norway	Scand J Prim Health Care	266 health professionals (139 nurses and 124 doctors)	quantitative cross-sectional study	IV
Bondevik GT, et al.⁽²³23 Bondevik GT, Hofoss D, Hansen EH, Deilkas ECT. The safety attitudes questionnaire -Ambulatory version: Psychometric properties of the Norwegian translated version for the primary care setting. BMC Health Serv Res [Internet]. 2014 [cited 2019 Feb 6];14:139. Available from: https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-14-139 https://bmchealthservres.biomedcentral.c... ⁾	2014 Norway	BMC Health Serv Res	266 health professionals (139 nurses and 124 doctors)	quantitative cross-sectional study	IV
Bell GB, et al.⁽²¹21 Bell GB, Spencer R, Avery JA, Campbell MS. Tools for measuring patient safety in primary care settings using the RAND_UCLA appropriateness method. BMC Family Practice [Internet] 2014 [cited 2019 Feb 6];15:110. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24902490 https://www.ncbi.nlm.nih.gov/pubmed/2490... ⁾	2014 England	BMC Family Practice	9 experienced specialists in patient safety and general practice	qualitative study	VII
Webair HH, et al.⁽¹⁷17 Webair HH, Al-Assani SS, Al-Haddad RH, Al-Shaeeb WH, Selm MAB, Alyamani AS. Assessment of patient safety culture in primary care setting, Al-Mukala, Yemen. BMC Fam Pract[Internet]. 2015 [cited 2019 Mar 13];16:136. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604039/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	2015 Yemen	BMC Family Practice	78 respondents (17 doctors, 46 nurses and 15 management staff)	quantitative study	IV
Marchon SG, Mendes Junior WV, Pavão ALB⁽⁸8 Marchon SG, Mendes Jr WV, Pavão ALB. Characteristics of adverse events in primary health care in Brazil. Cad Saúde Pública. 2015;31(11):2313-30. doi: 10.1590/0102-311X00194214 https://doi.org/10.1590/0102-311X0019421... ⁾	2015 Brazil	Cad Saúde Pública	15 health professionals (8 nurses and 7 doctors)	descriptive, quantitative observational study	IV
Bowie P, et al.⁽¹⁸18 Bowie P, Forrest E, Price J, Verstappen W, Cunningham D, Halley L, et al. Good practice statements on safe laboratory testing: A mixed methods study by the LINNEAUS collaboration on patient safety in primary care. Eur J Gen Pract [Internet]. 2015 [cited 2019 Feb 6];21 (sup1):19-25. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4828633/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	2015 United Kingdom and Ireland	Eur J Gen Pract.	10 professionals (doctors, nurses, practice managers, patient safety researchers, clinical educators and medical damages specialists)	qualitative and quantitative study	VI
Verbakel NJ, et al.⁽²⁰20 Verbakel NJ, Bont AA, Verheij TJM, Wagner C, Zwart DLM. Improving patient safety culture in general practice: an interview study. Br J Gen Pract. [Internet]. 2015[cited 2019 Feb 6];65(641):e822-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26622035 https://www.ncbi.nlm.nih.gov/pubmed/2662... ⁾	2015 Holland	Br J Gen Pract	24 doctors and 24 nurses	qualitative study	VI
Parker D, et al.⁽¹⁹19 Parker D, Wensing M, Esmail A, Valderas JM. Measurement tools and process indicators of patient safety culture in primary care: mixed methods study by the LINNEAUS collaboration on patient safety in primary care. Eur J Gen Pract. [Internet] 2015 [cited 2019 Feb 6]; 21 Suppl:26-30. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26339832 https://www.ncbi.nlm.nih.gov/pubmed/2633... ⁾	2015 Poland, Germany, England and Greece	Br J Gen Pract.	Primary health care doctors	qualitative study	VI
Marchon SG, Mendes Junior WV⁽¹⁶16 Marchon SG, Mendes Jr WV. Tradução e adaptação de um questionário elaborado para avaliar a segurança do paciente na atenção primária em saúde. Cad Saúde Pública. 2015;31(7):1395-402. doi: 10.1590/0102-311X00157214. https://doi.org/10.1590/0102-311X0015721... ⁾	2015 Brazil	Cad Saúde Pública	Panel of experts (doctors, researchers, managers)	qualitative study	VII
Timm M, Rodrigues MCS⁽²⁸28 Timm M, Rodrigues MCS. Adaptação transcultural de instrumento de cultura de segurança para a Atenção Primária. Acta Paul Enferm. 2016;26-37. doi: 10.1590/1982-0194201600005 https://doi.org/10.1590/1982-01942016000... ⁾	2016 Brazil	Acta Paul Enferm	37 professionals (11 nursing technicians, 7 nurses, 4 doctors, 3 dentists, 3 management staff, 2 laboratory technicians, 1 nutritionist, 1 oral health technician, 1 supervisor, 1 manager, 1 head of nursing, 1 head of archives department and 1 community health agent)	methodological quantitative study	VI
Paranaguá TTB, et al.⁽³⁰30 Paranaguá TTB, Bezerra ALQ, Tobias GC, Ciosak SI. Support for learning in the perspective of patient safety in primary health care. Rev Latino-Americana Enferm. [Internet] 2016 [cited 2019 Feb 6]; Available from: http://dx.doi.org/10.1590/1518-8345.0784.2771 http://dx.doi.org/10.1590/1518-8345.0784... ⁾	2016 Brazil	Rev Latino-Americana Enferm.	86 health professionals (38 nurses, 15 dentists, 14 doctors)	quantitative cross-sectional study	IV
López-Liria R, et al⁽³²32 López-Liria R, Rocamora-Pérez P, Aguilar-Parra JM, Vargas-Muñoz ME, del Pilar Díaz-López M, Padilla-Góngora D. Evaluation in Primary Care Professionals: The Patient’s Safety Culture. Procedia -Soc Behav Sci[Internet]. 2017[cited 2019 Feb 6]. Available from: https://doi.org/10.1016/j.sbspro.2017.02.209 https://doi.org/10.1016/j.sbspro.2017.02... ⁾	2017 Spain	Procedia -Soc Behav Sci.	216 workers (84 nurses; 80 doctors; 33 management staff; 11 nursing assistants; 6 from ambulances and 2 physiotherapists)*	quantitative cross-sectional study	IV
Michel P, et al.⁽³⁵35 Michel P, Brami J, Chanelière M, Kret M, Mosnier A, Dupie I, et al. Patient safety incidents are common in primary care: A national prospective active incident reporting survey. PLoS One[Internet]. 2017[cited 2019 Feb 6]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28196076 https://www.ncbi.nlm.nih.gov/pubmed/2819... ⁾	2017 France	PLoS One	127 general practitioners	quantitative study	IV
Galhardi NM, et al.⁽²⁷27 Galhardi NM, Roseira CE, Orlandi F de S, Figueiredo RM de. Assessment of the patient safety culture in primary health care. Acta Paul Enferm. 2018;31(4):409-16. doi: 10.1590/1982-0194201800057 https://doi.org/10.1590/1982-01942018000... ⁾	2018 Brazil	Acta Paul Enferm	240 professionals (18 doctors, 14 nurses, 6 dentists, 2 social workers, 2 psychologists, 4 pharmacists, 1 physiotherapist, 1 speech therapist, 15 managers, 20 management staff, 83 community health agents, 9 nursing assistants, 6 pharmacy assistants and 1 oral health assistant)	cross-sectional, quantitative study	IV
Litchfield I, et al.⁽²⁴24 Litchfield I, Gill P, Avery T, Campbell S, Perryman K, Marsden K, et al. Influences on the adoption of patient safety innovation in primary care: A qualitative exploration of staff perspectives. BMC Family Practice. [Internet] 2018 [cited 2019 Jun 5];19(1):1-12. Available from: https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-018-0761-2 https://bmcfampract.biomedcentral.com/ar... ⁾	2018 England	BMC Family Practice	39 interviews (general practitioners, practice managers, nurses and a health care assistant).	qualitative study	VI
Lyson HC, et al.⁽³³33 Lyson HC, Ackerman S, Lyles C, Schillinger D, Williams P, Gourley G, et al. Redesigning primary care in the safety net: a qualitative analysis of team-based care implementation. Healthcare[Internet]. 2018[cited 2019 Feb 6];1-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30552044 https://www.ncbi.nlm.nih.gov/pubmed/3055... ⁾	2018 United States	Healthcare	doctors, nurses, team coordinators, administrative support, pharmacists and behavioral health specialists	qualitative study	VI
Raimondi DC, et al.⁽¹1 Raimondi DC, Bernal SCZ, Oliveira JLC, Matsuda LM. Cultura de segurança do paciente na atenção primária à saúde: análise por categorias profissionais. Rev Gaúcha Enferm. 2019;40(spe):e20180133. doi: 10.1590/1983-1447.2019.20180133 https://doi.org/10.1590/1983-1447.2019.2... ⁾	2019 Brazil	Rev Gaúcha Enferm	144 workers (63 community health workers, 31 nursing assistants and/or technicians, 16 nurses, 15 dentists, 11 oral health technicians and 8 doctors)	cross-sectional, quantitative study	IV
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[1] Corresponding author: Carlise Rigon Dalla Nora. E-mail: carlise.nora@ufrgs.br