A segurança do paciente na atenção primária à saúde

Objective: This thesis sought to contribute to improving the quality of care, adapting methodologies to assess the occurrence of incidents in the APS in Brazil. Methods: The thesis is developed in three stages. Initially a systematic review of the literature in bibliographic databases: Pubmed, Scopus, Lilacs, Scielo and Capes from 2007 to 2012, in Portuguese, English and Spanish. Then organized a panel with experts, based on the Delphi methodology for adaptation of study Primary Care International Study of Medical Errors (PCISME) to the Brazilian context. In the last stage we tried to assess the occurrence of incidents in the care of the APS patient, through a questionnaire adapted to the Brazilian context, where twenty health professionals working in the family health strategy units were asked to register in order anonymous and confidential, incidents with patients. Results: In stage one we selected 33 items: 26% related to retrospective studies; 44% to prospective studies; 30% cross-sectional studies. The types of incidents most commonly found in APS were associated with medication and diagnosis. The most important contributing factor was miscommunication between members of the healthcare team. In step two the process translation and adaptation of PCISME Australian study in the Brazilian context was conducted by a panel of experts, in five steps. In step three were identified eight types of errors, and the administrative error the most common. The communication was cited as the most common contributing factor for the occurrence of incident in the APS (53%). The incidence of all incidents involving rate was 1.11% (125 / 11,233). The rate of incidents that did not reach the patients was 0.11% (13/11233). The incidence rate of incidents affecting patients, but caused no damage was 0.09% (10 / 11,233). The incidence rate of incidents affecting patients and caused damage (EA) was 0.90% (102 / 11,233). Conclusion: The patient safety issue in APS has been growing in importance in major international health organizations. In Brazil the issue received more attention, according to the National Patient Safety Program, launched by the Ministry of Health in 2013, which included the APS. The incidents also occur in APS comes as pointing studies in developing countries. However one must consider that research in this field are still incipient. Further studies need to enter the agenda of the Brazilian health policy, in search of safer care.

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