Estrategias de transición de cuidados en los países latinoamericanos: una revisión integrativa

Lima, Maria Alice Dias da Silva; Magalhães, Ana Maria Müller de; Oelke, Nelly Donszelmann; Marques, Giselda Quintana; Lorenzini, Elisiane; Weber, Luciana Andressa Feil; Fan, Iris

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Sumário

Integrative Review • Rev. Gaúcha Enferm. 39 • 2018 • https://doi.org/10.1590/1983-1447.2018.20180119 copiar

Estrategias de transición de cuidados en los países latinoamericanos: una revisión integrativa

Autoría SCIMAGO INSTITUTIONS RANKINGS

Resumen

OBJETIVO

Identificar la literatura disponible sobre estrategias de transición del cuidado entre niveles de atención a la salud en países de América Latina.

MÉTODOS

Revisión integradora que incluyó estudios indexados en las bases de datos PubMed, LILACS, Web of Science Core Collection, CINAHL, Scopus y Scientific Electronic Library Online (SciELO), publicados en portugués, español o inglés, entre 2010 y 2017.

RESULTADOS

Se seleccionaron once artículos y las estrategias fueron agrupadas en componentes de la transición del cuidado: planificación de alta, planificación anticipada de cuidados, educación del paciente y promoción de la autogestión, seguridad de la medicación, comunicación completa de las informaciones y acompañamiento ambulatorial. Estas estrategias fueron realizadas por miembros del equipo multidisciplinario, en los que las enfermeras desempeñan un papel de liderazgo en la promoción de transiciones de cuidados seguras.

CONCLUSIÓN

Las actividades de transición del cuidado generalmente se inician muy cerca del alta del paciente, esto difiere de las recomendaciones de programas y modelos de transición de cuidados, que sugieren la implementación de estrategias de transición del cuidado desde el momento de la admisión hasta la alta.

Palabras clave:
Continuidad de la atención al paciente; Transferencia de pacientes; Educación en salud; Alta del paciente; Readmissión del paciente

Authors and Year of Publication	Country, Language, Level of Evidence	Objective	Method, Setting and Sample	Care Transition Strategies
Góes FGB, Cabral IE, 2017¹⁵15. Góes FGB, Cabral IE. Discourses on discharge care for children with special healthcare needs. Rev Bras Enferm. 2017;70(1):154-61. doi: https://doi.org/10.1590/0034-7167-2016-0248. https://doi.org/10.1590/0034-7167-2016-0...	Brazil Portuguese English Level 4	Analyze and understand the discourse of healthcare professionals and families on the hospital discharge process for children with special healthcare needs.	Qualitative Research A Public Pediatric Teaching hospital in Rio de Janeiro 10 children with special healthcare needs, 6 professionals, and 11 family members	Health education for patients/families based on individual needs (PEPS); engage family members in the care of patient/child during hospitalization (PEPS); use of feedback method to review understanding of the instructions given (PEPS).
Ferreira EB et al., 2017¹⁶16. Ferreira EB, Cruz FOAM, Jesus CAC, Pinho DLM, Kamada I, Reis PED. Telephone contact as a strategy for the promotion of comfort to the patient submitted to chemotherapy. J Nurs UFPE on line. 2017[cited 2018 Mar 12];11(5):1936-42. Available from: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/23343/18949. https://periodicos.ufpe.br/revistas/revi...	Brazil Portuguese English Level 4	To monitor the adverse effects of antineoplastic chemotherapy in patients undergoing outpatient treatment through telephone follow-up as a strategy to provide comfort.	Longitudinal, prospective, quantitative- qualitative study High Complexity in Oncology Center (CACON) A total of 21 patients, aged between 30 and 78 years	Telephone follow-up during the course of treatment increases the relationship of trust and creates opportunities for patients to clarify questions/doubts (OF); nursing consultations were conducted via telephone during chemo to monitor patients' signs and symptoms related to the adverse effects of chemo (OF) and (PEPS).
Figueiredo TP et al., 2016¹⁷17. Figueiredo TP, Carmo Jr NM, Groia RCS, Pereira RCC, Silveira RR, Malta JS, et al. Análise das intervenções realizadas na alta hospitalar de idosos acompanhados em serviço de orientação e referenciamento farmacoterapêutico. Rev APS. 2016 [cited 2017 Nov 15];19(3):376-83. Available from: https://aps.ufjf.emnuvens.com.br/aps/article/view/2722/1014. https://aps.ufjf.emnuvens.com.br/aps/art...	Brazil Portuguese Level 3	Analyze the instructions given at discharge, described in the pharmacotherapeutic referrals and the profile of patients in post-discharge contacts.	Retrospective cohort study General Public Hospital, Belo Horizonte, Brazil 135 patients before hospital discharge and 65 patients post-discharge follow-up	Outpatient monitoring in the primary care unit(OF); care planning at the time of discharge (DP); telephone calls for follow-up (OF); patient education and promotion of medication self-management (PEPS) and (MS); sending patients’ information to the health care team at the primary care unit (CCI).
Lima LF et al., 2016¹⁸18. Lima LF, Martins BC, Oliveira FR, Cavalcante RM, Magalhães VP, Firmino PY, et al. Pharmaceutical orientation at hospital discharge of transplant patients: strategy for patient safety. Einstein. 2016;14(3):359-65. doi: https://doi.org/10.1590/S1679-45082016AO3481. https://doi.org/10.1590/S1679-45082016AO...	Brazil Portuguese English Level 4	Describe and analyze pharmaceutical instructions provided at the time of discharge of transplant patients.	Cross-sectional, descriptive and retrospective study University Hospital of Walter Cantídio, Fortaleza, Brazil 74 patients	Discharge planning (DP) and health education with a focus on self-care and diet by multiprofessional teams (PEPS); educational actions aimed at medication safety (MS); provide patients with a pharmaceutical orientation prior to discharge at the clinical ward (PEPS), and follow-up at the outpatient clinic (OF)
Oliveira PR et al., 2016¹⁹19. Oliveira PR, Felix CS, Carvalho VC, Giovani AM, Reis RS, Beraldo M, et al. Outpatient parenteral antimicrobial therapy for orthopedic infections: a successful public healthcare experience in Brazil. Braz J Infect Dis. 2016;20(3):272-5. doi: https://doi.org/10.1016/j.bjid.2016.03.005. https://doi.org/10.1016/j.bjid.2016.03.0...	Brazil English Level 4	Describe the implementation process and preliminary results of an outpatient parenteral antimicrobial therapy program (OPAT) for treating orthopedic infections in a public health service centre in São Paulo, Brazil.	Descriptive study Orthopedic and Traumatology Institute of São Paulo University Hospital, São Paulo, Brazil 450 primary healthcare professionals, 116 patients were discharge for OPAT.	Outpatient monitoring in primary care units (OF); health education activities with a focus on central venous catheters (PEPS); discharge planning based on assessment of health conditions, cognitive capacity, and social support for getting to treatment units (DP); a clinical pathway including detailed treatment plans was utilized as a communication tool between hospitals and primary care facilities (CCI).
Hernandez AMT, 2015²⁰20. Hernández Tapia AM. Plan de alta y seguimiento domiciliario a un preescolar con alteraciones funcionales y morfológicas del corazón. Rev Mex Enferm Cardiol. 2015 [cited 2017 Nov 13];23(1):22-7. Available from: http://www.medigraphic.com/pdfs/enfe/en-2015/en151d.pdf. http://www.medigraphic.com/pdfs/enfe/en-...	Mexico Spanish Level 4	Formulate a comprehensive, specialized, individualized care plan during discharge and home follow-up for a preschooler with functional and morphological heart changes, based on the Virginia Henderson care model.	Case study National Institute of Cardiology Ignacio Chávez, Mexico 1 pediatric patient and his family	Monitoring through home visits (OF); medication safety instructions (MS); patient and caregiver education (PEPS).
Carmo TM et al., 2015²¹21. Carmo TM, Paiva BSR, Siqueira MR, Rosa LTB, Oliveira CZ, Nascimento MAS, et al. A phase II study in advanced cancer patients to evaluate the early transition to palliative care (the PREPArE trial): protocol study for a randomized controlled trial. Trials. 2015;16:160. doi: https://doi.org/10.1186/s13063-015-0655-8. https://doi.org/10.1186/s13063-015-0655-...	Brazil English Level 1	Evaluate the feasibility of psychological interventions and palliative care for patients with advanced cancer.	Randomized, open-label, phase II trial, with 2 intervention arms and a control group Oncology clinics at Barretos Cancer Hospital, São Paulo, Brazil 150 Patients	Advance care planning by multidisciplinary teams (ACP); educational and psychological interventions to provide support to families and patients (PEPS).
Aristizábal D et al., 2015²²22. Aristizábal D, Gallo J, Valencia A, Jaime J, Correa M, Aristizábal A, et al. Effect of a comprehensive ambulatory care model on outcomes of patients with acute coronary syndrome in Colombia. Rev Panam Salud Publica. 2015 [cited 2017 Nov 15];38(5):362-9. Available from: https://www.scielosp.org/article/rpsp/2015.v38n5/362-369/en/. https://www.scielosp.org/article/rpsp/20...	Colombia English Level 2	To evaluate the effect of a care program designed according to a comprehensive ambulatory care model (CACM) on the appearance of new cardiovascular/coronary events in patients with acute coronary syndrome.	Quasi- experimental intervention study Cardiovic Clinic Medellín, Colombia 442 patients	Telephone and treatment plan follow-up post-discharge (OF); patient education (PEPS) and use of the feedback method to review understanding of medication safety (MS).
Becerra-Camargo J et al., 2015²³23. Becerra-Camargo J, Martínez-Martínez F, García-Jiménez E. The effect on potential adverse drug events of a pharmacist-acquired medication history in an emergency department: a multicentre, double-blind, randomised, controlled, parallel-group study. BMC Health Serv Res. 2015;13:337. doi: https://doi.org/10.1186/s12913-015-0990-1. https://doi.org/10.1186/s12913-015-0990-...	Colombia English Level 1	To measure the impact of potential adverse drug events by having the pharmacist collect the history of drugs in use, before the consultation with the physician in the emergency department.	Multicentre, double-blind, randomised, controlled parallel-group study Three large teaching hospitals, Bogota, Colombia 270 Patients	Medication reconciliation between pharmacists, doctors, and patients (MS); communication by phone with family members or caregivers to confirm patients’ current medication regime is correct (MS).
Marques LFG, Romano-Lieber NS, 2014²⁴24. Marques LFG, Romano-Lieber NS. Patient safety and medication use after discharge: exploratory study. Saúde Sociedade. 2014;23(4):1431-44. doi: https://doi.org/10.1590/S0104-12902014000400025. https://doi.org/10.1590/S0104-1290201400...	Brazil Portuguese English Level 4	This study aims to understand the dynamics and challenges of care provided to patients by hospital providers focusing on safe use of medications after discharge.	Qualitative, Exploratory Study São Paulo University Hospital, São Paulo, Brazil 11 Healthcare Professionals (4 physicians, 3 nurses, 3 pharmacists, 1 social worker)	Discharge planning only for patients with complex health care needs (DP); home visit follow-ups for patients under the Home Care Program (OF); medication education and counselling for pediatric patients and caregivers (PEPS) and (MS).
Costa JM et al., 2014²⁵25. Costa JM, Abelha LL, Pinto IVL, Reis AMM. Análise de um programa para otimização da transição do cuidado de pacientes em terapia antimicrobiana. Rev APS. 2014 [cited 2017 Nov 15];17(3):318-24. Available from: https://aps.ufjf.emnuvens.com.br/aps/article/view/2114/823. https://aps.ufjf.emnuvens.com.br/aps/art...	Brazil Portuguese Level 4	Present the results of a project to guide discharged patients on the use of antimicrobial pharmacotherapy, carried out in a teaching hospital.	Retrospective, descriptive, and exploratory study Hospital Risoleta Tolentino Neves, Belo Horizonte, Brazil	Telephone follow-ups post discharge (OF); Discharge planning (DP); patient orientation to medication safety (PEPS) and (MS);

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[1] Corresponding author:
Maria Alice Dias da Silva Lima. malice@enf.ufrgs.br