Uma revisão de escopo do uso excessivo de mamografia de rastreamento / Una revisión de alcance del uso excesivo de mamografía de tamizaje / A scoping review of excessive use of mammography screening

Resumo Objetivos Identificar como os estudiosos definem o rastreamento excessivo para mulheres sem risco de desenvolver câncer de mama, examinar os determinantes (barreiras e facilitadores) do uso excessivo da mamografia de rastreamento e descrever as taxas de observação do uso excessivo da mamografia de rastreamento. Métodos Revisão de escopo baseada em busca realizada em maio de 2022 em seis bancos de dados e bibliotecas eletrônicas de saúde. Artigos revisados por pares em qualquer idioma e ano de publicação foram incluídos. Resultados Na amostra de 18 artigos publicados a partir de 1991, a maioria deles dos Estados Unidos, o uso excessivo de mamografia foi definido como a intenção ou realização de mamografia fora da faixa etária ou intervalo recomendado, entre mulheres com expectativa de vida limitada, em programas, organizados e oportunísticos, coexistentes. As taxas de observação do uso excessivo de mamografia de rastreamento nos estudos selecionados variaram de 1,4% a 87,2%. Os facilitadores da mamografia excessiva são preocupações relacionadas ao câncer; a recomendação médica, especialmente de especialistas; e ao maior acesso a exames. As mais expostas ao rastreamento excessivo são as mulheres com maior escolaridade e renda. As barreiras para o excesso de mamografia incluíram orientações nas consultas sobre os malefícios da mamografia e a expectativa de vida, por médicos generalistas, principalmente os da atenção primária. Conclusão Nosso estudo identificou que o uso excessivo da mamografia de rastreamento tem alta prevalência quando realizado como rastreamento e é permeado por fatores multiníveis. Nossa lista de determinantes pode fornecer algumas orientações para estudos futuros com o objetivo de desimplementar o cuidado de baixo valor do uso excessivo da mamografia de rastreamento.

Resumen Objetivos Identificar cómo los académicos definen el tamizaje excesivo en mujeres sin riesgo de presentar cáncer de mama, examinar los determinantes (barreras y facilitadores) del uso excesivo de mamografía de tamizaje y describir los índices de observación del uso excesivo de mamografía de tamizaje. Métodos Revisión de alcance basada en una búsqueda realizada en mayo de 2022 en seis bases de datos y bibliotecas electrónicas de salud. Se incluyeron artículos revisados por pares en cualquier idioma o año de publicación. Resultados En la muestra de 18 artículos publicados a partir de 1991, la mayoría de Estados Unidos, el uso excesivo de mamografía fue definido como la intención o realización de mamografía fuera del grupo de edad o intervalo recomendado, en mujeres con expectativa de vida limitada, en programas coexistentes, organizados y oportunistas. Los índices de observación del uso excesivo de mamografía de tamizaje en los estudios seleccionados varían de 1,4 % a 87,2 %. Los facilitadores de la mamografía excesiva son las preocupaciones relacionadas con el cáncer, las recomendaciones médicas, especialmente de especialistas, y el mayor acceso al examen. Las personas más expuestas al tamizaje excesivo son las mujeres con mayor escolaridad e ingresos. Las barreras para el exceso de mamografías incluyeron orientaciones en consultas sobre los maleficios de la mamografía y expectativa de vida, por parte de médicos generales, principalmente los de atención primaria. Conclusión El estudio identificó que el uso excesivo de mamografía de tamizaje tiene alta prevalencia cuando se realiza como tamizaje y está impregnado de factores multinivel. La lista de determinantes puede ofrecer algunas orientaciones para estudios futuros con el objetivo de dejar de implementar esta atención de escaso valor que es el uso excesivo de mamografía de tamizaje.

Abstract Objectives To identify how scholars define excessive screening for women without risk of developing breast cancer, examine the determinants (barriers and facilitators) of excessive use of mammography screening, and describe the rates of observations of excessive use mammography screening. Methods Scoping review based on a search in May 2022 in six electronic health databases and libraries. Articles included were peer-reviewed articles, in any language and year of publication. Results In a sample of 18 articles, published from 1991 onwards, most of them from the United States, the excessive use of mammography were defined as the intention or performance of mammography outside the recommended age or interval range, among women with limited life expectancy, in coexisting, organized and opportunistic programs. The rates of observations of excessive use of mammography screening in the selected studies ranged from 1.4% to 87,2%. Facilitators for excessive mammography are related concerns of getting cancer; to the medical advice, especially from specialists; and to the increased access to tests. The most exposed to excessive screening are women with higher levels of education and income. Barriers for excessive mammography included guidance in consultations about the harm of mammography and life expectancy by general practitioners, particularly those in primary care. Conclusion Our study identified that the excessive use of mammography screening has a high prevalence when done as screening and is permeated by multi-level factors. Our list of determinants can provide some guidance for future studies aiming to de-implement the low-value care of excessive mammography screening.

Evaluación del uso inapropiado de los servicios de emergencia de un hospital del seguro social en Lima Perú / Evaluation of the inappropriate use of emergency services of a social security hospital in Lima Peru

Se denomina uso inapropiado de los servicios de emergencia a la búsqueda de servicios de salud de manera urgente por parte de los pacientes que presentan una patología no urgente, cuyo problema de salud puede y debe ser atendido en el nivel primario o por consultorio externo. El objetivo planteado fue el de encontrar ciertas características que pudieran ser relevantes a la hora de hacer uso inapropiado de los servicios de emergencia. Estudio transversal analítico en el que se administró un cuestionario por medio de entrevista para realizar una encuesta a una muestra aleatoria de usuarios del servicio de emergencia del Hospital Nacional Guillermo Almenara que cumplían con los criterios de selección desde abril a noviembre del 2015. El análisis bivariante identificó siete variables significativas relacionadas al uso inapropiado, con OR [IC 95 %] y valor p: género femenino (1.49 [1.07, 2.08], p = .018), presencia de enfermedad crónica (0.50 [0.35. 0.72], p < .001), percepción de ausencia de equipos en nivel primario (2.56 [1.66, 3.94], p < .001), percepción de ausencia de especialistas en nivel primario (2.25 [1.43, 3.55], p < .001), autorreferencia (1.69 [1.12, 2.57], p = .012), percepción de que la atención del nivel terciario cuesta igual o menos (2.02 [1.42, 2.89], p < 0.001), encontrarse en el trabajo al momento de decidir acudir a emergencia (1.87 [1.12, 3.13], p = 0.015). El análisis multivariante identificó tres variables significativas, con ORaj [IC 95 %] y valor p: percepción de ausencia de equipos en nivel primario (2.21 [1.42, 3.44], p < .001), autorreferencia (1.72 [1.05, 2.77], p = .032) y percepción de menor costo (2.0 [1.35, 3.09], p = .001). La presencia de enfermedad crónica, la percepción de ausencia de equipos y de especialistas en nivel primario fueron las variables que se asociaron con mayor fuerza al uso inapropiado de los servicios de emergencia

Inappropriate use of emergency services is defined as the misuse of emergency room services for pathologies that could be attended as a non-urgent basis, either at an outpatient or in primary services. e purpose of this research was to find some characteristics associated with this misuse. Analytical cross-sectional study, in which a random sample of users of the emergency service of the National Hospital "Guillermo Almenara" who met the selection criteria from April to November 2015, was administered. e bivariate analysis identified seven significant variables related to the inappropriate use: female gender (OR = 1.49, 95% CI [1.07, 2.08], p = .018), presence of chronic disease (OR = 0.50, 95% CI [0.35, 0.72], p < .001), perception of absence of equipment at primary level (OR = 2.56, 95% CI [1.66, 3.94], p < .001), perception of absence of specialists at primary level (OR = 2.25, 95%CI [1.43, 3.55], p < .001), self-reference (OR = 1.69, 95% CI [1.12, 2.57], p = .012), perception that the tertiary level care costs equal or less (OR = 2.02, 95% CI [1.42, 2.89], p < .001), and being at work when deciding to go to emergency (OR = 1.87, 95% CI [1.12, 3.13], p = .015). e multivariate analysis identified three significant variables: perception of absence of equipment at primary level (Adj. OR = 2.21, IC95% [1.42, 3.44], p < .001), self-reference (Adj. OR = 1.72, 95% CI, [1.05, 2.77], p = .032), and lower cost perception (Adj. OR = 2.0, 95% CI [1.35, 3.09], p = .001). e presence of chronic disease, the perception of lack of equipment, and specialists at the primary level were the variables that were most strongly associated with the inappropriate use of emergency services

Uso de los servicios de urgencias en Bogotá, Colombia: Un análisis desde el Triaje / Use of emergency services in Bogotá, Colombia: An analysis from the triage

Resumen Introducción: Los servicios de urgencias son puntos críticos para la calidad de la atención. Comprender los motivos de su uso aporta al mejoramiento de los sistemas de salud. Objetivo: Se describieron las características de afiliados al régimen contributivo que usaron servicios de urgencias en tres hospitales de nivel III de complejidad en Bogotá, así como las impresiones diagnósticas y distribución cronológica de la demanda, de acuerdo con los datos obtenidos al momento de ser clasificados en el Triaje. Materiales y métodos: Se realizó un estudio de corte transversal, con base en registros de Triaje en el lapso comprendido entre 1 de octubre de 2012 a 31 de marzo de 2013. Resultados: Un tercio de los registros fueron clasificados como consultas médicas no urgentes; el día lunes tuvo el mayor número de atenciones; las urgencias tuvieron un comportamiento diurno; variables como: sexo femenino, condición de afiliación como cotizante al sistema de salud y tener edad para trabajar, se asociaron con diferencias en la clasificación del Triaje al momento de demandar las urgencias. Conclusión: El uso de los servicios de urgencias está influenciado por la relación entre: características demográficas, condición de afiliación al sistema de salud y clasificación del Triaje.

Abstract Introduction: Emergency services are critical points for the quality of care. Understanding the reasons for their use contributes to the improvement of health systems. Objective: To describe the characteristics of members of the contributory regime who used emergency services in three level III hospitals of complexity in Bogotá, as well as the diagnostic impressions and chronological distribution of the demand, according to the data obtained at the time of being classified in the triage. Materials and methods: A cross-sectional study was conducted based on triage records from October 1, 2012 to March 31, 2013. Results: A third of the records were classified as non-urgent medical consultation. Monday had the greatest number of attentions. Emergencies had daytime behavior. Variables such as: female sex, membership status as a contributor to the health system and age to work were associated with differences in the classification of triage at the time of demand for emergencies. Conclusion: The use of the emergency services is influenced by the relation between: demographic characteristics, condition of affiliation to the health system and classification of the triage.

Associação do perfil de usuários frequentes com as características de utilização de um serviço de emergência / Association of the frequent users profile with the characteristics of using an emergency service / Asociación del perfil de usuarios frecuentes con las características de uso de un servicio de emergencias

OBJETIVO: caracterizar o perfil e os atendimentos dos usuários frequentes de um serviço de emergência e associar as características sociodemográficas e clínicas dos usuários com as características de utilização do serviço. MÉTODO: estudo retrospectivo e analítico realizado no serviço de emergência de um hospital universitário localizado no município de São Paulo. Foram incluídos prontuários dos pacientes que procuraram o serviço de emergência no mínimo quatro vezes num período de 12 meses entre setembro de 2013 e agosto de 2014. RESULTADOS: incluídos 480 prontuários (2.808 atendimentos). A média de atendimentos foi de 5,85, sendo que a amostra variou de quatro a 28 atendimentos. Foram classificados como verdes após a classificação de risco 44,4% dos pacientes; como laranja, 13,1%; e como vermelho 8,1%, sendo que a maioria desses atendimentos foi realizada às segundas-feiras; 69,1% tiveram como desfecho a alta hospitalar. Predominaram os atendimentos não urgentes. CONCLUSÃO: os serviços de emergência podem elaborar estratégias junto com as unidades básicas de saúde que facilitem o gerenciamento dos casos a fim de suprir integralmente as necessidades dos usuários no nível adequado de assistência, implementando um sistema de fluxo de referência e contrarreferência dos pacientes.

Objective: to characterize the profile and outpatient care of frequent users of an emergency service, and to associate the sociodemographic and clinical patterns of users with the purpose of the emergency service. Method: Retrospective analysis and analytical examination performed at the Emergency Department of a university hospital, located in the city of São Paulo. Were used Patient records who sought emergency care at least four times in a twelve-month period, from September 2013 to August 2014. Results: Included 480 patient records (2,808 visits). The mean number of visits was 5.85, and the sample ranged from 4 to 28 visits. 44.4% of the patients were classified as green after a risk classification, 13.1% as orange and 8.1% as red, and the majority of these visits were performed on Mondays. 69.1% had the outcome of hospital discharge. Non-urgency visits predominated. Conclusion: Emergency services can develop strategies together with Basic Health Units that facilitate case management to fully meet users needs at the appropriate level of care, implementing a system flow and counter flow of patients.

Excesivo rastreo de osteoporosis en mujeres menores de 65 años: estudio de corte transversal / Excessive osteoporosis screening in women under 65 years: a cross-sectional study

RESUMEN El rastreo de osteoporosis en mujeres con bajo riesgo de fractura (sobreuso) puede conducir a sobrediagnóstico, tratamiento inapropiado y medicalización. El objetivo de este trabajo fue determinar la proporción de mujeres de 45 a 64 años afiliadas a un plan de medicina prepaga de Buenos Aires, Argentina, que realizaron al menos una densitometría ósea de cadera durante 2011 y no cumplían criterios para el rastreo. Se realizó un estudio observacional de corte transversal. Se identificaron 4.310 mujeres de este rango etario que se realizaron una densitometría ósea, entre las que se seleccionó una muestra aleatorizada de 401 mujeres y se obtuvieron datos completos para 178 mujeres. Para determinar si el rastreo era apropiado se utilizaron dos criterios: 1) tener un riesgo de fractura a 10 años mayor que una mujer de 65 años (regla FRAX®); 2) presentar al menos un factor de riesgo de fractura. Un 86,5% de las densitometrías óseas fueron realizadas en mujeres cuyo riesgo estimado por FRAX® no superaba el umbral mínimo recomendado, constatándose osteoporosis en el 5,8% y osteopenia en el 61,0%. En relación con el segundo criterio, el 49,4% no presentaba siquiera un factor de riesgo, documentándose osteoporosis en el 3,4%, y osteopenia en el 62,5%. Los resultados muestran que al menos la mitad de las mujeres no cumplía con los criterios de rastreo.

ABSTRACT Overuse of osteoporosis screening in women at low risk of fracture may lead to overdiagnosis, inappropriate treatment and medicalization. The objective of this work was to estimate the proportion of women aged 45 to 64 enrolled in a private health insurance plan in Buenos Aires undergoing hip dual-energy x-ray absorptiometry (DXA) in 2011 without meeting osteoporosis screening criteria. In this cross-sectional study, 4310 women of this age range that had undergone a hip DXA were identified. A randomly selected sub-group of 401 women was then assessed for the presence of risk factors for osteoporosis and complete data were retrieved for 178 women. Appropriate screening was defined by two criteria: 1) having a 10-year fracture risk higher than that of a 65-year old woman (estimated using the FRAX® tool); 2) having at least one risk factor for fracture. It was found that 86.5% of the women who underwent hip DXA did not exceed the minimum 10-year fracture risk threshold required for screening; 5.8% of them had osteoporosis and 61.0% osteopenia. According to the second criterion, 49.4% had no risk factors, 3.4% of these women had osteoporosis and 62.5% osteopenia. The results show that at least half the women screened did not meet osteoporosis screening criteria.

Estudio exploratorio del impacto del alfabetismo funcional sobre conductas sanitarias deficientes a nivel poblacional / An exploratory study of functional literacy on health care behaviors in Chile

Background: Health Literacy is the set of skills that constitute the ability to perform reading and numerical tasks to function in the health care environment. People with functional illiteracy are unable to understand written documents and therefore sanitary information. Aim: To explore the effects of functional illiteracy on personal health care behaviors in Chile. Material and Methods: Using the Chilean Social Characterization Survey of 2006, respondents were separated into those that had read a book in the last year and those that had not as a proxy variable for functional literacy. Using econometric models, the impact of this variable on having a Papanicolaou (PAP) smear done and consulting in primary health clinics rather than in emergency services, was explored. Results: The survey is nationally representative, and 76% interviewees declared not having read a book in the last year. Probability of having a PAP smear done during the last three years was higher among women who had read a book with an OR of 1.19 (1.15-1.25). Likewise, the probability of consulting in emergency services rather than in primary health clinics was lower among those who had read a book with an OR of 0.85 (0.80-0.91). Conclusions: This study provides evidence of possible impacts of low functional literacy in health care behaviors in the Chilean population.

A "cadeia alimentar" no mercado da saúde: do disease mongering ao doctor shopping / The "food chain" in health market: from 'disease mongering' to 'doctor shopping' / La "cadena alimentaria" en el mercado de salud: desde 'disease mongering' hasta 'doctor shopping'

Nos anos mais recentes, têm surgido na literatura médica diferentes conceitos, tais como disease mongering, selling sickness e doctor shopping. Estes são três grandes fenômenos do atual mercado de saúde, que enfrenta o desafio de aumentar o lucro obtido intervindo em pessoas não doentes. Nesse sentido, têm se tornado notórias as inter-relações entre estes conceitos: o disease mongering alimenta um selling sickness, ao gerar o receio que impele a pessoa não doente à busca de uma tranquilização com procedimentos clínicos sem benefícios comprovados. A procura da prevenção ou do controle de alterações encontradas (que são normais, mas veiculadas como potencialmente patológicas) faz crescer um doctor shopping. Esta sequência estimuladora de um crescimento do consumo nada mais é do que uma autêntica cadeia alimentar. O médico de família e comunidade (MFC), enquanto advogado de defesa de seus pacientes, sentir-se-á envolvido pelo ímpeto de protegê-los de intervenções excessivas e inúteis, que iriam comprometer seu bem-estar biopsicossocial.

In recent years, different concepts have emerged in the medical literature, such as disease mongering, selling sickness and doctor shopping. These are three major phenomena of the current healthcare market, which is facing the challenge of increasing its profit with healthy people. In this sense, the interrelationships between these concepts have made the news: disease mongering feeds selling sickness, generating fears that impel a healthy person to seek reassurance in clinical procedures with unproven benefits. This search for the prevention or control of casual body alterations (which are normal, but conveyed as possibly pathological) inflates doctor shopping. This enhancer sequence of consumption growth is nothing but an authentic food chain. General practitioners, as the defence lawyers of their patients, would feel taken by the need to protect them against excessive and unnecessary interventions that would compromise their biopsychosocial well-being.

En los últimos años, han surgido en la literatura médica diferentes conceptos tales como disease mongering, selling sickness y doctor shopping. Se trata de tres fenómenos del actual mercado de salud que se enfrenta al reto de querer aumentar el beneficio económico, interviniendo en personas sanas. En este sentido, se han hecho visibles las relaciones entre estos conceptos: el disease mongering alimenta el selling sickness, generando un recelo que impulsa a la persona sana a buscar una tranquilidad en procedimientos clínicos que no han sido científicamente comprobados. La búsqueda de la prevención o del control de las alteraciones en la salud (que son normales pero han sido transmitidas como potencialmente patológicas) aumenta el doctor shopping. Sin embargo, esta secuencia que estimula el aumento del consumo no es más que una auténtica cadena alimentaria. El médico familiar y comunitario (MFC), como abogado defensor de sus pacientes, se sentirá envuelto por el ímpetu de protegerlos de intervenciones excesivas e innecesarias que pondrían en peligro su bienestar biopsicosocial.

¿Sería útil la depuración de los trastornos mentales comunes en pacientes hiperfrecuentadores de servicios de salud en cuidado primario? / Would the screening of common mental disorders in primary-care health services hyper-frequent patients be useful?

La hiperfrecuentación de servicios de salud constituye un problema para los pacientes, la familia y las instituciones. Este trabajo busca determinar la frecuencia y las características de los trastornos mentales comunes en pacientes hiperfrecuentadores de servicios que acudieron con síntomas y signos imprecisos a una institución prestadora de servicios de cuidado primario en la ciudad de Cali (Colombia) en 2007. Método: Estudio descriptivo transversal. Mediante una encuesta telefónica, que incluyó varios módulos del instrumento PRIME MD, se detectaron los trastornos mentales más frecuentes en pacientes hiperfrecuentadores. Resultado: Los hiperfrecuentadores de servicios son, en general, mujeres laboralmente activas, con edad promedio de 38,7 años. Acuden fundamentalmente por cefalea, pero tienen una alta prevalencia de trastornos mentales comunes (somatización, depresión y ansiedad), que no son fácilmente diagnosticados por los médicos en cuidado primario. Los valores monetarios de las actividades adicionales en salud que generan estos pacientes se atribuyen fundamentalmente a las consultas médicas y a los procedimientos que se les realizan. Conclusión: Considerar a los híper frecuentadores de servicios de salud como un grupo de riesgo para trastornos mentales comunes plantea su tamización como una estrategia eficiente para evitar el abuso de servicios y mejorar la satisfacción con la atención recibida...

Hyper-frequentation in health services is a problem for patients, their families and the institutions. This study is aimed at determining the frequency and characteristics of common mental disorders in hyper-frequent patients showing vague symptoms and signs at a primary healthcare service during the year 2007 in the city of Cali (Colombia). Methodology: Cross sectional. The most frequent mental disorders in hyper-frequent patients were detected through a telephone interview which included several modules of the PRIME MD instrument. Results: In general, healthcare service hyper-frequenters are working women, 38,7-year old in average. Basically, the consultation is due to cephalalgia but they also exhibit a high prevalence of common mental disorders (somatization, depression and anxiety) not easily diagnosed by physicians in primary care. Expenses for additional health activities generated by these patients are attributed basically to medical consultation and required procedures. Conclusion: Considering hyper-frequenters in health care services as a risk group in terms of common mental disorders involves screening as an efficient strategy to prevent abuse in service use and to improve satisfaction with the attention received...

Characteristics of Frequent Users of Emergency Department

PURPOSE: Crowding causes dysfunction in the emergency department (ED) and is associated with poor quality of patient care, dissatisfaction of the physicians, and increased financial burden of medical care. Frequent use is often considered a major contributor to ED crowding. The present study sought to verify the relationship between the frequent ED users and ED crowding, and to ascertain the severity of the frequent ED users. METHODS: One-year ED visit data from a tertiary teaching hospital located in an urban area were analyzed. Frequent ED users were defined as four or more ED visits per year. Crowding indicators were defined as the length of stay and the percentage of patients staying over 6 hours. Severity indicators were defined as operation within 24 h, admission to intensive care unit, and expiry in the ED. RESULTS: The 2.7% of patients who had four or more ED visits were responsible for 11.9% of visits. The median length of stay of frequent users was significantly longer (6.18 h) than that of infrequent users (3.42 h). The percentage of patients who stayed more than 6 h was significantly larger in the frequent user group than infrequent user group (51.4% vs. 32.9%, respectively; OR=2.158; 95% CI, 2.041~2.281). However, the severity of frequent users was lower than that of infrequent users (3.0% vs. 5.3%, respectively; OR=0.553; 95% CI, 0.472~0.648). CONCLUSION: Frequent users presenting to an ED located in an urban area were more likely to stay longer in the ED, and were less likely to be severe. Active interventions to reduce ED crowding are required.

Characteristics of Frequent Users of Emergency Department

PURPOSE: Crowding causes dysfunction in the emergency department (ED) and is associated with poor quality of patient care, dissatisfaction of the physicians, and increased financial burden of medical care. Frequent use is often considered a major contributor to ED crowding. The present study sought to verify the relationship between the frequent ED users and ED crowding, and to ascertain the severity of the frequent ED users. METHODS: One-year ED visit data from a tertiary teaching hospital located in an urban area were analyzed. Frequent ED users were defined as four or more ED visits per year. Crowding indicators were defined as the length of stay and the percentage of patients staying over 6 hours. Severity indicators were defined as operation within 24 h, admission to intensive care unit, and expiry in the ED. RESULTS: The 2.7% of patients who had four or more ED visits were responsible for 11.9% of visits. The median length of stay of frequent users was significantly longer (6.18 h) than that of infrequent users (3.42 h). The percentage of patients who stayed more than 6 h was significantly larger in the frequent user group than infrequent user group (51.4% vs. 32.9%, respectively; OR=2.158; 95% CI, 2.041~2.281). However, the severity of frequent users was lower than that of infrequent users (3.0% vs. 5.3%, respectively; OR=0.553; 95% CI, 0.472~0.648). CONCLUSION: Frequent users presenting to an ED located in an urban area were more likely to stay longer in the ED, and were less likely to be severe. Active interventions to reduce ED crowding are required.

Inappropriate use of emergency services: a systematic review of prevalence and associated factors: [review] / Prevalência e fatores associados ao uso inadequado do serviço de emergência: uma revisão sistemática da literatura: [revisão]

This systematic review aimed to measure the prevalence of inappropriate emergency department (ED) use by adults and associated factors. The review included 31 articles published in the last 12 years. Prevalence of inappropriate ED use varied from 20 to 40 percent and was associated with age and income. Female patients, those without co-morbidities, without a regular physician, without a regular source of care, and those not referred to the ED by a physician also showed more inappropriate ED use, with the relative risk varying from 1.12 to 2.42. Difficulties in accessing primary health care (difficulties in setting appointments, longer waiting periods, and short business hours at the primary health care service) were also associated with inappropriate ED use. Thus, primary care requires fully qualified patient reception and efficient triage to promptly attend cases that cannot wait. It is also necessary to orient the population on situations in which they should go to the ED and on the disadvantages of consulting the ED when the case is not really urgent.

Esta revisão sistemática objetivou medir a prevalência e fatores associados ao uso inadequado do serviço de emergência, em adultos. Foram incluídos 31 artigos publicados nos últimos 12 anos. A prevalência de uso inadequado variou principalmente entre 20 e 40 por cento e foi diretamente associada à idade e nível econômico. Mulheres, pessoas sem co-morbidades, menor gasto em saúde, sem médico regular ou local regular de cuidado e que consultavam por conta própria também consultavam mais inadequadamente com risco relativo variando entre 1,12 e 2,42. Dificuldades de acesso à atenção primária à saúde, como dificuldade de agendamento, maior time de espera para consultar e o local de atenção primária ficar menos time aberto por dia, também estiveram associados com uso inadequado. Esta revisão indica que problemas no acesso à atenção primária à saúde são determinantes de uso inadequado. Assim, a atenção primária à saúde necessita realizar um acolhimento qualificado, com uma triagem eficiente de forma a atender rapidamente os casos que não podem esperar. Além disso, é preciso esclarecer a população acerca das situações em que devem procurar o serviço de emergência e sobre as desvantagens de se consultar no serviço de emergência quando o caso não é realmente urgente.

Utilização de serviços ambulatoriais de saúde em Pelotas, Rio Grande do Sul, Brasil: alguns fatores relacionados com as consultas médicas acima da média / Use of outpatient services in Pelotas, Rio Grande do Sul State, Brazil: factors related to above-average number of physician visits

Por meio de estudo transversal de base populacional, incluindo pessoas de ambos os sexos, de 20 a 69 anos, residentes na zona urbana de Pelotas, Rio Grande do Sul, Brasil, objetivou-se verificar características associadas a consultas médicas ambulatoriais acima da média. A média de consultas, com médico, no último ano foi 3,2, com desvio padrão 5,5. A análise foi realizada considerando-se dois desfechos: indivíduos com mais de oito consultas médicas por ano (um desvio padrão acima da média); e mais de 14 consultas (dois desvios padrões acima da média). Entre 1.962 pessoas, 183 (9,3 por cento) consultaram mais que oito vezes durante o ano. A regressão logística mostrou que estavam associadas as variáveis: sexo, idade, diabetes mellitus, hipertensão arterial, bronquite crônica, distúrbios psiquiátricos menores e hospitalizações no último ano. Encontraram-se 57 (2,9 por cento) indivíduos com mais de quatorze consultas médicas durante o ano. Na regressão logística, foram encontradas diferenças para sexo, hipertensão arterial, distúrbios psiquiátricos menores e hospitalizações no último ano. A elevada procura por serviços de saúde nem sempre significa inadequação, e sua restrição pode resultar em políticas que restrinjam o acesso aos cuidados, implicando sofrimento para pacientes em condições graves.

This cross-sectional, population-based study including males and females 20 to 69 years of age from the urban area of Pelotas, Rio Grande do Sul State, Brazil, aimed to verify characteristics associated with above-average number of medical consultations. The mean number of physician consultations in the previous year was 3.2, with a standard deviation of 5.5. The analysis considered two outcomes: individuals with more than eight physician visits per year (one SD above the mean) and more than 14 consultations (two SD above the mean). In the sample of 1,962 individuals, 183 (9.3 percent) reported more than eight physician consultations in the previous year. Logistic regression compared the outcomes with the following variables: sex, age, diabetes mellitus, hypertension, chronic bronchitis, minor psychiatric disorders, and hospitalization in the previous year. There were 57 individuals (2.9 percent) with more than 14 consultations during the year. Logistic regression showed significant differences for sex, hypertension, minor psychiatric disorders, and hospitalization in the previous year. The high demand does not always mean inadequate health services, and restricting the demand could result in policies that limit access to care, causing suffering to patients with serious conditions.