Sobrediagnóstico (Overdiagnosis) / Overdiagnosis

Trata-se de revisão bibliográfica sobre o termo sobrediagnóstico ("overdiagnosis"). Refere-se a um fenômeno do campo da saúde que pode ser definido como o diagnóstico de doenças ou lesões que jamais seriam conhecidas ou causariam danos ao indivíduo se não fossem detectadas, tornando essas pessoas "pacientes" de forma desnecessária (Brodersen et al., 2018). É uma "doença" por sua definição fisiopatológica, mas que não se tornaria clinicamente aparente e, portanto, não causaria nenhum sintoma ou prejuízo ao longo da vida, ou seja, uma pseudo-doença (Olmos, 2021). O sobrediagnóstico desencadeia uma cascata de outros excessos, como de intervenções diagnósticas: sobreintervenção ou "overintervention"; e/ou terapêuticas: sobretratamento ou "overtreatment" (Camargo, 2014). A reflexão sobre o tema é necessária e urgente. É preciso revisar a definição de doença e reconectar diagnóstico com o sofrimento do paciente (Kale & Korenstein, 2018)

This is a literature review on the term overdiagnosis ("overdiagnosis"). It refers to a phenomenon in the field of health that can be defined as the diagnosis of diseases or injuries that would never be known or would cause harm to the individual if they were not detected, making these people unnecessary "patients" (Brodersen et al., 2018). It is a "disease" by its pathophysiological definition, but it would not become clinically apparent and, therefore, would not cause any symptoms or harm throughout life, that is, a pseudo-disease (Olmos, 2021). Overdiagnosis triggers a cascade of other excesses, such as diagnostic interventions: overintervention or "overintervention"; and/or therapeutics: overtreatment or "overtreatment" (Camargo, 2014). Reflection on the subject is necessary and urgent. It is necessary to revise the definition of disease and reconnect diagnosis with the patient's suffering (Kale & Korenstein, 2018).

Deprescripción en el anciano polimedicado. Una mirada reflexiva en el contexto cubano / Deprescription in the polymedicated elderly. A reflexive look at the Cuban context

Introducción: El intervencionismo terapéutico excesivo propicia polifarmacia y errores de prescripción en ancianos. En Cuba, el anciano polimedicado es un problema recurrente; sin embargo, la información sobre deprescripción posee difusión limitada en el ámbito científico. Objetivo: Describir el conocimiento actual sobre deprescripción y la necesidad de una estrategia dirigida al anciano polimedicado en Cuba. Material y Métodos: Se realizó una revisión extendida desde 2003 hasta 2020, basado en la experticia de los autores. Los criterios de búsqueda, selección y el acceso a bases de datos y fuentes indexadas Cochrane Library, SciELO, Lilacs, PubMed, Hinari, MEDLINE, ScienceDirect, Elsevier permitió citar 54 investigaciones (70 por ciento actualización) y redactar con metodología cualitativa, enfoque histórico-lógico, análisis-síntesis el documento final. Desarrollo: La deprescripción aparece desde 2003 para resolver la polifarmacia, es una herramienta de la prevención cuaternaria, implica desmontaje de medicación con varios matices. Su auge revolucionó diversas corrientes de trabajo en el mundo. Suficientes evidencias científicas de su necesidad y oportunidad para el mejor manejo farmacoterapéutico del anciano justifican un diseño e implementación atendiendo a las determinantes sociales de cada país. Se proponen elementos a la definición, se asevera la importancia de la farmacología geriátrica ante diseños de intervención. Conclusiones: La deprescripción es un proceso inherente de decisiones farmacoterapéuticas en ancianos atendidos en sistemas sanitarios de avanzada. Demuestra reducir mortalidad, medicamentos prescritos y prescripciones inapropiadas. El Programa Nacional de Medicamentos no dispone de directrices para su implementación, por lo que desarrollar una estrategia será un reto para la Salud Pública Cubana(AU)

Introduction: The excessive therapeutic interventionism promotes polypharmacy and prescription errors in the elderly. In Cuba, the polymedicated elderly is a recurrent problem; however, the information about prescription has a limited diffusion in the scientific field. Objective: To describe the current knowledge about deprescription and the need for a strategy aimed at addressing the problem of the polymedicated elderly in Cuba. Material and Methods: An extended review based on the authors' expertise was carried out from 2003 to 2020. The search and selection criteria and the access to databases and sources indexed in Cochrane Library, SciELO, Lilacs, PubMed, Hinari, MEDLINE, ScienceDirect, and Elsevier allowed us to cite 54 research works (70 percent updated). The final document was written on the basis of qualitative research methodology and historical-logical and analysis-synthesis approaches. Development: The term "deprescription" appeared in 2003 to solve the problem of polypharmacy. It is a quaternary prevention tool that involves dismantling medication treatment with various nuances. Its rise revolutionized different work currents worldwide. Adequate scientific evidences of its need and opportunity for the best pharmacotherapeutic management in the elderly justify a design and implementation that takes into account the social determinants of each country. Some elements are suggested for the definition; the importance of geriatric pharmacology is affirmed in the face of intervention designs. Conclusions: Deprescription is an inherent process of pharmacotherapeutic decisions in elderly patients attended in advanced healthcare systems. It shows a reduction of mortality, prescription of drugs and inappropriate prescriptions. The National Drug Program does not have guidelines for its implementation; therefore, to develop a strategy will be a challenge for the Cuban Public Health(AU)