Humanização nos serviços de saúde: perspectivas de profissionais atuantes na atenção primária à saúde / Humanization in health services: perspectives of professionals working in primary health care / Humanización en los servicios de salud: perspectivas de los profesionales que trabajan en atención primaria

Investigar o conhecimento dos profissionais que atuam na atenção básica sobre o atendimento humanizado. Estudo descritivo, exploratório, de abordagem qualitativa, realizado com 16 profissionais que atuam em unidade básica de saúde, realizado no mês de abril de 2022. Os dados foram coletados por meio de entrevista gravada, norteada pela questão: "Fale-me sobre o que você, senhor/senhora, sabe sobre humanização na assistência ao paciente. Após a conclusão das entrevistas, as mesmas foram transcritas, sendo submetidas à técnica de análise de conteúdo proposta por Bardin. Da análise das entrevistas, emergiram três categorias: Impactos da realização do cuidado humanizado e de sua ausência, na qual nota-se por meio dos discursos, que o cuidado à saúde do ser humano, quando prestado de modo humanizado é considerado como maneira mais eficaz para se ter um atendimento adequado e ético nos serviços de atenção à saúde. Estratégias para fortalecer a prática da assistência humanizada, pela qual verificou-se que a assistência à saúde realizada ao ser humano de uma forma humanizada, se torna muito mais forte e eficaz. Atividade laboral como sinônimo de cuidado empático, a qual evidenciou que é preciso continuar conscientizando a todos esses profissionais, que atuam nessa área, sobre esse cuidado humanizado, ou seja, o cuidado com empatia. Assim, concluiu-se que os profissionais apresentaram conhecimento básico sobre humanização no atendimento, sobre as consequências ao paciente caso ela não ocorra e como implementá-la, com constância, em suas atividades laborais, na atenção primária à saúde.

To investigate the knowledge of professionals working in primary care about humanized care. Descriptive, exploratory study, with a qualitative approach, carried out with 16 professionals who work in a basic health unit, carried out in April 2022. Data were collected through a recorded interview, guided by the question: "Tell me about what you, sir/madam, know about humanization in patient care. After completing the interviews, they were transcribed and submitted to the content analysis technique proposed by Bardin. From the analysis of the interviews, three categories emerged: Impacts of carrying out humanized care and its absence, in which it is noted through the speeches that human health care, when provided in a humanized way, is considered the most effective way to have adequate and ethical care in health care services. Strategies to strengthen the practice of humanized care, through which it was found that health care provided to human beings in a humanized way becomes much stronger and more effective. Work activity as a synonym for empathic care, which showed that it is necessary to continue making all these professionals, who work in this area, aware of this humanized care, that is, care with empathy. Thus, it was concluded that the professionals presented basic knowledge about humanization in care, about the consequences for the patient if it does not occur and how to implement it consistently in their work activities, in primary health care.

Investigar el conocimiento de los profesionales que trabajan en atención primaria sobre la atención humanizada. Estudio descriptivo, exploratorio, de enfoque cualitativo, realizado con 16 profesionales que trabajan en la unidad básica de salud, realizado en abril de 2022. Los datos se recogieron mediante una entrevista grabada, guiada por la pregunta: "Háblame de lo que sabes sobre la humanización en la atención al paciente". Una vez finalizadas las entrevistas, se transcribieron y se sometieron a la técnica de análisis de contenido propuesta por Bardin. Del análisis de las entrevistas surgieron tres categorías: Impactos de la implementación de la atención humanizada y su ausencia, en la que se observa a través de los discursos, que la atención a la salud del ser humano, cuando se brinda de manera humanizada, se considera la forma más efectiva de tener una atención adecuada y ética en los servicios de salud. Estrategias para fortalecer la práctica de la atención humanizada, mediante las cuales se verificó que la atención a la salud brindada al ser humano de manera humanizada, se hace mucho más fuerte y efectiva. La actividad laboral como sinónimo de atención empática, lo que demostró que es necesario seguir concienciando a todos estos profesionales que trabajan en este ámbito sobre la atención humanizada, es decir, la atención con empatía. Así, se concluyó que los profesionales tenían conocimientos básicos sobre la humanización en la atención sanitaria, sobre las consecuencias para el paciente si ésta no se produce y sobre cómo implementarla con constancia en su actividad laboral en la atención primaria.

Clinical pharmaceutical services in primary health care of the Federal District: Performance frequency and conditioning factors

Abstract Pharmaceutical services correspond to a set of actions that aim to guarantee the integral access and rational use of drugs by the population. In this sense, this study aimed to identify the frequency and conditioning factors for clinical services of primary care in the Federal District, Brazil. A quantitative cross-sectional study was conducted, in which 34 pharmacists were interviewed. The most frequently developed clinical pharmaceutical services were dispensing, pharmaceutical guidance for users, and technical-pedagogical activities for the health team. There is a greater frequency of operation of clinical services by pharmacists working in pharmacies with physical infrastructure, with better levels of adequacy, greater support from management and health staff, and the inclusion in Family Health Support Nucleus activities. Although the clinical pharmaceutical services in primary care are incipient, the study raises important data for the reorientation and qualification of these actions.

Implantação e utilização de dispositivo móvel na Atenção Primária à Saúde no Brasil / Application and use of mobile devices in Primary Health Care in Brasil

RESUMO de dispositivos móveis na Atenção Primária à Saúde. Estudo de abordagem qualitativa fundamentado na Teoria Ator-Rede e na Cartografia de Controvérsias. Realizou-se entrevistas com seis enfermeiros, 12 Agentes Comunitários de Saúde, dois coordenadores da Atenção Primária à Saúde, três Técnicos de Informática e sete pacientes, a observação participante e coleta de dispositivos de inscrição em um Município de Minas Gerais, Brasil. Os dados foram analisados utilizando a Análise de Conteúdo e, sistematizados, com o software Atlas.ti. A rede de actantes, entendida como articuladora de conexões, construindo rede em associação com outros mediadores humanos e não humanos, tem emitido efeitos sobre a utilização de tablets, na forma de (re)invenções, além do normatizado. Verificou-se resistências, acordos, conflitos e o tablet como um actante influenciador da relação profissional-pacientes. É preciso considerar os efeitos emitidos por humanos e não humanos na adoção de tecnologias, permanecendo o desafio de utilizá-las e aprimorá-las com vistas à qualificação da gestão do cuidado(AU)

La investigación tuvo como objetivo analizar la red de actores y sus efectos sobre el uso de dispositivos móviles en la Atención Primaria de Salud. El estudio tuvo un carácter cualitativo basado en la Teoría Actor-Red y la Cartografía de Controversia. Se realizaron entrevistas con seis enfermeras, 12 agentes comunitarios de salud, dos coordinadores de Atención Primaria de Salud, tres técnicos en informática y siete pacientes, y se efectuó la recolección de dispositivos de registro en un municipio de Minas Gerais, Brasil. Los datos se analizaron mediante Content Analysis y se sistematizaron con el software Atlas.ti. La red de actores, entendida como un articulador de conexiones, al construir una red en asociación con otros mediadores humanos y no humanos causó efectos sobre el uso de tabletas, en forma de (re) invenciones, además del estándar. Hubo resistencias, acuerdos, conflictos y la tableta como un actor influyente de la relación profesional-paciente. Es necesario considerar los efectos emitidos por humanos y no humanos en la adopción de tecnologías, y mantener el desafío de usarlas y mejorarlas con miras a calificar la gestión del cuidado(AU)

The research aimed to assess the network of actors and their effects on the use of mobile devices in Primary Health Care. Qualitative study was carried out based on the Actor-Network Theory and the Cartography of Controversies. Interviews were conducted with six nurses, 12 Community Health Agents, two Primary Health Care coordinators, three IT Technicians, and seven patients, participant observation and collection of inscription devices in a city in Minas Gerais, Brazil. The data was analyzed using Content Analysis and systematized using Atlas.ti software. The network of actors, understood as an articulator of connections, building a network in association with other human and nonhuman mediators, has had effects on the use of tablets, in the form of (re)inventions, in addition to the regulated uses. There was resistance, agreement, and conflicts. The tablet was an actant that influenced the professional-patient relationship. It is necessary to take into account the effects emitted by humans and nonhumans in the adoption of technologies, and the challenge of using and improving technologies to qualify health care management remains(AU)

Child Psychiatrists and Psychologists: Enhanced Collaboration in Primary Care.

Psychiatry and psychology have a long history of competition that too often interferes with the collaboration that can characterize complementary contributions to our common missions. We hope this article will inspire our disciplines to expand on this collaboration, for the sake of our children and families, our communities, our colleagues, and honestly, ourselves. We are better together than apart. This text is a blueprint for the assumptions, attitudes, skills, and advocacy that can make this partnership healthy and successful.

Cuidado à criança na atenção primária à saúde: conflitos (bio)éticos / Child health care in primary health care: conflicts (bio)ethics / El cuidado infantil en la atención primaria de salud: conflictos (bio)éticos

Resumo Os conflitos bioéticos no cotidiano do cuidado à criança e ao adolescente na atenção primária à saúde, embora bastante complexos, têm sido pouco abordados, diferentemente do que ocorre no nível de atenção terciária. O amparo a essa população especialmente vulnerável envolve conflitos que demandam do profissional de saúde, além de competência técnica, uma série de conhecimentos legais e atributos éticos indispensáveis. É importante, portanto, reconhecer e analisar as questões (bio)éticas envolvidas, a fim de possibilitar uma tomada de decisão que contemple o melhor interesse da criança. O objetivo do artigo é delimitar, com base em revisão de literatura, os principais conflitos éticos relacionados ao cuidado da criança na atenção primária.

Abstract Although quite complex, bioethical conflicts in the daily routine of child and adolescent health care in primary health care have been little addressed, unlike what occurs at the tertiary care level. Providing support to this especially vulnerable population involves conflicts that require from the health professional, in addition to technical competence, a series of essential legal knowledge and ethical attributes. Therefore, it is important to recognize and analyze the pertinent (bio)ethical issues in order to enable decision-making that is in the best interests of the child. From a literature review, this article aims to delimit the main ethical conflicts related to child health care in primary health care.

Resumen Los conflictos bioéticos en el cuidado diario de niños y adolescentes en la atención primaria de salud, aunque bastante complejos, han sido mal abordados, a diferencia de lo que ocurre en el nivel de atención terciaria. El apoyo a esta población particularmente vulnerable implica conflictos que requieren del profesional de la salud, además de competencia técnica, una serie de conocimientos jurídicos y atributos éticos esenciales. Por lo tanto, es importante reconocer y analizar las cuestiones (bio)éticas involucradas, a fin de permitir la toma de decisiones en el mejor interés del niño. El objetivo del artículo es delimitar, a partir de una revisión de la literatura, los principales conflictos éticos relacionados con el cuidado infantil en la atención primaria.

Social Prescribing in National Health Service Primary Care: What Are the Ethical Considerations?

Policy Points Social prescribing is proposed as a way of improving patients' health and well-being by attending to their non-clinical needs. This is done by connecting patients with community assets (typically voluntary or charitable organizations) that provide social and personal support. In the United Kingdom, social prescribing is used to improve patient well-being and reduce use of National Health Service resources. Although social prescribing schemes hold promise, evidence of their effects and effectiveness is sparse. As more information on social prescribing is gathered, it will be important to consider the associated ethical issues for patients, clinicians, link workers, and community assets.

[Ethical issues in primary care during the coronavirus (SARS-CoV-2) pandemic]. / Problemas éticos en atención primaria durante la pandemia del coronavirus (SARS-CoV-2).

Public health emergencies, such as the current SARS-CoV-2 coronavirus pandemic, have led to tragic resource constraints that prevent lives from being saved. This has led to tensions in patient-centered care as the backbone of the system in normal conditions and the same care in emergencies originating in the COVID-19. In this review we address some of the healthcare, organizational and ethical problems that this scenario has caused in primary care such as: cancellation of programmed activities; scarce home care and follow-up of elderly, chronically ill and immobilized patients; shortage of PPE and the exposure to risk of healthcare professionals, and finally the problems associated with telemedicine and telephone attention to patients.

Problemas éticos en atención primaria durante la pandemia del coronavirus (SARS-CoV-2) / Ethical issues in primary care during the coronavirus (SARS-CoV-2) pandemic

Las emergencias de salud pública, como la que estamos viviendo con la pandemia originada por el coronavirus SARS-CoV-2, han originado trágicas limitaciones de recursos que impiden salvar vidas. Provocan tensiones en la atención sanitaria centrada en el paciente como eje del sistema en condiciones normales, y en la misma atención sanitaria en situaciones de emergencia originadas en la COVID-19. En esta revisión abordamos algunos de los problemas asistenciales, organizativos y éticos que este escenario ha provocado en la atención primaria, como: cancelación de actividades programadas; escasa atención domiciliaria y seguimiento de pacientes ancianos, enfermos crónicos e inmovilizados; desabastecimiento de EPI y exposición al riesgo de los profesionales sanitarios, y finalmente los problemas asociados a la telemedicina y a la atención telefónica a los pacientes

Public health emergencies, such as the current SARS-CoV-2 coronavirus pandemic, have led to tragic resource constraints that prevent lives from being saved. This has led to tensions in patient-centered care as the backbone of the system in normal conditions and the same care in emergencies originating in the COVID-19. In this review we address some of the healthcare, organizational and ethical problems that this scenario has caused in primary care such as: cancellation of programmed activities; scarce home care and follow-up of elderly, chronically ill and immobilized patients; shortage of PPE and the exposure to risk of healthcare professionals, and finally the problems associated with telemedicine and telephone attention to patients

Construção de um inventário de problemas éticos na Atenção Primária para a saúde bucal / Constructing an inventory of ethical problems in primary health for oral health / Construcción de un inventario de problemas éticos en la atención primaria para la salud bucal

Considerando-se as especificidades dos problemas éticos em saúde bucal, esta pesquisa objetivou construir uma proposta de Inventário de Problemas Éticos na Atenção Primária à Saúde (IPE-APS) para a saúde bucal (SB), estudo metodológico desenvolvido por um comitê de juízes. Após levantamento prévio de 32 problemas éticos específicos, fez-se sua equivalência com quarenta itens do IPE-APS: de itens; de semântica e conteúdo; de avaliação dos itens não equivalentes; de avaliação dos problemas específicos não equivalentes. Apontaram-se 18 itens do IPE-APS equivalentes a 17 problemas específicos, confluindo para 16 itens finais. Dos 22 itens não equivalentes, 5 foram mantidos. Incluíram-se os 15 problemas éticos específicos não equivalentes. Evidenciou-se a complexidade do trabalho de equivalência de inventários de natureza ética. Chegou-se à proposta de um IPE-APS-SB de 36 itens. (AU)

Considering the specificities of ethical problems in oral health, the aim of this study was to develop a proposal for an Inventory of Ethical Problems in Primary Health Care (IPE-APS) for oral health (SB). A methodological study was developed by a committee of judges. Thirty-two previously identified specific ethical problems were matched to the 40 items of the IPE-APS: items; semantics and content; evaluation of unmatched items; evaluation of unmatched specific problems. Eighteen of the items of the IPE-APS were matched to 17 specific problems, converging into 16 final items. Five of the 22 unmatched items were maintained and 15 unmatched specific ethical problems were included. The findings reveal the complexity of matching ethical Inventories. We achieved the aim of proposing a 46-item IPE-APS for oral health. (AU)

Llevando en consideración las especificidades de los problemas éticos en salud bucal, esta investigación tuvo el objetivo de construir una propuesta de Inventario de Problemas Éticos en la Atención Primaria de la Salud (IPE-APS) para la salud bucal (SB). Estudio metodológico desarrollado por un comité de jueces. Después de un levantamiento de 32 problemas éticos específicos, se realizó su equivalencia con cuarenta ítems del IPE-APS: de ítems; semántica y de contenido; evaluación de los ítems no equivalentes; evaluación de los problemas específicos no equivalentes. Se señalaron 18 ítems del IPE-APS equivalentes a 17 problemas específicos, confluyendo para 16 ítems finales. De los 22 ítems no equivalentes, 5 se mantuvieron. Se incluyeron los 15 problemas éticos específicos no equivalentes. Se dejó en evidencia la complejidad del trabajo de equivalencia de inventarios de naturaleza ética. Se llegó a la propuesta de un IPE-APS-SB de 36 ítems. (AU)

Email Consultations Between Patients and Doctors in Primary Care: Content Analysis.

BACKGROUND: Increasingly, consultations in health care settings are conducted remotely using a range of communication technologies. Email allows for 2-way text-based communication, occurring asynchronously. Studies have explored the content and nature of email consultations to understand the use, structure, and function of email consultations. Most previous content analyses of email consultations in primary care settings have been conducted in North America, and these have shown that concerns and assumptions about how email consultations work have not been realized. There has not been a UK-based content analysis of email consultations. OBJECTIVE: This study aims to explore and delineate the content of consultations conducted via email in English general practice by conducting a content analysis of email consultations between general practitioners (GPs) and patients. METHODS: We conducted a content analysis of anonymized email consultations between GPs and patients in 2 general practices in the United Kingdom. We examined the descriptive elements of the correspondence to ascertain when the emails were sent, the number of emails in an email consultation, and the nature of the content. We used a normative approach to analyze the content of the email consultations to explore the use and function of email consultation. RESULTS: We obtained 100 email consultations from 85 patients, which totaled 262 individual emails. Most email users were older than 40 years, and over half of the users were male. The email consultations were mostly short and completed in a few days. Emails were mostly sent and received during the day. The emails were mostly clinical in content rather than administrative and covered a wide range of clinical presentations. There were 3 key themes to the use and function of the email consultations: the role of the GP and email consultation, the transactional nature of an email consultation, and the operationalization of an email consultation. CONCLUSIONS: Most cases where emails are used to have a consultation with a patient in general practice have a shorter consultation, are clinical in nature, and are resolved quickly. GPs approach email consultations using key elements similar to that of the face-to-face consultation; however, using email consultations has the potential to alter the role of the GP, leading them to engage in more administrative tasks than usual. Email consultations were not a replacement for face-to-face consultations.

Perspectives on Precision Medicine in a Tribally Managed Primary Care Setting.

BACKGROUND: Precision medicine (PM) research and clinical application is moving forward at a rapid pace. To ensure ethical inclusion of all populations in PM, in-depth understanding of diverse communities' views of PM research and PM implementation is necessary. METHODS: Semi-structured interviews were conducted to explore perspectives on PM in a tribally managed healthcare organization. Thematic analysis was used to analyze data from 46 interviews. RESULTS: Participants described gains in diagnostic efficiency, risk identification for preventable disease, and the advancement of population-specific biomedical research as key benefits of PM. Concerns expressed related to privacy risks associated with data-sharing, overpromising on PM, and managing patient expectations related to PM. Stakeholders encouraged PM implementation to be preceded by health education activities that leverage a range of communication strategies. CONCLUSION: Perspectives described in this study may aid in and should be considered prior to implementation of PM in this and other healthcare systems, especially those serving diverse populations.

Ethical Use of Electronic Health Record Data and Artificial Intelligence: Recommendations of the Primary Care Informatics Working Group of the International Medical Informatics Association.

OBJECTIVE: To create practical recommendations for the curation of routinely collected health data and artificial intelligence (AI) in primary care with a focus on ensuring their ethical use. METHODS: We defined data curation as the process of management of data throughout its lifecycle to ensure it can be used into the future. We used a literature review and Delphi exercises to capture insights from the Primary Care Informatics Working Group (PCIWG) of the International Medical Informatics Association (IMIA). RESULTS: We created six recommendations: (1) Ensure consent and formal process to govern access and sharing throughout the data life cycle; (2) Sustainable data creation/collection requires trust and permission; (3) Pay attention to Extract-Transform-Load (ETL) processes as they may have unrecognised risks; (4) Integrate data governance and data quality management to support clinical practice in integrated care systems; (5) Recognise the need for new processes to address the ethical issues arising from AI in primary care; (6) Apply an ethical framework mapped to the data life cycle, including an assessment of data quality to achieve effective data curation. CONCLUSIONS: The ethical use of data needs to be integrated within the curation process, hence running throughout the data lifecycle. Current information systems may not fully detect the risks associated with ETL and AI; they need careful scrutiny. With distributed integrated care systems where data are often used remote from documentation, harmonised data quality assessment, management, and governance is important. These recommendations should help maintain trust and connectedness in contemporary information systems and planned developments.

Principais problemas éticos nos cuidados de saúde primários / Major ethical problems in primary health care

Introduction: Identifying the ethical problems experienced in Primary Health Care leads us to the importance of reflection on them being essential for a humanizing care culture. Aim: To describe the main ethical problems in the daily life of health professionals in Primary Health Care. Methods: Integrative Literature Review, conducted between October / December 2016. The following databases were used: Medline, Scielo, UCP Institutional Repository and RCAAP. Inclusion criteria were: primary studies that met the study objectives and studies under 10 years. We found 200 studies. 97 were excluded for not meeting the study objectives, 24 because they were not from primary sources, 45 because they were not fully presented, and 34 because they were older than 10 years. They incorporated the integrative review 5 articles. Results and Discussion: It was noticed that the main ethical problems identified can be distributed in 3 groups: ethical problems in relations with users and families; ethical problems in team relations and ethical problems in health system relations. It has been noted that as the number of years of experience increases, ethical problems become more supported and sustained. It was found that there are differences in the identification of ethical problems between nurses and doctors working in Primary Health Care. Conclusions: All studies present ethical issues in relationships with clients and family members; interprofessional relations and relations with the health system. In addition, it was found that ethical problems are influenced by length of service and profession

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¿Por qué se ha obviado la bioética en la pandemia? / Why has Bioethics been obviated in the pandemic?

La bioética aplicada a la clínica es el arte de elegir la opción óptima en una situación determinada. Lo que no sea óptimo es por definición malo. Nos plantea el problema moral por antonomasia, la cuestión del deber para saber escoger la opción más correcta, teniendo en cuenta los hechos y los valores. Somos agentes morales y tenemos responsabilidad en ello. En cualquier situación hay un momento adecuado u oportuno para hacer algo (Kairós) y hay que saber aprovecharlo. La pandemia no ha afectado a todos por igual, siendo especialmente grave en las personas vulnerables por patología previa o nivel socioeconómico bajo y en los ancianos. La muerte en soledad de miles de personas es un drama que nos interroga sobre la supuesta medicina humanizada y la necesidad de cuidar a la vez o antes que curar. Ahora más que nunca es necesaria una profunda y sincera reflexión que nos permita asumir los posibles errores y tratar de enmendarlos

Bioethics applied to clinical practice is the art of choosing the best option in a given scenario. Any decision which is not optimal is an intrinsically poor one. We are faced by the eternal moral dilemma: how one's sense of duty determines the most suitable path to follow, taking into account both factual evidence and values. We are moral agents and we have a responsibility in this respect. In any situation, there is always a propitious or timely moment to act (Kairos) and we must know how to make the most of it. The current pandemic has not impacted everyone equally; the most severely affected are senior citizens, and clinically vulnerable people with pre-existing medical conditions or of low socioeconomic status. The lonely death of thousands of people is a tragedy that raises questions about supposedly humanized medicine and about the need to provide care while or even instead of healing. More than ever, now is the moment to carry out a profound, honest reflection which may enable us to admit possible errors and endeavour to rectify them