Integrative Care Model of Complementary Therapies and Humanizing Practices in Primary Health Care: Qualitative Meta-synthesis.

Context: The World Health Organization (WHO) seeks to support member states in providing Traditional, Complementary, and Integrative Medicine (TCIM) services within Primary Health Care (PHC). Health professionals' offer of and referral to complementary therapies and humanizing practices can encounter some difficulties due to both conventional medical knowledge and institutional organizations. An integrative care model of complementary therapies and humanizing practices may be a strategy to overcome such difficulties. Objective: The study aimed to identify an integrative care model of complementary therapies and humanizing practices and to determine their influence on PHC. Design: The research team performed: (1) a qualitative meta-synthesis based on data from two systematic reviews that included more than 15000 professionals from 18 countries, and (2) qualitative research conducted with 24 participants, professionals from the South and Southeast regions of São Paulo, SP, Brazil. Setting: The study occurred at the Paulista School of Medicine at the Federal University of Sao Paulo (UNIFESP) in Sao Paulo, Brazil. Results: The analysis of the integrative care model resulted in two syntheses: (1) that PHC is offering complementary therapies and humanizing practices that have had a positive and subjective influence on PHC and (2) complementary therapies and humanizing practices improve PHC's service quality and resolvability and reduce medicalization. Conclusions: The work process in PHC may pose difficulties for the provision of integrative and holistic care yet promoting a model to integrate complementary therapies and humanizing practices with conventional medicine in health services may improve PHC and the perceptions of health professionals, managers, and patients about the positive and subjective effects of these practices.

Mapa de evidências sobre a efetividade clínica da aromaterapia: informe executivo / Evidence map on the clinical effectiveness of aromatherapy: report executive

O mapa apresenta uma visão geral das evidências sobre os efeitos clínicos da Aromaterapia em humanos. A partir de uma ampla busca bibliográfica foram incluídos 73 estudos de revisão sistemática que analisaram o efeito clínico de intervenções com óleos essenciais (49 óleos essenciais), óleos vegetais (06 óleos vegetais graxos), misturas (66 sinergias) e 01 hidrolato, utilizando cinco formas de aplicação: inalação, banho, massagem, ingestão ou tópico. Principais Achados: • Estas formas de aplicação foram associadas a 55 desfechos de saúde distribuídos em 7 grupos: Dor; Indicadores Metabólicos e Fisiológicos; Doenças Não Transmissíveis; Bem-Estar, Vitalidade e Qualidade de Vida; Saúde Mental; Doenças Infectocontagiosas; Saúde Reprodutiva. No total, foram 420 associações entre intervenções e desfechos. • Dentre os grupos de desfechos, o grupo Saúde Mental recebeu 154 associações, seguido pelo grupo Dor (93 associações) e Bem-Estar, Vitalidade e Qualidade de Vida (85 associações). • A maior parte dos estudos reportou efeito positivo para 333 associações. O efeito potencial positivo foi reportado para 50 associações, inconclusivo para 19 associações e sem efeito para 18 associações. Não foram reportados efeitos negativos. • A Lavanda (Lavandula angustifolia) foi o óleo essencial mais analisado, com 116 associações com o óleo puro e outras 89 associações com a lavanda em 49 sinergias com outros essenciais, vegetais e hidrolato. As intervenções com Lavanda demonstraram efeitos relevantes para a Saúde Mental, especialmente transtornos de ansiedade. • O segundo óleo essencial mais pesquisado foi o de Rosa de damasco (Rosa x damascena), com 24 intervenções unitárias (puro) e em sinergias (11). Estas intervenções foram associadas a 10 desfechos de saúde, com destaque para os desfechos de Dor (12 associações). Implicações para prática: Apesar da Aromaterapia trabalhar com produtos naturais, existem técnicas específicas para cada tipo de população que precisam respeitar o modo da intervenção, a diluição, o tempo de uso e a frequência com que se utiliza. A formação profissional adequada é essencial para o uso seguro da Aromaterapia em intervenções terapêuticas. Implicações para pesquisa: Destaca-se que há grande heterogeneidade nos estudos clínicos primários de Aromaterapia, o que dificulta a sistematização da evidência disponível. Recomenda-se, prioritariamente, o fomento em estudos de ensaios clínicos randomizados, principalmente para os óleos essenciais/sinergias. Recomenda-se ampliar este Mapa com novos estudos, em especial com os óleos essenciais dos biomas brasileiros. Implicações para gestão: Espera-se que as associações identificadas possam promover a implementação da Aromaterapia por gestores e profissionais que atuam nos serviços do SUS, especialmente para os desfechos que apresentaram efeito positivo e potencialmente positivo.

This map presents overview evidence of the clinical effects of essential oils in humans. The search was conducted in several databases, and 73 systematic review studies were included. Main Findings: This Map collects evidence for interventions with 49 essential oils, 9 fatty vegetable oils or in 66 mixtures (synergies) and one hydrolate, with applications through inhalation, massage, bath, ingestion, or topical. Each intervention was associated with at least one of 55 health outcomes classified into 8 groups: Pain; Metabolic and Physiological Indicators; Noncommunicable Diseases; Mental Health; Infectious Diseases; Reproductive Health and Other, totaling 420 associations. The effects reported by each study included: positive, potentially positive, no effect, and inconclusive effects. Highlighting that no negative effect was reported. The essential oil most researched was Lavender (Lavandula angustifolia - 116 associations). The Roses essential oil was the second most researched (Rosa damascena - 24 associations). The interventions with Lavender essential oil demonstrated more relevant effects on Mental Health, especially anxiety disorders. Interventions with Rose essential oil the more relevant effects on outcomes related to Women's Health, especially dysmenorrhea and pain in childbirth. This Map found 333 positive effect for different health outcomes. Implications for practice: The therapeutic interventions with Aromatherapy are diverse, where the main focus is on the person, an integral and unique being, with no overlooking health outcomes. Adequate training is of paramount importance for a professional who applies Aromatherapy in health. Although Aromatherapy is a natural product, specific techniques for each type of population need to respect the method of intervention, dilution, time of use, and the frequency with which it is used. Thus, aromatherapy safe practice health will contribute even more to the results already achieved. Implications for research: Noteworthy, that there is heterogeneity in the primary clinical trials of Aromatherapy, which hampered systematizing the available evidence. Recommended, as a priority, the promotion of studies of randomized clinical trials, especially for essential oils/synergies. Besides, expanding this Map is necessary so that new publications are included, especially with essential oils from Brazilian biomes.

Primary health care performance according to clusters of convergent municipalities in the state of São Paulo.

OBJECTIVE: To describe the performance of Primary Health Care, according to conglomerates of São Paulo cities that present homogeneous indicators. METHODS: This is a descriptive study, based on secondary data extracted from official sources of the Unified Health System, for the year 2018. An analysis matrix was created, with the proposition of performance (access, effectiveness and adequacy) and context indicators (population, health determinants and financing) selected and organized in dimensions and sub-dimensions. Cluster Analysis was used to identify the groups of homogeneous municipalities. RESULTS: 645 municipalities were divided in 6 conglomerates. Clusters 2 and 3 were formed predominantly by small municipalities with greater access to health; cluster 3 has less social vulnerability and greater investment in health. Clusters 1, 4 and 5 were formed by the largest municipalities with less access to health; cluster 4 presents greater social vulnerability, less coverage of private health plans and a greater percentage of health resources; cluster 5 was characterized by greater Gross Domestic Product per capita and greater coverage of private health plans. Cluster 6, formed by the city of São Paulo, was a particular case. Cluster 2 drew attention, as it was shown to have increased coverage, but signaled lower efficacy and adequacy levels. Cluster 3 had the best performance among all clusters. CONCLUSION: These findings can support regional and municipal management, given the complexity of the territory of São Paulo, pointing to scenarios that demand broader public management initiatives.

Occupational health, integrative and complementary practices in primary care, and the Covid-19 pandemic.

OBJECTIVE: To identify the possible repercussions of the COVID-19 pandemic on the workers' health, the care strategies used, and the provision of Integrative and Complementary Practices in health services in the context of COVID-19. METHOD: Descriptive study, with a qualitative approach, which used a focus group for data collection and content analysis according to Bardin. RESULTS: Eleven health professionals from the city of Registro (SP) participated and, based on the information analysis, four categories emerged: (1) Changes in work routine caused by the pandemic and the feelings they generate in health professionals; (2) Integrative and Complementary Practices as a self-care strategy in the pandemic; (3) Provision of Integrative and Complementary Practices during the pandemic; and (4) Occupational health as the focus and strategy motivator to resume the provision of Integrative and Complementary Practices in the municipality. CONCLUSION: This study allowed the identification of the impact of the pandemic, especially on workers' mental health, which influenced the search for care strategies that included the Integrative and Complementary Practices. Professionals with this training began to offer the Integrative and Complementary Practices in the service to other workers, given the interruption of their provision to the population due to the COVID-19 pandemic.

Primary health care performance according to clusters of convergent municipalities in the state of São Paulo / Desempenho da atenção primária à saúde, segundo clusters de municípios convergentes no estado de São Paulo

ABSTRACT: Objective: To describe the performance of Primary Health Care, according to conglomerates of São Paulo cities that present homogeneous indicators. Methods: This is a descriptive study, based on secondary data extracted from official sources of the Unified Health System, for the year 2018. An analysis matrix was created, with the proposition of performance (access, effectiveness and adequacy) and context indicators (population, health determinants and financing) selected and organized in dimensions and sub-dimensions. Cluster Analysis was used to identify the groups of homogeneous municipalities. Results: 645 municipalities were divided in 6 conglomerates. Clusters 2 and 3 were formed predominantly by small municipalities with greater access to health; cluster 3 has less social vulnerability and greater investment in health. Clusters 1, 4 and 5 were formed by the largest municipalities with less access to health; cluster 4 presents greater social vulnerability, less coverage of private health plans and a greater percentage of health resources; cluster 5 was characterized by greater Gross Domestic Product per capita and greater coverage of private health plans. Cluster 6, formed by the city of São Paulo, was a particular case. Cluster 2 drew attention, as it was shown to have increased coverage, but signaled lower efficacy and adequacy levels. Cluster 3 had the best performance among all clusters. Conclusion: These findings can support regional and municipal management, given the complexity of the territory of São Paulo, pointing to scenarios that demand broader public management initiatives.

RESUMO: Objetivo: Descrever o desempenho da atenção primária à saúde, segundo clusters de municípios paulistas que apresentaram indicadores homogêneos. Métodos: Trata-se de um estudo descritivo, com base em dados secundários extraídos de fontes oficiais do Sistema Único de Saúde, referentes ao ano de 2018. Foi elaborada uma matriz de análise, com a proposição de indicadores de desempenho (acesso, efetividade e adequação) e contexto (população, determinantes de saúde e financiamento), selecionados e organizados em dimensões e subdimensões. Para identificar os grupos de municípios homogêneos, foi utilizada a análise de cluster Resultados: Dos 645 municípios, constituíram-se seis clusters. Os clusters 2 e 3 foram formados, predominantemente, por municípios pequenos e com maior acesso; entre eles, o cluster 3 apresentou menor vulnerabilidade social e maior investimento em saúde. Os clusters 1, 4 e 5, em contrapartida, foram formados por municípios maiores e com menor acesso; entre eles, o cluster 4 apresentou maior vulnerabilidade social, menor cobertura de planos privados de saúde e maior percentual de recursos utilizados em saúde; e o cluster 5, maior produto interno bruto per capita e maior cobertura de planos privados de saúde. O cluster 6, formado pelo município de São Paulo, demonstrou ser um caso particular. Ainda, o cluster 2 chamou atenção. Apresentando maior cobertura, sinalizou menor efetividade e adequação. Entre todos os clusters, o cluster 3 alcançou o melhor desempenho. Conclusão: Os resultados podem subsidiar a gestão regional e municipal, diante da complexidade do território paulista, apontando para cenários que demandam maiores inciativas de gestão pública.

Occupational health, integrative and complementary practices in primary care, and the Covid-19 pandemic / Salud del trabajador, prácticas integrativas y complementarias en la atención básica y pandemia de Covid-19 / Saúde do trabalhador, práticas integrativas e complementares na atenção básica e pandemia da COVID-19

ABSTRACT OBJECTIVE: To identify the possible repercussions of the COVID-19 pandemic on the workers' health, the care strategies used, and the provision of Integrative and Complementary Practices in health services in the context of COVID-19. METHOD: Descriptive study, with a qualitative approach, which used a focus group for data collection and content analysis according to Bardin. RESULTS: Eleven health professionals from the city of Registro (SP) participated and, based on the information analysis, four categories emerged: (1) Changes in work routine caused by the pandemic and the feelings they generate in health professionals; (2) Integrative and Complementary Practices as a self-care strategy in the pandemic; (3) Provision of Integrative and Complementary Practices during the pandemic; and (4) Occupational health as the focus and strategy motivator to resume the provision of Integrative and Complementary Practices in the municipality. CONCLUSION: This study allowed the identification of the impact of the pandemic, especially on workers' mental health, which influenced the search for care strategies that included the Integrative and Complementary Practices. Professionals with this training began to offer the Integrative and Complementary Practices in the service to other workers, given the interruption of their provision to the population due to the COVID-19 pandemic.

RESUMEN Objetivo: Identificar las posibles repercusiones de la pandemia de COVID-19 en la salud de los trabajadores, las estrategias de cuidado utilizadas y la oferta de prácticas integrativas y complementarias en servicios de salud en el contexto de COVID-19. Método: Estudio descriptivo, con abordaje cualitativo, que utilizó grupo focal para recolección de datos y análisis de contenido según Bardin. Resultados: Participación de 11 profesionales de salud de la ciudad de Registro (SP) y, a partir del análisis de informaciones, emergieron cuatro categorías: (1) Las modificaciones en la rutina de trabajo causadas por la pandemia y los sentimientos generados en los profesionales de salud; (2) Prácticas integrativas y complementarias como estrategia de autocuidado en la pandemia; (3) La oferta de prácticas integrativas y complementarias durante la pandemia; y (4) La salud del trabajador en foco y motivadora de la estrategia para el recomienzo de la oferta de prácticas integrativas y complementarias en el municipio. Conclusión: En este estudio, fue posible identificar el impacto de la pandemia especialmente en la salud mental de los trabajadores, que influyó la búsqueda de estratégias de cuidado que incluyeron las prácticas integrativas y complementarias. Los profesionales con esa formación comenzaron a ofertar las prácticas integrativas y complementarias en el servicio a los demás trabajadores, ya que hubo interrupción en la oferta de las prácticas integrativas y complementarias a la población debido a la pandemia de COVID-19.

RESUMO Objetivo: Identificar as possíveis repercussões da pandemia de COVID-19 na saúde dos trabalhadores, as estratégias de cuidado utilizadas e a oferta de Práticas Integrativas e Complementares em serviços de saúde no contexto da COVID-19. Método: Estudo descritivo, com abordagem qualitativa, que utilizou grupo focal para coleta de dados e análise de conteúdo segundo Bardin. Resultados: Participação de 11 profissionais de saúde da cidade de Registro (SP) e, a partir da análise de informações, emergiram quatro categorias: (1) As modificações na rotina de trabalho causadas pela pandemia e os sentimentos gerados nos profissionais de saúde; (2) Práticas Integrativas e Complementares como estratégia de autocuidado na pandemia; (3) A oferta de Práticas Integrativas e Complementares durante a pandemia; e (4) A saúde do trabalhador em foco e motivadora da estratégia para retomada da oferta de Práticas Integrativas e Complementares no município. Conclusão: Neste estudo, foi possível identificar o impacto da pandemia especialmente na saúde mental dos trabalhadores, o que influenciou a busca de estratégias de cuidado que incluíram as Práticas Integrativas e Complementares. Os profissionais com essa formação começaram a ofertar as Práticas Integrativas e Complementares no serviço aos demais trabalhadores, devido ao interrompimento da oferta das Práticas Integrativas e Complementares à população em consequência da pandemia de COVID-19.

Mind-Body Therapies From Traditional Chinese Medicine: Evidence Map.

Background: The mind-body therapies of traditional Chinese medicine include several intervention types and combine physical poses with conscious relaxation and breathing techniques. The purpose of this Evidence Map is to describe these different interventions and report related health outcomes. Methods: This evidence map is based on the 3iE Evidence Gap Map methodology. We searched seven electronic databases (BVS, PUBMED, EMBASE, PEDro, ScienceDirect, Web of Sciences, and PschyInfo) from inception to November 2019 and included systematic reviews only. Systematic reviews were analyzed based on AMSTAR 2. We used Tableau to graphically display quality assessment, the number of reviews, outcomes, and effects. Results: The map is based on 116 systematic reviews and 44 meta-analyses. Most of the reviews were published in the last 5 years. The most researched interventions were Tai Chi and Qi Gong. The reviews presented the following quality assessment: 80 high, 43 moderate, 23 low, and 14 critically low. Every 680 distinct outcome effect was classified: 421 as potential positive; 237 as positive; 21 as inconclusive/mixed; one potential negative and none no effect. Positive effects were related to chronic diseases; mental indicators and disorders; vitality, well-being, and quality of life. Potential positive effects were related to balance, mobility, Parkinson's disease, hypertension, joint pain, cognitive performance, and sleep quality. Inconclusive/mixed-effects justify further research, especially in the following areas: Acupressure as Shiatsu and Tuiná for nausea and vomiting; Tai Chi and Qi Gong for acute diseases, prevention of stroke, stroke risk factors, and schizophrenia. Conclusions: The mind-body therapies from traditional Chinese medicine have been applied in different areas and this Evidence Map provides a visualization of valuable information for patients, professionals, and policymakers, to promote evidence-based complementary therapies.

Práticas integrativas e complementares e a qualidade dos serviços na Atenção Primária à Saúde: uma avaliação a partir do olhar da equipe multiprofissional / Integrative and complementary practices and the quality of services in Primary Health Care: an evaluation from the perspective of the multi-professional team

Introdução: O modelo de atenção biomédico é ainda predominante na saúde, no entanto, já não soluciona como deveria os problemas de saúde de grande parte da população, especialmente pelo seu caráter mecanicista, cujo foco é a doença e não o doente. As Práticas Integrativas e Complementares em Saúde (PICS) constituem um modelo vitalista e holístico, pois consideram que as crenças e saberes das diferentes culturas são indissociáveis do processo cuidado ­ cura, e isso faz dessas práticas um modelo de cuidado mais humanizado, centrado na pessoa. Uma recente conquista dos profissionais que integram as equipes multiprofissionais foi ter a inserção das PICS na Atenção Primária à Saúde (APS) e a possiblidade de desenvolver uma prática generalista e promotora de saúde através de atividades clínicas; educativas; focada na saúde holística e na qualidade de vida dos usuários, desenvolvendo uma nova relação profissional ­ usuário. Acredita-se que uma avaliação das atividades realizadas por esses profissionais inseridos na APS, bem como a qualidade do serviço de saúde e o uso das PICS, deva ser melhor apreciada e descrita. Objetivo: Analisar a oferta das PICS; avaliar a qualidade dos serviços de saúde nas unidades da APS e apreciar esses dois aspectos, e suas relações, na medida em que se influenciam ou não. Método: Trata-se de uma pesquisa de campo do tipo transversal, exploratória e de natureza quantitativa e qualitativa, realizada com os profissionais que integram as equipes multiprofissionais da APS os quais utilizam PICS em seus atendimentos. Foi realizada entrevista semi - estruturada e aplicação de questionários contendo perguntas avaliativas e explicativas, como o Primary Care Assessment Tool (PCATool ­ Brasil) versão profissionais e questionário sobre PICS com perguntas abertas. A análise dos dados quantitativos, obtidos com o Instrumento PCATool, foi estatística e organizada conforme sua natureza seguindo orientação do próprio instrumento. Já a análise dos dados qualitativos obtidos através do questionário PICS, recebeu o tratamento de análise de conteúdo na perspectiva de Bardin. Resultados: A maioria da população foi composta por profissionais do sexo feminino (86,66%), a idade variou de 30 a 62 anos, sendo a média de 45 anos. Com relação aos achados qualitativos, surgiram 8 categorias: Formação, Interesse, Oferta, Prática, Efeitos, Qualidade da APS, Dificuldades e Facilitadores. Em relação aos dados quantitativos do PCATool, os escores médios dos atributos variaram de 2,16 (Acessibilidade) a 3,58 (Orientação Familiar). Sendo que os dois melhores escores avaliados foram: Orientação Familiar, com 3,58 e Coordenação das Informações, com 3,42. Além disso, os dois piores escores foram: Acessibilidade, com 2,16 e Integralidade dos Serviços Disponíveis, com 2,70. Conclusão: As PICS contribuem para uma melhora na qualidade dos serviços da APS, pois se mostraram eficazes: na melhora da resolutividade; na diminuição da medicalização; na melhoria do acesso aos cuidados integrativos/holísticos em saúde através das práticas corporais e auriculoterapia; na melhora da integralidade do cuidado e reforçam a utilização das tecnologias leves e de baixo custo, como: vínculo, autonomia e co-responsabilidade.

Introduction: Biomedical health care model, despite being the standard in health care, has been showing itself not sufficient to solve health problems for most of the population, particularly because of its mechanistic character, which focuses on the illness instead of focusing on the patient. Complementary Therapies (CT), on the other hand, offers a holistic and vitalist approach, since it acknowledges that beliefs and wisdom from different cultures are inseparable from the Healing Care process, which makes this model more humanized and person-centered. In recent past, an important achievement for the professionals in a multiprofessional team was CT they inclusion in the Primary Health Care (PHC), in which they could develop a generalist, health-promoting practice through educational and clinical activities, focusing on the patient's holistic health and life quality, and therefore cultivating a new relationship between health professional and patient. Evaluation of the activities performed by these professionals in the PHC, as well as the service quality in health care and the use of the CT, should be better executed and described. Objective: To analyze CT offer and to evaluate the service quality in health care at PHC units, assessing the relationship between these two aspects and to what extent they influence each other or not. Method: Cross-sectional, exploratory, qualitative and quantitative field survey conducted with the professionals that integrate the multiprofessional teams of PHC which use CT in their care. A semi - structured interview and questionnaires containing evaluative and explanatory questions, such as the Primary Care Assessment Tool (PCATool - Brazil), and a questionnaire on CT with open questions were conducted. The analysis of the quantitative data, obtained with the PCATool Instrument, was statistical and organized according to its nature, following the orientation of the instrument itself. The analysis of the qualitative data obtained through the CT questionnaire, received the content analysis treatment from Bardin 's perspective. Results: Most of the population was composed of female professionals (86.66%), age ranged from 30 to 62 years, with a mean of 45 years. Regarding the qualitative findings, there were 8 categories: Training, Interest, Supply, Practice, Effects, Quality of PHC, Difficulties and Facilitators. Regarding the quantitative data of PCATool, the mean scores of attributes ranged from 2.16 (Accessibility) to 3.58 (Family Orientation). The two best scores were: Family Orientation, with 3.58 and Information Coordination, with 3.42. In addition, the two worst scores were: Accessibility, with 2.16 and Integrality of Available Services, with 2.70. Conclusion: CT corroborates to an improvement in the quality of PHC services, since they have proved effectiveness: improvement of response capacity; reduction of medicalization; improving access to integrative / holistic health care through body and auriculotherapy practices; improvement of integrality of care and reinforce the use of the light and low cost technologies, such as: professional-patient bond, autonomy and co-responsability.