Validated medication deprescribing instruments for patients with palliative care needs: a systematic review / Instrumentos validados de desprescripción de medicamentos para los pacientes que reciben cuidados paliativos: una revisión sistemática

Objectives: Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. Methods: A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by 2 independent researchers. Experimental and observational studies were eligible for inclusion. Results: Out of the 5791 studies retrieved, after excluding duplicates (n = 1050), conducting title/abstract screening (n = 4741), and full reading (n = 41), only 1 study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to 2 groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. Conclusions: Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only 1 of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs)...(AU)

Objetivo: Los pacientes con enfermedades terminales son propensos a la polifarmacia innecesaria. Las herramientas de desprescripción pueden contribuir a minimizar los resultados negativos. Por lo tanto, los objetivos del estudio fueron identificar instrumentos validados para la desprescripción de medicamentos inapropiados en pacientes con necesidades de cuidados paliativos y evaluar el impacto en los resultados clínicos, humanísticos y económicos. Métodos: Se realizó una revisión sistemática en las bases de datos LILACS, PUBMED, EMBASE, COCHRANE y WEB OF SCIENCE (hasta mayo de 2021). Se realizó una búsqueda manual en las referencias de los artículos incluidos. La selección, elegibilidad, extracción y evaluación del riesgo de sesgo se llevaron a cabo por dos investigadores independientes. Se aceptó la inclusión de estudios observacionales y experimentales. Resultados: De los 5791 estudios recuperados, después de excluir duplicados (n = 1050), realizar la selección de títulos/resúmenes (n = 4741) y la lectura completa (n = 41), solo un estudio cumplió con los criterios de inclusión. En este estudio incluido, se realizó un ensayo controlado aleatorizado, que mostró un alto nivel de riesgo de sesgo en general. A los adultos de 75 años o más (n = 130) con esperanza de vida limitada y polifarmacia se les asignaron dos grupos [grupo de intervención (desprescripción) y grupo de control (atención habitual)]. Se realizó la desprescripción con la ayuda de la herramienta STOPPFrail. El número promedio de medicamentos inapropiados y los costos mensuales de los medicamentos fueron significativamente más bajos en el grupo de intervención. No se encontraron diferencias estadísticamente significativas en términos de presentaciones hospitalarias no programadas, caídas, fracturas, mortalidad y calidad de vida. Conclusiones: A pesar de la disponibilidad de varias herramientas para apoyar la deprescripción en pacientes con necesidades de cuidados paliativos...(AU)

Instrumentos validados de desprescripción de medicamentos para los pacientes que reciben cuidados paliativos: una revisión sistemática / Validated medication deprescribing instruments for patients with palliative care needs: a systematic review

Objectives: Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. Methods: A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by 2 independent researchers. Experimental and observational studies were eligible for inclusion. Results: Out of the 5791 studies retrieved, after excluding duplicates (n = 1050), conducting title/abstract screening (n = 4741), and full reading (n = 41), only 1 study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to 2 groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. Conclusions: Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only 1 of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs)...(AU)

Objetivo: Los pacientes con enfermedades terminales son propensos a la polifarmacia innecesaria. Las herramientas de desprescripción pueden contribuir a minimizar los resultados negativos. Por lo tanto, los objetivos del estudio fueron identificar instrumentos validados para la desprescripción de medicamentos inapropiados en pacientes con necesidades de cuidados paliativos y evaluar el impacto en los resultados clínicos, humanísticos y económicos. Métodos: Se realizó una revisión sistemática en las bases de datos LILACS, PUBMED, EMBASE, COCHRANE y WEB OF SCIENCE (hasta mayo de 2021). Se realizó una búsqueda manual en las referencias de los artículos incluidos. La selección, elegibilidad, extracción y evaluación del riesgo de sesgo se llevaron a cabo por dos investigadores independientes. Se aceptó la inclusión de estudios observacionales y experimentales. Resultados: De los 5791 estudios recuperados, después de excluir duplicados (n = 1050), realizar la selección de títulos/resúmenes (n = 4741) y la lectura completa (n = 41), solo un estudio cumplió con los criterios de inclusión. En este estudio incluido, se realizó un ensayo controlado aleatorizado, que mostró un alto nivel de riesgo de sesgo en general. A los adultos de 75 años o más (n = 130) con esperanza de vida limitada y polifarmacia se les asignaron dos grupos [grupo de intervención (desprescripción) y grupo de control (atención habitual)]. Se realizó la desprescripción con la ayuda de la herramienta STOPPFrail. El número promedio de medicamentos inapropiados y los costos mensuales de los medicamentos fueron significativamente más bajos en el grupo de intervención. No se encontraron diferencias estadísticamente significativas en términos de presentaciones hospitalarias no programadas, caídas, fracturas, mortalidad y calidad de vida. Conclusiones: A pesar de la disponibilidad de varias herramientas para apoyar la deprescripción en pacientes con necesidades de cuidados paliativos...(AU)

Validated medication deprescribing instruments for patients with palliative care needs: a systematic review

Objectives Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. Methods A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by 2 independent researchers. Experimental and observational studies were eligible for inclusion. Results Out of the 5791 studies retrieved, after excluding duplicates (n = 1050), conducting title/abstract screening (n = 4741), and full reading (n = 41), only 1 study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to 2 groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. Conclusions Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only 1 of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs) and decrease the monthly costs of pharmacotherapy. Nevertheless, the impact on patient safety and humanistic outcomes remain unclear.

Validated medication deprescribing instruments for patients with palliative care needs a systematic review.

OBJECTIVES: Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. METHODS: A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by 2 independent researchers. Experimental and observational studies were eligible for inclusion. RESULTS: Out of the 5791 studies retrieved, after excluding duplicates (n = 1050), conducting title/abstract screening (n = 4741), and full reading (n = 41), only 1 study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to 2 groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. CONCLUSIONS: Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only 1 of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs) and decrease the monthly costs of pharmacotherapy. Nevertheless, the impact on patient safety and humanistic outcomes remain unclear.

Occurrence and preventability of adverse events in hospitals: a retrospective study.

OBJECTIVES: to analyze the incidence of preventable adverse events related to health care in adult patients admitted to public hospitals in Brazil. METHODS: observational, analytical, retrospective study based on medical records review. RESULTS: medical records from 370 patients were evaluated, 58 of whom had at least one adverse event. The incidence of adverse events corresponded to 15.7%. Adverse events were predominantly related to healthcare-related infection (47.1%) and procedures (24.5%). Regarding the adverse event severity, 13.7% were considered mild, 51.0% moderate, and 35.3% severe. 99% of adverse events were classified as preventable. Patients admitted to the emergency room had a 3.73 times higher risk for adverse events. CONCLUSIONS: this study's results indicate a high incidence of avoidable adverse events and highlight the need for interventions in care practice.

Validated medication deprescribing instruments for patients with palliative care needs: a systematic review

Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. Methods A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by 2 independent researchers. Experimental and observational studies were eligible for inclusion. Results Out of the 5791 studies retrieved, after excluding duplicates (n = 1050), conducting title/abstract screening (n = 4741), and full reading (n = 41), only 1 study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to 2 groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. Conclusions Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only 1 of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs) and decrease the monthly costs of pharmacotherapy. Nevertheless, the impact on patient safety and humanistic outcomes remain unclear.

Occurrence and preventability of adverse events in hospitals: a retrospective study / Incidencia y evitabilidad de acontecimientos adversos en hospitales: un estudio retrospectivo / Ocorrência e evitabilidade de eventos adversos em hospitais: estudo retrospectivo

ABSTRACT Objectives: to analyze the incidence of preventable adverse events related to health care in adult patients admitted to public hospitals in Brazil. Methods: observational, analytical, retrospective study based on medical records review. Results: medical records from 370 patients were evaluated, 58 of whom had at least one adverse event. The incidence of adverse events corresponded to 15.7%. Adverse events were predominantly related to healthcare-related infection (47.1%) and procedures (24.5%). Regarding the adverse event severity, 13.7% were considered mild, 51.0% moderate, and 35.3% severe. 99% of adverse events were classified as preventable. Patients admitted to the emergency room had a 3.73 times higher risk for adverse events. Conclusions: this study's results indicate a high incidence of avoidable adverse events and highlight the need for interventions in care practice.

RESUMEN Objetivos: analizar la incidencia de eventos adversos evitables relacionados al cuidado de la salud en pacientes adultos internados en hospitales públicos brasileños. Métodos: estudio observacional, analítico, retrospectivo, basado en la revisión de historias clínicas. Resultados: se evaluaron las historias clínicas de 370 pacientes, 58 de los cuales sufrieron al menos un evento adverso. La incidencia de eventos adversos correspondió al 15,7%. Los eventos adversos estaban relacionados, principalmente, con: infecciones por asistencia sanitaria (47,1%) y procedimientos (24,5%). Respecto a la gravedad de los eventos adversos, el 13,7% era leve, el 51%, moderado y el 35,3%, grave. Se clasificó como evitable el 99% de los eventos adversos. Los pacientes ingresados en urgencias presentaron un riesgo 3,73 veces mayor de aparición de eventos adversos. Conclusiones: los resultados de este estudio señalan una incidencia elevada de eventos adversos evitables y resaltan la necesidad de intervenciones en la práctica asistencial.

RESUMO Objetivos: analisar a incidência de eventos adversos evitáveis relacionados ao cuidado em saúde em pacientes adultos internados em hospitais públicos brasileiros. Métodos: estudo observacional, analítico, de corte retrospectivo, baseado na revisão de prontuários. Resultados: avaliaram-se prontuários de 370 pacientes, dos quais 58 sofreram pelo menos um evento adverso. A incidência de eventos adversos correspondeu a 15,7%. Os eventos adversos foram vinculados: à infecção relacionada à assistência à saúde (47,1%) e a procedimentos (24,5%), predominantemente. No que tange à gravidade dos eventos adversos, averiguou-se que 13,7% foram considerados leves, 51,0%, moderados e 35,3%, graves. Classificou-se como evitáveis 99% dos eventos adversos. Pacientes internados em caráter de urgência apresentaram risco 3,73 vezes maior para a ocorrência de um evento adverso. Conclusões: os resultados deste estudo apontam elevada incidência de eventos adversos evitáveis e contribuem para evidenciar a necessidade de intervenções na prática assistencial.

Hospitalizations of older people in an emergency department related to potential medication-induced hyperactive delirium: a cross-sectional study.

Background Although delirium is one of the most common adverse drug reactions observed in hospitalized older people, it remains underdiagnosed. Aim To estimate the prevalence of hospitalization of older people with potential medication-induced hyperactive delirium in the emergency department (ED); to identify the risk factors and the medicines frequently associated with the occurrence of the syndrome. Method A cross-sectional, retrospective study was performed with older people (age ≥ 60) admitted in 2018 to a Brazilian ED. The hospitalizations with suspected hyperactive delirium were screened with the aid of trigger-tools: International Code of Diseases-10th Revision, intra-hospital prescriptions of antipsychotics, and trigger-words related to the syndrome. A chart-review and medication review were developed to establish the causality assessment between adverse event and medicine. Logistic regression was used to determine risk factors for occurrence. Results Among the hospitalizations included, 67.5% (193/286) were screened by at least one trigger-tool. Of these, potential medication-induced hyperactive delirium was observed in 26.0% (50/193). The prevalence estimated in the ward was 17.5% (50/286). Opioids (31.9%), benzodiazepines (18.8%) and corticosteroids (10.6%) were the commonest medicines associated with delirium. Long-lived patients (p = 0.005), potentially inappropriate medicines (PIMs) (p = 0.025), and high weighted deliriogenic load (p = 0.014) were associated with potential medication-induced hyperactive delirium. Conclusion Approximately one in six hospitalizations of older people in the ED showed potential medication-induced hyperactive delirium. Data suggest PIMs and high weighted deliriogenic load, rather than polypharmacy or anticholinergic burden, are considered the most important characteristics of pharmacotherapy associated with avoidable hyperactive delirium among long-lived patients.

Gastos com internações por condições sensíveis à atenção primária: estudo ecológico / Gastos con internaciones por condiciones sensibles en la atención primaria: estudio ecológico / Expenses with hospitalizations by sensitive conditions to the primary care: an ecological study

Resumo Objetivo Analisar os gastos com Internações por Condições Sensíveis à Atenção Primária no Estado de Minas Gerais. Métodos Estudo ecológico e retrospectivo das internações dos anos de 2014 e 2019, com dados do Sistema de Informação Hospitalar analisados por meio de estatística descritiva e teste pareado de Wilcoxon. Resultados Observou-se redução de valores gastos (-9,88%), em internações eletivas (-1,77%) e de urgência (-10,54%), nos sexos masculino e feminino e em todas as faixas etárias; com diferença significativa de valores gastos nas faixas etárias de 5 a 14 anos (p=0,005) e de 15 a 49 anos (p<0,001). Os maiores valores absolutos se deram nos grupos Angina, Insuficiência Cardíaca e Doenças Cerebrovasculares; as principais reduções ocorreram nas Doenças inflamatórias de órgãos pélvicos, Gastroenterites infecciosas e Asma. Conclusão A análise por grupos e caráter de internação das condições sensíveis possibilita a identificação de frequência e custos elevados e/ou desproporcionais, mostrando condições de maior risco e atuação dos serviços de cuidados primários em saúde no momento oportuno à demanda da população.

Resumen Objetivo Analizar los gastos con Internaciones por Condiciones Sensibles en la Atención Primaria en el Estado de Minas Gerais. Métodos Estudio ecológico y retrospectivo de las internaciones en los años de 2014 y de 2019, con datos del Sistema de Información Hospitalaria analizados por medio de estadística descriptiva y pruebas pareadas de Wilcoxon. Resultados Se observó una reducción en los montos gastados (-9,88 %), en internaciones electivas (-1,77 %) y de urgencia (-10,54 %), en los sexos masculino y femenino y en todos los grupos de edad; con una diferencia significativa en los montos gastados en los grupos de edad de los 5 a los 14 años (p=0,005) y de los 15 a los 49 años (p<0,001). Los mayores valores absolutos se dieron en los grupos Angina, Insuficiencia Cardíaca y Enfermedades Cerebrovasculares; las principales reducciones se dieron en las Enfermedades inflamatorias de órganos pélvicos, Gastroenteritis infecciosas y Asma. Conclusión El análisis por grupos y tipo de internación de las condiciones sensibles posibilita la identificación de frecuencia y elevados costos o desproporcionales, mostrando condiciones de mayor riesgo y actuación de los servicios de cuidados primarios en salud en el momento oportuno a la demanda de la población.

Abstract Objective To analyse the expenses with hospitalizations by Sensitive Conditions to the Primary Care at the Minas Gerais State. Methods Ecological and retrospective study of the hospitalizations from 2014 to 2019, with data from the Hospital Information System, analysed through descriptive statistics and Wilcoxon paired test. Results We observed a decrease in the expense values (-9.88%), in electives hospitalizations (-1.77%) and urgency hospitalizations (-10.54%), in male and female sexes, and all group ages; with significant expense values difference in the age groups from 5 to 14 years old (p=0.005), and from 15 to 49 (p<0.001). We found the absolute higher values in the Angina, Cardiac insufficiency, and Cerebrovascular diseases groups; the main decreases occurred in Pelvic organs inflammatory diseases, Infectious gastroenteritis, and Asthma. Conclusion The analysis by groups and hospitalization character of the sensitive conditions allows the identification of frequency and elevated and/or disproportionate expenses, highlighting conditions of greater risk and action of the primary care services in health in the appropriate moment to the population demand.

Satisfação no trabalho de técnicos de enfermagem do atendimento pré-hospitalar: um estudo observacional analítico / Job satisfaction of nursing technicians in pre-hospital care: an analytical observational study / Satisfacción laboral de los técnicos de enfermería en la atención prehospitalaria: un estudio analítico observacional

Objetivo: avaliar a satisfação no trabalho dos técnicos de enfermagem atuantes no Serviço de Atendimento Móvel de Urgência e sua relação com variáveis relacionadas aos aspectos profissionais e demográficos. Método: estudo observacional analítico, com 155 técnicos de enfermagem do Serviço de Atendimento Móvel de Urgência. Empregaram-se o Job Satisfaction Survey e testes estatísticos não paramétricos para analisar a correlação e a associação entre as dimensões do instrumento com as variáveis sociodemográficas e profissionais, com nível de significância de p<0,05. Resultados: os profissionais estão nem insatisfeitos nem satisfeitos em relação ao seu trabalho. Identificaram-se correlações fracas entre alguns domínios do instrumento com as variáveis idade e tempo na unidade. Houve associações entre a satisfação no trabalho com as variáveis: sexo, graduação, escala e tipo de vínculo. Conclusão: evidenciou-se que a satisfação no trabalho dos técnicos de enfermagem atuantes no atendimento pré-hospitalar está associada às variáveis sexo, graduação, escala de serviço e tipo de vínculo.

Objective: to assess job satisfaction among nursing technicians working in a Mobile Emergency Care Service and its relationship with professional and demographic variables. Method: in this analytical observational study of 155 nursing technicians from the Mobile Emergency Care Service, the Job Satisfaction Survey and non-parametric statistical tests were used to examine correlations and associations between the dimensions of the instrument and sociodemographic and professional variables, to a p < 0.05 level of significance. Results: the technicians were neither dissatisfied nor satisfied with their work. Weak correlations were identified between some domains of the instrument, age and time in the unit. Job satisfaction was associated with sex, graduation, scale of service and type of employment relationship. Conclusion: job satisfaction among nursing technicians working in pre-hospital care was found to be associated with sex, graduation, scale of service and type of employment relationship.

Objetivo: evaluar la satisfacción no trabajo de los técnicos de enfermería que trabajan en el Servicio de Atención Móvil de Urgencias y su relación con variables relacionadas con los aspectos profesionales y demográficos. Método: estudio analítico observacional junto a 155 técnicos de enfermería del Servicio de Atención Móvil de Urgencias. Se utilizaron la Encuesta de Satisfacción Laboral y pruebas estadísticas no paramétricas para analizar la correlación y la asociación entre las dimensiones del instrumento y las variables sociodemográficas y profesionales, con el nivel de significancia de p <0.05. Resultados: los profesionales no están insatisfechos ni satisfechos con respecto a su trabajo. Se identificaron correlaciones débiles entre algunos dominios del instrumento con las variables edad y tiempo en la unidad. Hubo asociaciones entre la satisfacción laboral con las variables: sexo, graduación, escala y tipo de vínculo laboral. Conclusión:se evidenció que la satisfacción laboral de los técnicos de enfermería que laboran en la atención prehospitalaria se asocia con las variables sexo, grado, escala de servicio y tipo de vínculo.

Expenses of hospitalization for ambulatory care sensitive conditions in the Health Regional Offices of the State of São Paulo.

OBJECTIVE: To analyze the expenses of hospitalizations for ambulatory care sensitive conditions in the Health Regional Offices of the State of São Paulo. METHODS: An ecological, retrospective cohort, with analysis of hospital admissions for ambulatory care sensitive conditions in the state of São Paulo, from 2014 to 2018, compiled by the Hospital Information System. Data were extracted using the Tabwin application and analyzed using descriptive statistics. RESULTS: There was a 14.49% reduction in the amount spent on hospitalizations for ambulatory care sensitive conditions. There were reductions in the frequency of hospitalizations (-1.26) and hospital stay (-0.54), and an increase in the occurrence of deaths (8.02). The Regional Offices of Barretos, Taubaté and Araraquara showed an increase in expenses in the period, by 37.86%, 15.38% and 3.78%, respectively, while all other Regional Offices showed a reduction; in that, the most significant were in Bauru (-31.90%), São João da Boa Vista (-26.18%), Presidente Prudente (-21.00%) and São Paulo (-19.17%). The value of hospitalizations for ambulatory care sensitive conditions showed a strong and positive correlation with the variables frequency and hospital stay. CONCLUSION: The results pointed to a difference in the amounts spent on hospitalizations for ambulatory care sensitive conditions in the Regional Offices, although there was no difference in the frequency and duration of these hospitalizations. The expansion of Primary Health Care resources is a possible element for reducing the frequency and spending on hospitalizations for ambulatory care sensitive conditions; nonetheless, it is necessary to consider other factors, such as social determinants and the organization of health services.

Expenditure on psychiatric hospitalizations in the State of São Paulo, Brazil: a descriptive ecological study, 2014 and 2019. / Gastos com internações psiquiátricas no estado de São Paulo: estudo ecológico descritivo, 2014 e 2019.

OBJECTIVE: To analyze expenditure on psychiatric hospitalizations in the State of São Paulo in 2014 and 2019. METHODS: This was a descriptive ecological study, with analysis of data on psychiatric hospital admissions in the State of São Paulo, retrieved from the Hospital Information System. RESULTS: 115,652 hospitalizations that occurred in 2014 and 79,355 that occurred in 2019 were analyzed (reduction of 31.38%). There were reductions in the amounts spent on psychiatric hospitalizations (-42.94%), in particular expenditure on urgency hospitalizations, on female patients (-46.46%), on people aged 15-49 years (-36.85%) and on those aged over 50 years (-51.54%). CONCLUSION: The reduction in expenditure on psychiatric hospitalizations and the reduction in their frequency provide elements for the assessment and allocation of resources for mental health care, within the scope of hospital admissions and use of community-based services.

Incidence and preventability of adverse events in adult patients admitted to a Brazilian teaching hospital.

OBJECTIVE: To analyze the incidence and preventability of adverse events related to health care in adult patients admitted to a Brazilian teaching hospital. METHODS: A retrospective cohort study, in which the incidence and preventability of adverse events related to health care were based on a two-stage retrospective review of 368 medical records (nurses and pharmacist review of medical records, followed by physicians review of triggered medical records) of adult patients whose hospitalizations occurred during 2015 in a high-complexity public teaching hospital located in Brazil. Data were collected from February 2018 to February 2019. RESULTS: A total of 266 adverse events were observed in 124 patients. The incidence of adverse events related to health care was 33.7% (95% CI 0.29-0.39), and the incidence density was 4.97 adverse events per 100 patient-days. Adverse events were responsible for 701 additional days of hospitalization, and the estimated length of additional hospital stay attributable to them was, on average, 6.8 days per event. The most common types of events were related to general care (60; 22.6%), medications (50; 18.8%), nosocomial infection (35; 13.2%), any other type (11; 4.1%), and diagnoses (2; 0.8%). Regarding the severity of adverse events, it was found that 168 (63.2%) were mild, 55 (20.7%) were moderate, and 43 (16.2%) were severe. In addition, it was estimated that 155 (58.3%) events were preventable. The length of a patient's hospital stay was identified as a risk factor for the occurrence of adverse events (RR 1.20; 95% CI 1.04-1.39). CONCLUSIONS: Through knowledge of the incidence, nature, severity, preventability, and risk factors for the occurrence of adverse events, it is possible to create the opportunities to prioritize the implementation of strategies for mitigating specific events based on reliable data and concrete information.

Spending on psychiatric hospitalizations in the State of São Paulo, Brazil: a descriptive ecological study, 2014-2019 / Gasto en hospitalizaciones psiquiátricas en el estado de São Paulo, Brasil: estudio ecológico descriptivo, 2014-2019 / Gastos com internações psiquiátricas no estado de São Paulo: estudo ecológico descritivo, 2014-2019

Objective: To analyze spending on psychiatric hospitalizations in the State of São Paulo in the years 2014 and 2019. Methods: Descriptive ecological study, with data analysis of psychiatric hospital admissions in the State of São Paulo, obtained from the Hospital Information System. Results: 115,652 hospitalizations that occurred in 2014 and 79,355 that occurred in 2019 were analyzed (reduction of 31.38%). There were reductions in the amounts spent on psychiatric hospitalizations (-42.94%), with emphasis on urgency hospitalizations, of female patients (-46.46%), in the age groups of 15 to 49 years (-36.85%) and over 50 years (-51.54%). Conclusion: The reduction in the amounts spent and the frequency of psychiatric hospitalizations provide elements for the assessment and allocation of resources for mental health care, within the scope of hospital admissions and the use of community-based services.

Objetivo: Analisar os gastos com internações psiquiátricas no estado de São Paulo, Brasil, nos anos de 2014 e 2019. Métodos: Estudo ecológico descritivo, com análise de dados das internações hospitalares psiquiátricas no estado, obtidos do Sistema de Informações Hospitalares do Sistema Único de Saúde. Resultados: Foram analisadas 115.652 internações ocorridas em 2014, e 79.355 em 2019 (redução de 31,38%). Observaram-se reduções nos valores gastos com internações psiquiátricas (-42,94%), destacando-se as internações de caráter de urgência, de pessoas do sexo feminino (-46,46%), nas idades de 15 a 49 (-36,85%) e mais de 50 anos (-51,54%). Conclusão: As reduções de frequência e de valores gastos com internações psiquiátricas fornecem elementos para a avaliação e alocação de recursos destinados à atenção da saúde mental, no âmbito das internações hospitalares e da utilização de serviços de base comunitária.

Gastos com internações psiquiátricas no estado de São Paulo: estudo ecológico descritivo, 2014 e 2019 / Gasto en hospitalizaciones psiquiátricas en el estado de São Paulo, Brasil: estudio ecológico descriptivo, 2014 y 2019 / Expenditure on psychiatric hospitalizations in the State of São Paulo, Brazil: a descriptive ecological study, 2014 and 2019

Objetivo: Analisar os gastos com internações psiquiátricas no estado de São Paulo, Brasil, nos anos de 2014 e 2019. Métodos: Estudo ecológico descritivo, com análise de dados das internações hospitalares psiquiátricas no estado, obtidos do Sistema de Informações Hospitalares do Sistema Único de Saúde. Resultados: Foram analisadas 115.652 internações ocorridas em 2014, e 79.355 em 2019 (redução de 31,38%). Observaram-se reduções nos valores gastos com internações psiquiátricas (-42,94%), destacando-se as internações de caráter de urgência, de pessoas do sexo feminino (-46,46%), nas idades de 15 a 49 (-36,85%) e mais de 50 anos (-51,54%). Conclusão: As reduções de frequência e de valores gastos com internações psiquiátricas fornecem elementos para a avaliação e alocação de recursos destinados à atenção da saúde mental, no âmbito das internações hospitalares e da utilização de serviços de base comunitária.

Objetivo: Analizar el gasto en hospitalizaciones psiquiátricas en el Estado de São Paulo, Brasil, en los años 2014 y 2019. Métodos: Estudio ecológico descriptivo, con análisis de datos de ingresos hospitalarios psiquiátricos en el Estado de São Paulo, obtenidos del Sistema de Información Hospitalaria del Sistema Único de Salud. Resultados: Se analizaron 115,652 hospitalizaciones ocurridas en 2014 y 79,355 ocurridas en 2019 (reducción del 31.38%). Hubo reducciones en los montos gastados en hospitalizaciones psiquiátricas (-42,94%), con énfasis en hospitalizaciones de urgencia, de pacientes del sexo femenino (-46,46%), en los grupos de edad de 15 a 49 años (-36,85%) y mayores de 50 años (-51,54%). Conclusión: Las reducciones en la frecuencia y los montos gastados en hospitalizaciones psiquiátricas proporcionan elementos para la evaluación y asignación de recursos para la atención de la salud mental, dentro del alcance de las admisiones hospitalarias y el uso de servicios comunitarios.

Objective: To analyze expenditure on psychiatric hospitalizations in the State of São Paulo in 2014 and 2019. Methods: This was a descriptive ecological study, with analysis of data on psychiatric hospital admissions in the State of São Paulo, retrieved from the Hospital Information System. Results: 115,652 hospitalizations that occurred in 2014 and 79,355 that occurred in 2019 were analyzed (reduction of 31.38%). There were reductions in the amounts spent on psychiatric hospitalizations (-42.94%), in particular expenditure on urgency hospitalizations, on female patients (-46.46%), on people aged 15-49 years (-36.85%) and on those aged over 50 years (-51.54%). Conclusion: The reduction in expenditure on psychiatric hospitalizations and the reduction in their frequency provide elements for the assessment and allocation of resources for mental health care, within the scope of hospital admissions and use of community-based services.

Expenses of hospitalization for ambulatory care sensitive conditions in the Health Regional Offices of the State of São Paulo / Gastos com internações por condições sensíveis à Atenção Primária nas Regionais de Saúde do Estado de São Paulo

ABSTRACT Objective: To analyze the expenses of hospitalizations for ambulatory care sensitive conditions in the Health Regional Offices of the State of São Paulo. Methods: An ecological, retrospective cohort, with analysis of hospital admissions for ambulatory care sensitive conditions in the state of São Paulo, from 2014 to 2018, compiled by the Hospital Information System. Data were extracted using the Tabwin application and analyzed using descriptive statistics. Results: There was a 14.49% reduction in the amount spent on hospitalizations for ambulatory care sensitive conditions. There were reductions in the frequency of hospitalizations (−1.26) and hospital stay (−0.54), and an increase in the occurrence of deaths (8.02). The Regional Offices of Barretos, Taubaté and Araraquara showed an increase in expenses in the period, by 37.86%, 15.38% and 3.78%, respectively, while all other Regional Offices showed a reduction; in that, the most significant were in Bauru (−31.90%), São João da Boa Vista (−26.18%), Presidente Prudente (−21.00%) and São Paulo (−19.17%). The value of hospitalizations for ambulatory care sensitive conditions showed a strong and positive correlation with the variables frequency and hospital stay. Conclusion: The results pointed to a difference in the amounts spent on hospitalizations for ambulatory care sensitive conditions in the Regional Offices, although there was no difference in the frequency and duration of these hospitalizations. The expansion of Primary Health Care resources is a possible element for reducing the frequency and spending on hospitalizations for ambulatory care sensitive conditions; nonetheless, it is necessary to consider other factors, such as social determinants and the organization of health services.

RESUMO Objetivo: Analisar os gastos com internações por condições sensíveis à Atenção Primária nas Regionais de Saúde do estado de São Paulo. Métodos: Estudo ecológico, de coorte retrospectiva, com análise de internações hospitalares por condições sensíveis à Atenção Primária ocorridas no estado de São Paulo, no período de 2014 a 2018, computadas pelo Sistema de Informação Hospitalar. Os dados foram extraídos por meio do aplicativo Tabwin e analisados por estatística descritiva. Resultados: Houve redução de 14,49% do valor gasto com internações por condições sensíveis à Atenção Primária. Foram observadas reduções na frequência das internações (−1,26) e na permanência hospitalar (−0,54) e aumento da ocorrência de óbitos (8,02). As Regionais de Barretos, Taubaté e Araraquara apresentaram elevação de gastos no período, em 37,86%, 15,38% e 3,78%, respectivamente, enquanto todas as demais Regionais apresentaram redução; e as mais expressivas foram em Bauru (−31,90%), São João da Boa Vista (−26,18%), Presidente Prudente (−21,00%) e São Paulo (−19,17%). O valor das internações por condições sensíveis à Atenção Primária apresentou correlação forte e positiva com as variáveis frequência e permanência hospitalar. Conclusão: Houve diferença de valores gastos com internações por condições sensíveis à Atenção Primária nas regionais, mas não houve diferença na frequência e na duração dessas internações. A expansão de recursos da Atenção Primária à Saúde é um possível elemento para a redução de frequência e dos gastos com internações por condições sensíveis à Atenção Primária; porém é necessário considerar outros fatores, como os determinantes sociais e a organização dos serviços de saúde.

Coaching Leadership in the context of the Mobile Emergency Care Service. / Liderança Coaching no contexto do Serviço de Atendimento Móvel de Urgência.

OBJECTIVE: To analyze the Coaching Leadership exercised by nursing coordinators in the Mobile Emergency Care Service units, in the coordinators and nursing technicians' perception, in addition to its correlation with three sociodemographic variables. METHOD: Descriptive and analytical study carried out on nursing coordinators and nursing technicians from the pre-hospital care units, using the Coaching Leadership questionnaires and the Spearman correlation test to analyze the results. RESULTS: 11 nursing coordinators and 155 nursing technicians participated in the study. The Coaching Leadership exercise was observed in the perception of two professional categories: "giving and receiving feedback", which was the domain with the highest average for the coordinators (21.45; SD=2.84); and "communication" (20.43; SD=5.57) for technicians. Furthermore, in the coordinators' self-perception of the Coaching Leadership, there was an indirect correlation between the domains "giving and receiving feedback" (Spearman -0.720; p-value 0.012) and "total scale score" (Spearman -0.652 and p-value 0.029) with regard to "training time". CONCLUSION: The research results indicate significant contributions to nursing practices and denote this competence impact on the pre-hospital care nursing staff, in the work environment, and in the care provided to the patient.

Organizational culture, authentic leadership and quality improvement in Canadian healthcare facilities.

OBJECTIVE: To investigate relationships among flexible and hierarchical organizational cultures, quality improvement domains, and authentic leadership competencies in Canadian healthcare facilities. METHOD: Observational cross-sectional study conducted in Alberta, Canada. Nurse managers (n=226) completed a survey including validated measures of organizational culture, quality improvement and authentic leadership. Data were analyzed using descriptive statistics, Spearman's correlation coefficient and Chi-squared test (p<0.05). RESULTS: Quality improvement through accreditation is related to organizational culture and authentic leadership. We saw a propensity for participants who reported working in a more flexible culture also reported greater quality improvement implementation and authentic leadership practices. CONCLUSION: This study assessed and reported the relationships between flexible organizational cultures, quality improvement through the accreditation process, and authentic leadership practices of healthcare managers. Flexible organizational cultures influence the adoption of authentic leadership, participatory management model and also improves quality.

Assessment of the incidence and preventability of adverse events in hospitals: an integrative review.

OBJECTIVE: To highlight the scientific production related to the use of the retrospective chart review methods to assess the incidence and preventability of adverse events in hospitals. METHOD: An integrative review in the MEDLINE, LILACS, SCOPUS, Web of Science and EMBASE databases conducted in May 2019 with the following guiding question: What is known about the retrospective chart review methods to assess the incidence and preventability of adverse events in hospitals? Subsequently, the categorization, synthesis, and classification of the evidence levels of the included publications were performed. RESULTS: In the 13 selected studies, the instruments adopted to assess the occurrence of adverse events were the Harvard Medical Practice Study, the Canadian Adverse Event Study, the Quality in Australian Health Care Study, and the Global Trigger Tool. Incidence ranged from 5.7 to 14.2%, while preventability ranged from 31 to 83%. CONCLUSION: Differences in incidence and preventability were found, showing different results in the quality of care provided, the information registered in medical records, the screening criteria used, and the assessments of the reviewers.

A liderança exemplar na perspectiva de enfermeiros do atendimento pré-hospitalar: estudo descritivo / Liderazgo ejemplar en la perspectiva de enfermeros de la atención prehospitalaria: estudio descriptivo / The exemplary leadership from the perspective of pre-hospital care nurses: a descriptive study

OBJETIVO: Identificar e analisar os aspectos relacionados às práticas da liderança exemplar na perspectiva de enfermeiros do Serviço de Atendimento Móvel de Urgência (SAMU), distinguindo a autopercepção desses profissionais enquanto líderes e caracterizando a percepção da liderança exercida por enfermeiros integrantes de suas equipes. MÉTODO: Estudo descritivo, realizado com enfermeiros do SAMU Regional dos 26 municípios de um Departamento Regional de Saúde do interior de São Paulo. A coleta de dados ocorreu mediante aplicação das versões EU e OBSERVADOR do Leadership Practices Inventory (LPI). RESULTADOS: Considerando as versões do LPI, as avaliações dos participantes atinentes ao comportamento do líder apresentaram diferenças mínimas em comparação com suas autoavaliações. Contudo, os respondentes se autoavaliaram positivamente na maior parte das práticas que delineiam a liderança exemplar. CONCLUSÃO: As práticas da liderança exemplar mostraram-se presentes no comportamento dos enfermeiros que atuavam no SAMU, despontando como competências imprescindíveis aos enfermeiros do atendimento pré-hospitalar.

OBJETIVO: Identificar y analizar los aspectos relacionados a las prácticas de liderazgo ejemplar en la perspectiva de enfermeros del Servicio de Asistencia Móvil de Urgencia (SAMU), distinguiendo su autopercepción como líderes y caracterizando la percepción del liderazgo ejercida por enfermeros integrantes de sus equipos. MÉTODO: Estudio descriptivo, realizado con enfermeros del SAMU Regional de los 26 municipios de un Departamento Regional de Salud del interior de São Paulo. Los datos se recolectaron mediante la aplicación de las versiones YO y OBSERVADOR del Leadership Practices Inventory (LPI). RESULTADOS: Considerando las versiones del LPI, las valoraciones de los participantes atinentes al comportamiento del líder presentaron diferencias mínimas en comparación a sus autovaloraciones. Sin embargo, los respondientes se autoevaluaron positivamente en la mayoría de las prácticas que delinean el liderazgo ejemplar. CONCLUSIÓN: Las prácticas del liderazgo ejemplar se mostraron presentes en el comportamiento de los enfermeros que actuaban en el SAMU, destacándose como competencias imprescindibles en los enfermeros de la atención prehospitalaria.

OBJECTIVE: Identify and analyze the aspects related to the practices of exemplary leadership from the perspective of nurses of the Mobile Emergency Services (SAMU), distinguishing the self-perception of these professionals as leaders and characterizing the perception of leadership exercised by nurses in their teams. METHOD: This is a descriptive study, carried out with nurses from SAMU Regional of the 26 municipalities of a Regional Health Department of the interior of São Paulo. The data collection occurred through the application of the SELF and OBSERVER versions of Leadership Practices Inventory (LPI). RESULTS: Considering the LPI versions, the participants' evaluations regarding the leader's behavior presented minimal differences compared to their self-evaluations. However, respondents rated themselves positively in most of the practices that delineate exemplary leadership. CONCLUSION: The practices of exemplary leadership were present in the behavior of the nurses who worked at SAMU, emerging as essential skills for nurses in pre-hospital care.