Construção e validação de um instrumento de avaliação da segurança do paciente para os serviços de atenção primária à saúde
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Data
2020-02-20
Autores
Togashi, Gabriela Benjamin
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A segurança do paciente vem sendo amplamente discutida e relacionada à assistência prestada nos serviços de saúde. Os estudos relacionados à segurança são mais evidentes no cenário hospitalar, embora os incidentes possam ocorrer em qualquer nível de assistência. A atenção primária à saúde por ser o primeiro contato do sistema de saúde e ordenadora do cuidado, concentra um grande número de atendimentos com diferentes níveis de complexidade, onde uma falha pode representar o início de uma sucessão de outras falhas e resultar em um dano à saúde do usuário. Desta forma, compreender a segurança do paciente no contexto da atenção primária à saúde é fundamental para que ações possam ser realizadas. Objetivo: Construir e validar um instrumento de avaliação da segurança do paciente para os serviços de atenção primária à saúde. Métodos: Trata-se de um estudo de desenvolvimento metodológico. Foi elaborado um instrumento, com padrões relacionados à segurança do paciente, embasados nos construtos teóricos da literatura, legislação nacional vigente e instrumentos já validados que abordam em algum aspecto a segurança do paciente. A validação de conteúdo foi realizada junto à juízes especialistas, com a utilização da técnica Delphi, onde buscou-se encontrar um índice mínimo de concordância de 80%. O instrumento foi submetido à um estudo piloto para validação de consistência e coerência a partir do cálculo de alpha de Cronbach. Após o estudo piloto, a aplicação do instrumento foi ampliada para 35 participantes de modo a obter a Análise Fatorial Exploratória e avaliar os domínios propostos inicialmente pelo instrumento. Resultados: O instrumento teve seu conteúdo validado em três rodadas de avaliação, resultando em 34 padrões distribuídos em 5 domínios. O instrumento apresentou consistência e coerência satisfatórias, com alpha de Cronbach de 0,91. Com os dados de 35 participantes, foi aplicada a análise fatorial exploratória utilizando o método de componentes principais com rotação varimax e ponto de corte 0,5. A análise incluiu todos os itens do questionário mostrando uma variação explicada de 71% considerando cinco fatores ou domínios. Apesar disso, a análise mostrou a necessidade de uma redistribuição dos fatores de forma diferente da proposta inicial. Conclusão: O estudo pode contribuir para esclarecer métodos e etapas de validação de um instrumento de medida e entrega um instrumento validado pelos juízes que deve evidenciar as potencialidades e fragilidades dos serviços de atenção primária em relação à segurança do paciente. No entanto, em virtude da AFE mostrar fatores diferentes dos domínios propostos no instrumento é necessário a reorganização desses domínios e ampla aplicação do instrumento para uma avaliação confirmatória dos domínios obtidos.
Background: Patient safety has been widely discussed and related to the assistance provided in health services. Safety-related studies are more evident in hospital settings, although incidents may occur at any level of assistance. Primary Health Care, as the first contact and organizer of the health-care system, concentrates a great number of services with different complexity levels, where one error can mean the beginning of a series of other errors and result in damage to the user’s health. Therefore, understanding patient safety in the context of primary health care is fundamental in order to undertake any action. Objectives: To build and validate an assessment tool for patient safety in Primary Health Care services. Methods: This is a methodological development study. An assessment tool was developed, with standards related to patient safety based on the theoretical constructs of the literature, current national legislation, and previously-validated tools that address patient safety in some aspects. The content was validated by specialist judges, using the Delphi method, where the aim was to find at least an 80% correlation index. The assessment tool was subjected to a pilot study in order to validate consistency and coherence using Cronbach’s alpha. After the pilot study, the application of the assessment tool was expanded to 35 participants in order to obtain an Exploratory Factor Analysis and evaluate the areas initially proposed for the tool. Results: The assessment tool had its contents validated in three evaluation rounds, resulting in 34 standards distributed in 5 areas. The tool presented satisfactory consistency and coherence, with a Cronbach’s alpha of 0.91. Using the data from 35 participants, we applied exploratory factor analysis using the method of principal component analysis with varimax rotation and a cut-off of 0.5. The analysis included all items from the questionnaire, exhibiting explained variance of 71%, considering five factors or areas. Despite this, the analysis showed the need for a redistribution of the factors differently from what was initially proposed. Conclusions: This study can contribute to clarify methods and validation steps for an assessment tool, and delivers a tool validated by judges, which should emphasize the potential and fragilities of primary health care regarding patient safety. However, due to the EFA presenting factors different from the aspects proposed by the assessment tool, it is necessary to reorganize those aspects and amplify the application of the tool for a confirmatory evaluation of the obtained areas.
Background: Patient safety has been widely discussed and related to the assistance provided in health services. Safety-related studies are more evident in hospital settings, although incidents may occur at any level of assistance. Primary Health Care, as the first contact and organizer of the health-care system, concentrates a great number of services with different complexity levels, where one error can mean the beginning of a series of other errors and result in damage to the user’s health. Therefore, understanding patient safety in the context of primary health care is fundamental in order to undertake any action. Objectives: To build and validate an assessment tool for patient safety in Primary Health Care services. Methods: This is a methodological development study. An assessment tool was developed, with standards related to patient safety based on the theoretical constructs of the literature, current national legislation, and previously-validated tools that address patient safety in some aspects. The content was validated by specialist judges, using the Delphi method, where the aim was to find at least an 80% correlation index. The assessment tool was subjected to a pilot study in order to validate consistency and coherence using Cronbach’s alpha. After the pilot study, the application of the assessment tool was expanded to 35 participants in order to obtain an Exploratory Factor Analysis and evaluate the areas initially proposed for the tool. Results: The assessment tool had its contents validated in three evaluation rounds, resulting in 34 standards distributed in 5 areas. The tool presented satisfactory consistency and coherence, with a Cronbach’s alpha of 0.91. Using the data from 35 participants, we applied exploratory factor analysis using the method of principal component analysis with varimax rotation and a cut-off of 0.5. The analysis included all items from the questionnaire, exhibiting explained variance of 71%, considering five factors or areas. Despite this, the analysis showed the need for a redistribution of the factors differently from what was initially proposed. Conclusions: This study can contribute to clarify methods and validation steps for an assessment tool, and delivers a tool validated by judges, which should emphasize the potential and fragilities of primary health care regarding patient safety. However, due to the EFA presenting factors different from the aspects proposed by the assessment tool, it is necessary to reorganize those aspects and amplify the application of the tool for a confirmatory evaluation of the obtained areas.
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Palavras-chave
Atenção Primária à Saúde, Segurança do paciente, Estudos de validação, Inquéritos e questionários, Primary health care, Patient safety, Validation studies, Surveys and questionnaires