Recomendações para avaliação de doenças em idosos assintomáticos
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Data
2019-08-01
Autores
Carmelin, Ariane Maria
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A população mundial de idosos vem crescendo mais rapidamente do que todos os outros grupos etários, demandando condições específicas para os seus cuidados, com recomendações bem estabelecidas. Recomendações de qualidade são essenciais para nortear o profissional de saúde, por isso, a United States Preventive Services Task Force (USPSTF) atua desde 1984 produzindo recomendações de qualidade científica para rastreio de doenças, com base no sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation) de força de recomendação. No Brasil, o Ministério da Saúde tem publicado PCDTs (Protocolos Clínicos e Diretrizes Terapêuticas) sobre algumas condições clínicas, e as Sociedades Médicas produzem diretrizes sobre doenças específicas, mas ainda não há manuais organizados de recomendações clínicas. Recomendações com diretrizes clínicas de confiança devem ser a base para melhorar a qualidade e a segurança dos serviços de saúde. Objetivos: Revisão das recomendações da United States Preventive Services Task Force (USPSTF) destinadas ao rastreio das condições clínicas prevalentes da população idosa e comparação com recomendações desenvolvidas as Sociedades Científicas Brasileiras reconhecidas pela Associação Médica Brasileira, para produção de manual de rastreio clínico em idosos assintomáticos. Metodologia: Estudo descritivo, tendo como base principal as recomendações da USPSTF e consensos publicados pelas Sociedades Científicas Brasileiras e de órgãos governamentais do Brasil. As recomendações da USPSTF são divididas de acordo com o sistema GRADE, cujos graus são: A. certeza de benefício substancial; B. certeza de benefício ao menos moderado; C. pelo menos moderada certeza de que o benefício é pequeno; D. grande certeza de que não há benefício; I. evidências são insuficientes para recomendação. Os critérios para escolha dos tópicos foram: constituir condição clínica prevalente no idoso e população assintomática; importância para a saúde pública; potencial de a recomendação afetar a prática clínica; surgimento de novas recomendações que possam alterações das prévias. Resultados: Foram levantados 55 tópicos de acordo com os critérios estabelecidos, sendo excluídos 10 (5 referentes a recomendações de aconselhamento e 5 de uso de medicações), resultando em 45 tópicos finais, com 53 recomendações. O ano de maior número de publicação de recomendações foi 2016 (n=9; 20%), e no período a partir de 2014, foram publicadas 31 recomendações (68,9%). Do total de 53 condições clínicas, o grau de recomendação (GRADE) prevalente foi I (41,5%), e a soma das recomendações A e B foi de 32%. Observa-se que, entre as recomendações mais recentes (2017 e 2018; n=13), 61% são de grau I (n=8). Houve 44 posicionamentos das entidades brasileiras, sendo o Ministério da Saúde a instituição com maior número de recomendações (n=17; 31,8%). Há 11 tópicos sem recomendações nacionais (24,4%). Conclusão: Observa-se que a maioria das recomendações são dos últimos 5 anos e 32% mostram benefício moderado ou substancial (Graus A e B). A maioria das recomendações mais recentes ainda apresentam grau I. Há escassez de recomendações nacionais atualizadas, refletindo necessidade da elaboração de recomendações nacionais. Todas as recomendações devem levar em conta o contexto epidemiológico e individual do paciente idoso. Em idosos saudáveis, a ênfase deve ser na promoção de saúde e em atividades de prevenção de doenças. Por outro lado, idosos mais frágeis requerem avaliação mais ampla e especializada.
Introduction: World elderly population is growing faster than any other age group, requiring specific care conditions. Recommendations of good quality are essential for health professionals in clinical practice, and the use of science-based references is the main goal. The United States Preventive Services Task Force (USPSTF) works since 1984 producing evidence-based recommendations for disease screening, based on GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system to evaluate the strength of evidence. In Brazil, the Ministry of Health has been publishing the Clinical Protocols and Therapeutic Guidelines (PCDT, in Portuguese) about some clinical conditions, and Medical Associations has been working on some guidelines about specific diseases, but the country still lacks organized clinical recommendations. Good quality, evidence-based recommendations must be the base to improve the quality and safety of health systems. Objectives: USPSTF clinical recommendations review of elderly prevalent diseases and comparison with Brazillian recommendations produced by national entities, with the purpose of elaborating a screening manual for asymptomatic elderly. Methodology: The research was a review of USPSTF recommendations and guidelines published by Brazilian Medical Associations and governmental entities. The USPSTF recommendations are classified according to the GRADE system, and the grades are: A. certainty of substantial benefit; B. certainty of benefit at least moderate; C. at least moderate certainty that the net benefit is small; D. high certainty that there is no benefit; I. evidence is insufficient to recommend. The topic selection criteria were the same as USPSTF criteria and new ones defined by the authors: public health importance of the disease; potencial to affect clinical practice; new evidence that has the potential to change the prior recommendation; being a prevalent condition for aged people and the population of interest must be asymptomatic. Results: 55 topics were selected by defined criteria, 10 were excluded (5 refer to counseling recommendations and 5 refer to preventive medication), resulting in 45 final topics, with a total of 53 recommendations. The year of the greatest number of recommendations was 2016 (n=9; 20%), and between the period from 2014 to 2018, there were 31 recommendations (68,9%). From the total of 53 recommendations, the prevalent grade was I (41,5%), and the sum of A and B grades was 32%. There were 44 Brazillian entities positionings, with the Ministry of Health being the institution with the highest number of recommendations (n=17; 31,8%). Between the most recent recommendations (2017 and 2018; n=13), 61% have received an I statement (n=8). There are 11 topics without any national recommendations (24,4%). Conclusion: Most of the recommendations come from the last five years, and 32% of them show moderate to substantial benefit (GRADE A and B). The majority of the recommendations are classified with an I statement. Brazillian updated recommendations are lacking, show the need to elaborate more national recommendations. All recommendations must take into account the epidemiologic context and the individuality of the aged patient. Between healthy elderly, health promotion and preventive activities must be the priorities. On the other hand, frail elderly must be specially and broadly assessed.
Introduction: World elderly population is growing faster than any other age group, requiring specific care conditions. Recommendations of good quality are essential for health professionals in clinical practice, and the use of science-based references is the main goal. The United States Preventive Services Task Force (USPSTF) works since 1984 producing evidence-based recommendations for disease screening, based on GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system to evaluate the strength of evidence. In Brazil, the Ministry of Health has been publishing the Clinical Protocols and Therapeutic Guidelines (PCDT, in Portuguese) about some clinical conditions, and Medical Associations has been working on some guidelines about specific diseases, but the country still lacks organized clinical recommendations. Good quality, evidence-based recommendations must be the base to improve the quality and safety of health systems. Objectives: USPSTF clinical recommendations review of elderly prevalent diseases and comparison with Brazillian recommendations produced by national entities, with the purpose of elaborating a screening manual for asymptomatic elderly. Methodology: The research was a review of USPSTF recommendations and guidelines published by Brazilian Medical Associations and governmental entities. The USPSTF recommendations are classified according to the GRADE system, and the grades are: A. certainty of substantial benefit; B. certainty of benefit at least moderate; C. at least moderate certainty that the net benefit is small; D. high certainty that there is no benefit; I. evidence is insufficient to recommend. The topic selection criteria were the same as USPSTF criteria and new ones defined by the authors: public health importance of the disease; potencial to affect clinical practice; new evidence that has the potential to change the prior recommendation; being a prevalent condition for aged people and the population of interest must be asymptomatic. Results: 55 topics were selected by defined criteria, 10 were excluded (5 refer to counseling recommendations and 5 refer to preventive medication), resulting in 45 final topics, with a total of 53 recommendations. The year of the greatest number of recommendations was 2016 (n=9; 20%), and between the period from 2014 to 2018, there were 31 recommendations (68,9%). From the total of 53 recommendations, the prevalent grade was I (41,5%), and the sum of A and B grades was 32%. There were 44 Brazillian entities positionings, with the Ministry of Health being the institution with the highest number of recommendations (n=17; 31,8%). Between the most recent recommendations (2017 and 2018; n=13), 61% have received an I statement (n=8). There are 11 topics without any national recommendations (24,4%). Conclusion: Most of the recommendations come from the last five years, and 32% of them show moderate to substantial benefit (GRADE A and B). The majority of the recommendations are classified with an I statement. Brazillian updated recommendations are lacking, show the need to elaborate more national recommendations. All recommendations must take into account the epidemiologic context and the individuality of the aged patient. Between healthy elderly, health promotion and preventive activities must be the priorities. On the other hand, frail elderly must be specially and broadly assessed.
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Palavras-chave
Idoso, Prevenção de doenças, Guia de prática clínica, Aged, Disease prevention, Practice Guideline