Qualidade e segurança do paciente na perspectiva dos usuários da atenção primaria à saúde: construção e validação de instrumento e material audiovisual

Abstract

Introduction: Patient safety can be conceptualized as reducing the risk of unnecessary harm associated with health care to an acceptable minimum, and it is an essential element in the quality of health care, as it comprises actions that aim to manage and prevent risks to which patients, in different health scenarios, are exposed. Patient safety in primary health care settings has not been explored to the same depth as that of hospital settings, however, incidents also occur in this setting. It is important to understand the magnitude and nature of damage in the context of Primary Health Care (PHC), as a significant proportion of health care is provided in this environment. Objectives: To analyze factors related to patient safety incidents in Primary Health Care from the perspective of users. The specific objectives are: to validate an instrument to survey experiences among PHC users, regarding the occurrence of incidents within the scope of patient safety dimensions; prepare an instructional manual for the application of the instrument and map factors that can contribute to the occurrence of incidents involving professionals and users in Primary Health Care. Method: This is an exploratory, applied research, with a mixed approach, structured in two sequential exploratory stages: the first, qualitative, with the search for data to explore the phenomenon of patient safety in Primary Health Care, generating the categorization of constructs. From the exploratory results, the second phase, quantitative, was conducted to test or generalize the initial findings. At the interface between these two stages, it was built a data collection instrument. In the instrument development process, there was content validation with 10 (ten) expert judges and, after semantic validation, with 9 (nine) users of Primary Health Care. Data collection was directed to a representative portion of Primary Health Care users in the East Health Region of the Federal District, whose sample totaled 907 (nine hundred and seven) respondents, in person at two Basic Health Units. Exploratory factor analysis validated 26 items to compose the final version of the instrument. Results: 1) Construction and validation of the Quality and Patient Safety instrument from the perspective of Primary Health Care users; 2) Elaboration of the Instructional Manual for the application of the instrument; 3) Definition of construct categories for patient safety in Primary Health Care. Products developed: Article “Quality and Patient Safety in Primary Health Care: construction and validation of an instrument”, submitted to the Revista Brasileira de Enfermagem (REBEN), and Instructional Manual for implementing the instrument Quality and patient safety from the perspective of Primary Health Care users. Conclusions: The contributions of this study are linked to the knowledge of the vulnerabilities of Primary Health Care, in the occurrence of incidents in patient safety, knowledge that is scarce in the current literature, to guarantee the direction of preventive and/or corrective actions necessary for health care services and optimization of processes, with the aim of allowing better provision of health care to users, rationalizing human and material resources at institutions, which results in quality in the health care provided, in addition to promoting the issue of patient safety in this nascent scenario.