![](data:image/png;base64,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Pensar Enfermagem / v.27 n.01 / outubro 2023 | 111
DOI: 10.56732/pensarenf.v27i1.299
Questão Clínica: Qual a utilidade das chamadas
telefónicas para apoiar os cuidadores informais?
1
Objetivos
Avaliar a eficácia das intervenções de apoio telefónico,
realizadas por profissionais de saúde, quando comparadas
com cuidados habituais ou intervenções sem utilização de
telefone, na prestação de apoio educacional e psicossocial a
cuidadores informais (CI) de pessoas com doenças agudas
e crónicas, em termos da qualidade de vida (QV) e da
sobrecarga dos cuidadores. Secundariamente, avaliar o
custo efetividade das intervenções telefónicas.
Tipo e descrição do Estudo
Foi realizada uma revisão sistemática da literatura (RS) de
ensaios clínicos controlados e aleatorizados (RCTs),
incluindo aleatorização por clusters. Como resultados
principais consideraram-se a QV e a sobrecarga dos
cuidadores, e como secundários os indicadores económicos
da intervenção, bem como a aquisição de competências de
cuidar, a saúde psicológica, o conhecimento, a saúde e bem-
estar, a função familiar, e a satisfação dos cuidadores.
Foram considerados apenas os estudos relativos a
intervenções (individuais ou em grupo) em que a primeira
sessão possa ter sido presencial ou telefónica, mas em que
todas as restantes foram realizadas via telefone, comparado
com cuidados habituais. Excluíram-se estudos com
telechamada online com imagem. Os intervenientes tinham
de ser profissionais de saúde credenciados e os destinatários
CI adultos, independentemente da relação com o doente
(doença aguda ou crónica).
Foram pesquisadas as bases de dados de Ensaios Clínicos
da Cochrane Library (CENTRAL), MEDLINE, Embase,
PsycINFO, ProQuest, e a CINAHL complete, bem como
11 websites específicos de CI, três conferências
internacionais, e dois registos internacionais de ensaios
clínicos.
Resultados
Foram incluídos 21 RCTs, envolvendo 1.690 CI, com
intervenções providenciadas principalmente por assistentes
sociais (n=5), enfermeiros (n=4), psicólogos (n=4), ou
equipas multiprofissionais com enfermeiros, assistentes
sociais e outros (n=3).
Verificou-se que as intervenções de apoio telefónico
(n=19) possuem baixa ou nenhuma probabilidade de ter
efeito na QV do CI (certeza da evidência moderada), bem
como pouco efeito na sobrecarga dos mesmos (certeza de
evidência baixa) em comparação com os cuidados
habituais, imediatamente após a conclusão da intervenção.
Em termos de outcomes secundários, constatou-se que a
ansiedade possa ser ligeiramente reduzida e a preparação
para cuidar ligeiramente melhorada após a intervenção, mas
não existindo certeza sobre os efeitos na depressão. Em
geral, verificou-se pouco ou nenhum efeito nos resultados
definidos nesta revisão.
Dois estudos compararam intervenções de apoio por
telefone versus por outro meio à distância, existindo pouca
ou nenhuma evidência de efeito superior ao apoio por via
não telefónica.
Conclusões
As intervenções de apoio por telefone a CI, por parte de
profissionais de saúde poderão ter ligeiro benefício na
redução da ansiedade e melhoria da preparação para cuidar,
no final da intervenção, quando comparadas com os
cuidados habituais. Contudo, para a maioria dos resultados,
incluindo a QV e a sobrecarga do cuidador, as intervenções
por telefone aparentam ter pouco ou nenhum efeito. No
entanto, deve-se ter em consideração que os resultados da
revisão foram baseados principalmente em estudos com
alto risco de viés e com poucos participantes.
Comentário
Esta revisão Cochrane
1
foi realizada no período pré-
pandemia COVID-19, que como se sabe, aumentou
exponencialmente o desenvolvimento de tecnologias
telemáticas para a realização de consultas em saúde à
distância.
2
A telesaúde é, hoje em dia e no geral, bem-
recebida pelos utentes, ainda que permaneça mais acessível
a alguns grupos do que a outros, sendo a qualidade do
atendimento equivalente ao presencial para determinadas
doenças agudas e crónicas.
2
Em 2022, foi publicada uma
RS que avaliou a eficácia das intervenções de telesaúde,
com foco nas pessoas com doenças reumáticas e
musculoesqueléticas
3
para servir de base à elaboração de
recomendações europeias neste âmbito.
4
Um dos
princípios gerais destas recomendações salientam que as
intervenções de telesaúde devem ser desenvolvidas em
colaboração com todos os parceiros, incluindo os
profissionais de saúde, os CI e as pessoas com doença.
4
Durante a pandemia COVID-19 forma muitos os
enfermeiros que recorreram à consulta telefónica ou a
outros meios digitais (telenfermagem) para mitigar o
impacto na saúde das populações. Estes profissionais
viram-se confrontados com falta de condições e
orientações apropriadas para levar a cabo esta tarefa com a
qualidade e segurança necessárias. Como tal, a Secção
Regional do Centro da Ordem dos Enfermeiros definiu um
grupo de trabalho com o objetivo de definir
recomendações para promover o desenvolvimento e
uniformização da prestação de cuidados de telenfermagem
em Portugal.
5
Denotam-se como principais preocupações
o garante da segurança, qualidade, individualidade dos
cuidados, o que requer a adequabilidade de meios humanos,
técnicos e formativos/organizativos. Na recomendação 5
refere-se que “o enfermeiro e o utente, num processo de
decisão partilhada, devem decidir quais as ferramentas mais
adequadas, entre as existentes, a utilizar em