Solicitação de exames diagnósticos no contexto da Atenção Primária à Saúde: uma revisão integrativa
Palavras-chave:
Testes diagnósticos de rotina, Atenção Primária à Saúde, Educação médicaResumo
Objetivou-se verificar os fatores que influenciam a prática médica de solicitação de exames diagnósticos no contexto da Atenção Primária à Saúde. Trata-se de uma pesquisa exploratória nas bases de dados: Medline, SciELO e Lilacs. Realizou-se uma revisão integrativa da literatura publicada até 2011 utilizando os descritores de assunto: “teste diagnóstico de rotina”, “exames diagnósticos”, “exames complementares”, “atenção primária à saúde” e “atenção básica à saúde”. Foram selecionados 35 estudos. Verificou-se que há uma diversidade de fatores que influenciam a solicitação de exames, e que estão relacionados ao paciente, ao ambiente e aos profissionais médicos. Os fatores referentes ao serviço de saúde e à educação médica têm sido os mais contemplados pelos estudos. A prática apropriada de solicitação de exames diagnósticos pode ser favorecida por um ambiente enriquecido dentro das organizações de saúde, e deve ser norteada pela educação reflexiva, voltada para a prática, que pode ser propiciada pela implementação das comunidades de prática.
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Referências
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2. Da Silva DG, Dos Reis LB, Marinho Chrizóstimo M, Carvalho Alves EM. La concepción del enfermero sobre gerenciamiento del costo hospitalario. Enfermería Global. 2010; (19):1-8.
3. Sood R, Sood A, Ghosh AK. Non-evidence-based variables affecting physicians’ test-ordering tendencies: a systematic review. The Netherlands Journal of Medicine. 2007; 65(5):167-77.
4. Capilheira MF, Santos IS. Epidemiologia da solicitação de exame complementar em consultas médicas. Rev. Saúde Pública. 2006; 40(2):289-97.
5. Barba EJR. Utilización inapropiada del laboratorio clínico. Rev. Mex Patol Clin. 2003; 50(4):209-23.
6. Mathias LA, Guaratini AA, Gozzani JL, Rivetti LA. Exames complementares pré-operatórios: análise crítica. Rev. Bras. Anestesiol. 2006; 56(6):658-68.
7. Machado FO, Silva FSP, Argente JS, Mortiz RD. Avaliação da necessidade da solicitação de exames complementares para pacientes internados em unidade de terapia intensiva de hospital universitário. Rev. Bras. Ter. intensiva. 2006; 18(4):385-9.
8. Ney-Oliveira F, Silvany Neto AM, Santos MB, Tavares-Neto J. Relação entre a qualidade do exame clínico e o acerto na requisição da radiografia de tórax. Radiol. Bras. 2005; 38(3):187-93.
9. Freitas MB, Yoshimura EM. Levantamento da distribuição de equipamentos de diagnóstico por imagem e freqüência de exames radiológicos no Estado de São Paulo. Radiol. Bras. 2005; 38(5):347-54.
10. Ferrante JM Balasurbramanian BA, Hudson SV, Crabtree BF. Principles of the patient-centered medical home and preventive services delivery. Ann Fam Med. 2010; 8(2):108-16.
11. Vernon SW, Meissner HI. Evaluating approaches to increase uptake of colorectal cancer screening: lessons learned from pilot studies in diverse primary care settings. Med Care. 2008; 46(9 Suppl 1):S97-102.
12. Verstappen WH, van der Weijden T, Sibrandij J, Hermsen J, Grimshaw J, et al. Effect of a practice-based strategy on test ordering performance of primary care physicians: a randomized trial. JAMA. 2003; 289(18):2407-12.
13. Felsen CB, Piasecki A, Ferrante JM, Ohman-Strickland PA, Crabtree BF. Colorectal cancer screening among primary care patients: does risk affect screening behavior? J Community Health. 2011; 36(4):605-11.
14. Pinto R, Ashworth M, Seed P, Rowlandes G, Schofield P, Jones R. Differences in the primary care management of patients with psychosis from two ethnic groups: a population-based cross-sectional study. Fam Pract. 2010; 27(4):439-46.]
15. Arrington-Sanders R, Ellen J, Trent M. HIV testing in adolescents and young adults receiving STI testing in an urban primary care setting. Sex Transm Dis. 2008; 35(7):686-8.
16. Miglioretti DL, Rutter CM, Bradford SC, Zauber AG, Kessler LG, Feuer EJ, et al. Improvement in the diagnostic evaluation of a positive fecal occult blood test in an integrated health care organization. Med Care. 2008; 46(9 Suppl):S91-6.
17. Roberts L, Roalfe A, Wilson S, Lester H. Physical health care of patients with schizophrenia in primary care: a comparative study. Fam Pract. 2007; 24(1):34-40.
18. Kern LM, Callahan MA, Brillon DJ, Vargas M, Mushlin A. Glucose testing and insufficient follow-up of abnormal results: a cohort study. BMC Health Serv Res. 2006; 6(87).
19. Holmboe ES, Wang Y, Tate JP, Meehan TP. The effects of patient volume on the quality of diabetic care for Medicare beneficiaries. Med Care. 2006; 44(12):1073-7.
20. Rappaport KM, Forrest CB, Holtzman NA. Adoption of liquid-based cervical cancer screening tests by family physicians and gynecologists. Health Serv Res. 2004; 39(4):927-47.
21. Love RR, Baumann LC, Brow RL, Fontana SA, Clark CC, Sanner LA, et al. Cancer prevention services and physician consensus in primary care group practices. Cancer Epidemiol Biomarkers Prev. 2004; 13(6):958-66.
22. Sorum PC, Mullet E, Shim J, Bonnin-Scaon S, Chasseigne G, Cogneau J. Avoidance of anticipated regret: the ordering of prostate-specific antigen tests. Med Decis Making. 2004; 24(2):149-59.
23. Shell R, Tudiver F. Barriers to cancer screening by rural Appalachian primary care providers. J Rural Health. 2004; 20(4):368-73.
24. Engelman KK, Ellerbeck EF, Ahluwalia JS, Nazir N, Velasco A. Fecal occult blood test use by Kansas medicare beneficiaries. Prev Med. 2001; 33(6):622-6.
25. Solberg LI, Kottke TE, Brekke ML. Variation in clinical preventive services. Eff Clin Pract. 2001; 4(3):121-6.
26. Moran WP, Cohen SJ, Preisser JS, Wofford JL, McClatchey MW. Factors influencing use of the prostate-specific antigen screening test in primary care. Am J Manag Care. 2000; 6(3):315-24.
27. Meulepas MA, Braspenning JC, de Grauw WJ, Lucas AE, Harms L, Akkermans RP, et al. Logistic support service improves processes and outcomes of diabetes care in general practice. Fam Pract. 2007; 24(1):20-5.
28. Coleman K, Reiter KL, Fulwiler D. The impact of pay-for-performance on diabetes care in a large network of community health centers. J Health Care Poor Underserved. 2007; 18(4):966-83.
29. Haft HM. The digiscope dilated diabetic eye exam story. Physician Exec. 2006; 32(10:48-50.
30. Din-Dzietham R, Porterfield DS, Cohen SJ, Reaves J, Burrus B, Lamb BM. Quality care improvement program in a community-based participatory research project: example of Project DIRECT. J Natl Med Assoc. 2004; 96(10):1310-21.
31. Wandell PE, Gafvels C. Metabolic control and quality of data in medical records for subjects with type 2 diabetes in Swedish primary care: improvement between 1995 and 2001. Scand J Prim Health Care. 2002; 20(4):230-5.
32. Ruiz-Cantero MT, Ronda E, Alvarez-Dardet C. The importance of study design strategies in gender bias research: the case of respiratory disease management in primary care. J Epidemiol Community Health. 2007; 61(Suppl 2):ii11-16.
33. Tigges S, Roberts DL, Vydareny KH, Schulman DA. Routine chest radiography in a primary care setting. Radiology. 2004; 233(2):575-8.
34. Charles RJ, Cooper GS, Wong RC, Sivak Junior MJ, Chak A. Effectiveness of open-access endoscopy in routine primary-care practice. Gastrointest Endosc. 2003; 57(2):183-6.
35. Stafford RS, Misra B. Variation in routine electrocardiogram use in academic primary care practice. Arch Intern Med. 2001; 161(19):2351-5.
36. Keating NL, Landrum MB, Guadagnoli E, Winer EP, Avanian JZ. Surveillance testing among survivors of early-stage breast cancer. J Clin Oncol. 2007; 25(9):1074-81.
37. Singh D. How can chronic disease management programmes operate across care settings and providers? Birmingham: World Health Organization; 2008.
38. Franks P, Cameron C, Bertakis KD. On being new to an insurance plan: health care use associated with the first years in a health insurance plan. Ann Fam Med. 2003; 3(1):156-61.
39. Singh H, Weingart SN. Diagnostic errors in ambulatory care: dimensions and preventive strategies. Adv Health Sci Educ Theory Pract. 2009; 14(Suppl 1):.57-61.
40. Eagles JM, Howie FL, Cameron IM, Wileman SM,Andrew JE, Robertson C, et al. Use of health care services in seasonal affective disorder. Br J Psychiatry. 2002;180:449-54.
41. Petersons S, Eriksson M, Tibblin G. Practice variation in Swedish primary care. Scand J Prim Health Care. 1997; 15(2):68-75.
42. Tierney WM, Miller ME, McDonald CJ. The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. N Engl J Med. 1990; 322(21):1499-504.
43. González-Urzelai V, Palacio-Elua L, López-de-Munain J. Routine primary care management of acute low back pain: adherence to clinical guidelines. Eur Spine J. 2003; 12(6):589-94.
44. Ladabaum U, Fendrick AM, Gildden D, Scheiman JM. Helicobacter pylori test-and-treat intervention compared to usual care in primary care patients with suspected peptic ulcer disease in the United States. Am J Gastroenterol. 2002; 97(12):3007-14.
45. Verstappen WH, van Merode F, Grimshaw J, Dubois WI, Grol RP, van der Weijden T. Comparing cost effects of two quality strategies to improve test ordering in primary care: a randomized trial. Int J Qual Health Care. 2004; 16(5):391-8.
46. Stafford RS. Feedback intervention to reduce routine electrocardiogram use in primary care. Am Heart J. 2003; 145(6):979-85.
47. Schons CH, Schons C, Ribeiro MS, Lage N, Fialho FAPFP, Abreu AF. Universidade corporativa: teoria e análise documentária. Liinc em Revista. 2008; 4(1):104-19.
48. Ferreira A, Diogo C, Ferreira M, Valente AC. Construção e validação de uma Escala Multi-Factorial de Motivação no Trabalho (Multi-Moti). Comport. Organ. Gest. 2006; 12(2):187-198.
49. Schaeffer EL. Enriquecimento ambiental como estratégia para promover a neurogênese na doença de Alzheimer: possível participação da fosfolipase A2. Rev. Psiq. Clín. 2010; 37(2):73-80.
50. Nithianantharajah J, Hannan AJ. The neurobiology of brain and cognitive reserve: Mental and physical: activity as modulators of brain disorders. Progress in Neurobiology. 2009; 89:369–82.
51. Cruz D. Educação corporativa: a proposta empresarial no discurso e na prática. Educ. rev. 2010; 26(2):317-357.
52. Murphy CJ. Focusing on the essentials: learning for performance. Human Resources for Health. 2008;6:26.
53. Bate SP, Robert G. Knowledge Management and communities of practice in the private sector: lessons for modernising the National Health Service in England and Wales. Public Administration. 2002; 80(4):643-663.
54. Bentley C, Browan GP, Poole B.Conceptual and practical challenges for implementing the communities of practice model on a national scale - a Canadian cancer control initiative. BMC Health Services Research. 2010; 10(3):2010.
55. Thomas AU, Fried GP, Johnson P, Stilwell BJ. Sharing best practices through online communities of practice: a case study. Human Resources for Health. 2010; 8(25).
56. Fung-Kee-Fung M, Goubanova E, Sequeira K, Abdulla A, Cook R, Crossley C, et al. Development of communities of practice to facilitate quality improvement initiatives in surgical oncology. Qual Manag Health Care. 2008; 2(17):174-85.
57. Andrew N, Tolson D, Ferguson D. Building on Wenger: communities of practice in nursing. Nurse Educ Today. 2008; 28(2):246-52.
58. Iedema R, Meyerkort S, White L.Emergent modes of work and communities of practice. Health Serv Manage Res. 2005; 18(1):13-24.
59. Newell S, Edelman L, Scarbrough H, Swan J, Bresnen M. ‘Best practice’ development and transfer in the NHS: the importance of process as well as product knowledge. Health Serv Manage Res. 2003; 16(1):1-12.
60. Parboosingh JT. Physician communities of practice: where learning and practice are inseparable. J Contin Educ Health Prof. 2002; 22(4):230-6, 2002.
2. Da Silva DG, Dos Reis LB, Marinho Chrizóstimo M, Carvalho Alves EM. La concepción del enfermero sobre gerenciamiento del costo hospitalario. Enfermería Global. 2010; (19):1-8.
3. Sood R, Sood A, Ghosh AK. Non-evidence-based variables affecting physicians’ test-ordering tendencies: a systematic review. The Netherlands Journal of Medicine. 2007; 65(5):167-77.
4. Capilheira MF, Santos IS. Epidemiologia da solicitação de exame complementar em consultas médicas. Rev. Saúde Pública. 2006; 40(2):289-97.
5. Barba EJR. Utilización inapropiada del laboratorio clínico. Rev. Mex Patol Clin. 2003; 50(4):209-23.
6. Mathias LA, Guaratini AA, Gozzani JL, Rivetti LA. Exames complementares pré-operatórios: análise crítica. Rev. Bras. Anestesiol. 2006; 56(6):658-68.
7. Machado FO, Silva FSP, Argente JS, Mortiz RD. Avaliação da necessidade da solicitação de exames complementares para pacientes internados em unidade de terapia intensiva de hospital universitário. Rev. Bras. Ter. intensiva. 2006; 18(4):385-9.
8. Ney-Oliveira F, Silvany Neto AM, Santos MB, Tavares-Neto J. Relação entre a qualidade do exame clínico e o acerto na requisição da radiografia de tórax. Radiol. Bras. 2005; 38(3):187-93.
9. Freitas MB, Yoshimura EM. Levantamento da distribuição de equipamentos de diagnóstico por imagem e freqüência de exames radiológicos no Estado de São Paulo. Radiol. Bras. 2005; 38(5):347-54.
10. Ferrante JM Balasurbramanian BA, Hudson SV, Crabtree BF. Principles of the patient-centered medical home and preventive services delivery. Ann Fam Med. 2010; 8(2):108-16.
11. Vernon SW, Meissner HI. Evaluating approaches to increase uptake of colorectal cancer screening: lessons learned from pilot studies in diverse primary care settings. Med Care. 2008; 46(9 Suppl 1):S97-102.
12. Verstappen WH, van der Weijden T, Sibrandij J, Hermsen J, Grimshaw J, et al. Effect of a practice-based strategy on test ordering performance of primary care physicians: a randomized trial. JAMA. 2003; 289(18):2407-12.
13. Felsen CB, Piasecki A, Ferrante JM, Ohman-Strickland PA, Crabtree BF. Colorectal cancer screening among primary care patients: does risk affect screening behavior? J Community Health. 2011; 36(4):605-11.
14. Pinto R, Ashworth M, Seed P, Rowlandes G, Schofield P, Jones R. Differences in the primary care management of patients with psychosis from two ethnic groups: a population-based cross-sectional study. Fam Pract. 2010; 27(4):439-46.]
15. Arrington-Sanders R, Ellen J, Trent M. HIV testing in adolescents and young adults receiving STI testing in an urban primary care setting. Sex Transm Dis. 2008; 35(7):686-8.
16. Miglioretti DL, Rutter CM, Bradford SC, Zauber AG, Kessler LG, Feuer EJ, et al. Improvement in the diagnostic evaluation of a positive fecal occult blood test in an integrated health care organization. Med Care. 2008; 46(9 Suppl):S91-6.
17. Roberts L, Roalfe A, Wilson S, Lester H. Physical health care of patients with schizophrenia in primary care: a comparative study. Fam Pract. 2007; 24(1):34-40.
18. Kern LM, Callahan MA, Brillon DJ, Vargas M, Mushlin A. Glucose testing and insufficient follow-up of abnormal results: a cohort study. BMC Health Serv Res. 2006; 6(87).
19. Holmboe ES, Wang Y, Tate JP, Meehan TP. The effects of patient volume on the quality of diabetic care for Medicare beneficiaries. Med Care. 2006; 44(12):1073-7.
20. Rappaport KM, Forrest CB, Holtzman NA. Adoption of liquid-based cervical cancer screening tests by family physicians and gynecologists. Health Serv Res. 2004; 39(4):927-47.
21. Love RR, Baumann LC, Brow RL, Fontana SA, Clark CC, Sanner LA, et al. Cancer prevention services and physician consensus in primary care group practices. Cancer Epidemiol Biomarkers Prev. 2004; 13(6):958-66.
22. Sorum PC, Mullet E, Shim J, Bonnin-Scaon S, Chasseigne G, Cogneau J. Avoidance of anticipated regret: the ordering of prostate-specific antigen tests. Med Decis Making. 2004; 24(2):149-59.
23. Shell R, Tudiver F. Barriers to cancer screening by rural Appalachian primary care providers. J Rural Health. 2004; 20(4):368-73.
24. Engelman KK, Ellerbeck EF, Ahluwalia JS, Nazir N, Velasco A. Fecal occult blood test use by Kansas medicare beneficiaries. Prev Med. 2001; 33(6):622-6.
25. Solberg LI, Kottke TE, Brekke ML. Variation in clinical preventive services. Eff Clin Pract. 2001; 4(3):121-6.
26. Moran WP, Cohen SJ, Preisser JS, Wofford JL, McClatchey MW. Factors influencing use of the prostate-specific antigen screening test in primary care. Am J Manag Care. 2000; 6(3):315-24.
27. Meulepas MA, Braspenning JC, de Grauw WJ, Lucas AE, Harms L, Akkermans RP, et al. Logistic support service improves processes and outcomes of diabetes care in general practice. Fam Pract. 2007; 24(1):20-5.
28. Coleman K, Reiter KL, Fulwiler D. The impact of pay-for-performance on diabetes care in a large network of community health centers. J Health Care Poor Underserved. 2007; 18(4):966-83.
29. Haft HM. The digiscope dilated diabetic eye exam story. Physician Exec. 2006; 32(10:48-50.
30. Din-Dzietham R, Porterfield DS, Cohen SJ, Reaves J, Burrus B, Lamb BM. Quality care improvement program in a community-based participatory research project: example of Project DIRECT. J Natl Med Assoc. 2004; 96(10):1310-21.
31. Wandell PE, Gafvels C. Metabolic control and quality of data in medical records for subjects with type 2 diabetes in Swedish primary care: improvement between 1995 and 2001. Scand J Prim Health Care. 2002; 20(4):230-5.
32. Ruiz-Cantero MT, Ronda E, Alvarez-Dardet C. The importance of study design strategies in gender bias research: the case of respiratory disease management in primary care. J Epidemiol Community Health. 2007; 61(Suppl 2):ii11-16.
33. Tigges S, Roberts DL, Vydareny KH, Schulman DA. Routine chest radiography in a primary care setting. Radiology. 2004; 233(2):575-8.
34. Charles RJ, Cooper GS, Wong RC, Sivak Junior MJ, Chak A. Effectiveness of open-access endoscopy in routine primary-care practice. Gastrointest Endosc. 2003; 57(2):183-6.
35. Stafford RS, Misra B. Variation in routine electrocardiogram use in academic primary care practice. Arch Intern Med. 2001; 161(19):2351-5.
36. Keating NL, Landrum MB, Guadagnoli E, Winer EP, Avanian JZ. Surveillance testing among survivors of early-stage breast cancer. J Clin Oncol. 2007; 25(9):1074-81.
37. Singh D. How can chronic disease management programmes operate across care settings and providers? Birmingham: World Health Organization; 2008.
38. Franks P, Cameron C, Bertakis KD. On being new to an insurance plan: health care use associated with the first years in a health insurance plan. Ann Fam Med. 2003; 3(1):156-61.
39. Singh H, Weingart SN. Diagnostic errors in ambulatory care: dimensions and preventive strategies. Adv Health Sci Educ Theory Pract. 2009; 14(Suppl 1):.57-61.
40. Eagles JM, Howie FL, Cameron IM, Wileman SM,Andrew JE, Robertson C, et al. Use of health care services in seasonal affective disorder. Br J Psychiatry. 2002;180:449-54.
41. Petersons S, Eriksson M, Tibblin G. Practice variation in Swedish primary care. Scand J Prim Health Care. 1997; 15(2):68-75.
42. Tierney WM, Miller ME, McDonald CJ. The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. N Engl J Med. 1990; 322(21):1499-504.
43. González-Urzelai V, Palacio-Elua L, López-de-Munain J. Routine primary care management of acute low back pain: adherence to clinical guidelines. Eur Spine J. 2003; 12(6):589-94.
44. Ladabaum U, Fendrick AM, Gildden D, Scheiman JM. Helicobacter pylori test-and-treat intervention compared to usual care in primary care patients with suspected peptic ulcer disease in the United States. Am J Gastroenterol. 2002; 97(12):3007-14.
45. Verstappen WH, van Merode F, Grimshaw J, Dubois WI, Grol RP, van der Weijden T. Comparing cost effects of two quality strategies to improve test ordering in primary care: a randomized trial. Int J Qual Health Care. 2004; 16(5):391-8.
46. Stafford RS. Feedback intervention to reduce routine electrocardiogram use in primary care. Am Heart J. 2003; 145(6):979-85.
47. Schons CH, Schons C, Ribeiro MS, Lage N, Fialho FAPFP, Abreu AF. Universidade corporativa: teoria e análise documentária. Liinc em Revista. 2008; 4(1):104-19.
48. Ferreira A, Diogo C, Ferreira M, Valente AC. Construção e validação de uma Escala Multi-Factorial de Motivação no Trabalho (Multi-Moti). Comport. Organ. Gest. 2006; 12(2):187-198.
49. Schaeffer EL. Enriquecimento ambiental como estratégia para promover a neurogênese na doença de Alzheimer: possível participação da fosfolipase A2. Rev. Psiq. Clín. 2010; 37(2):73-80.
50. Nithianantharajah J, Hannan AJ. The neurobiology of brain and cognitive reserve: Mental and physical: activity as modulators of brain disorders. Progress in Neurobiology. 2009; 89:369–82.
51. Cruz D. Educação corporativa: a proposta empresarial no discurso e na prática. Educ. rev. 2010; 26(2):317-357.
52. Murphy CJ. Focusing on the essentials: learning for performance. Human Resources for Health. 2008;6:26.
53. Bate SP, Robert G. Knowledge Management and communities of practice in the private sector: lessons for modernising the National Health Service in England and Wales. Public Administration. 2002; 80(4):643-663.
54. Bentley C, Browan GP, Poole B.Conceptual and practical challenges for implementing the communities of practice model on a national scale - a Canadian cancer control initiative. BMC Health Services Research. 2010; 10(3):2010.
55. Thomas AU, Fried GP, Johnson P, Stilwell BJ. Sharing best practices through online communities of practice: a case study. Human Resources for Health. 2010; 8(25).
56. Fung-Kee-Fung M, Goubanova E, Sequeira K, Abdulla A, Cook R, Crossley C, et al. Development of communities of practice to facilitate quality improvement initiatives in surgical oncology. Qual Manag Health Care. 2008; 2(17):174-85.
57. Andrew N, Tolson D, Ferguson D. Building on Wenger: communities of practice in nursing. Nurse Educ Today. 2008; 28(2):246-52.
58. Iedema R, Meyerkort S, White L.Emergent modes of work and communities of practice. Health Serv Manage Res. 2005; 18(1):13-24.
59. Newell S, Edelman L, Scarbrough H, Swan J, Bresnen M. ‘Best practice’ development and transfer in the NHS: the importance of process as well as product knowledge. Health Serv Manage Res. 2003; 16(1):1-12.
60. Parboosingh JT. Physician communities of practice: where learning and practice are inseparable. J Contin Educ Health Prof. 2002; 22(4):230-6, 2002.
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Publicado
20-05-2020
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Maria Vitrícia de Souza, A. ., Talma Ramenta Gonçalves Barbosa, F. ., Felício Rodrigues Neto, J. ., Mendes Araújo, L., Paulo Souza e Souza, L. ., Tavares Leite, M. ., Fernanda Santos Figueiredo Brito, M., Brito Messias, R. ., & Carvalho Reis, T. (2020). Solicitação de exames diagnósticos no contexto da Atenção Primária à Saúde: uma revisão integrativa. Revista Renome, 3(2), 120–143. Recuperado de https://www.periodicos.unimontes.br/index.php/renome/article/view/2516
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