Dialogue between primary and secondary health care providers in a Brazilian hypertensive population

Abstract

OBJECTIVE: To describe clinical and epidemiological profiles of patients with hypertension referred to a secondary care unit and to assess the adequacy of the referral criteria.METHOD: This descriptive transversal study analysed 943 hypertensive patients referred to a secondary healthcare unit from September 2010 to August 2012. Clinical and sociodemographic data as well as data regarding the liaison between secondary and primary care services were collected. RESULTS: Patients' mean age was 59±13.1 years, and 61.3% were female. Sedentary lifestyle, alcohol consumption, and smoking were observed in 80.3%, 31.1%, and 18.1% of the patients, respectively. Uncontrolled blood pressure was observed in 72.5% of the sample, and 80.1% of individuals were overweight or obese. There was a high prevalence of dyslipidaemia (73.1%), cardiovascular disease (97.5%), and reduced glomerular filtration rate (49.9%). Thirty-eight percent of patients did not meet the referral criteria, of whom approximately 25% were not hypertensive. CONCLUSION: Even in a universal-access healthcare system, poor control of hypertension and high prevalence of obesity and cardiovascular diseases were observed. Inadequate referrals and the presence of clinical complications suggest low efficiency of the assistance provided in primary care and reinforce the need for sharing care with the secondary level.

Predição epidemiológica dos usuários do programa HIPERDIA em relação às doenças cardiovasculares em um município Amazônida / Epidemiological prediction of HIPERDIA program in relation to cardiovascular disease, in an Amazonic city

“…A idade acima de 60 anos já se constitui um fator de risco para o desenvolvimento de complicações relativas à HA, o que torna os idosos pertencentes aos grupos de risco médio ou alto na estratificação do risco cardiovascular (14,16) . Características semelhantes foram encontradas em um estudo com pacientes hipertensos com história familiar de infarto, o risco cardiovascular para essa população foi considerado baixo em 11 casos (22%), sendo estimado como alto em 11 (22%) com hipertensão arterial com idade entre 20 a 79 anos (17) .…”

“…Na busca pela literatura notou-se que quanto a taxa de prevalência de pessoas portadores de DCNT é inversamente proporcional à taxa de alfabetização, configurando adversidade no acesso à informação. Logo, por apresentar dificuldades para leitura, escrita, a interpretação e a busca de informação para condição patológica que possui, tal como tratamento adequado ficam prejudicados (10,11,16) .…”

Non‐systematic review: Correspondence quality and interoperability between family physicians and hospital clinicians

“…57 Furthermore, if any action from a GP is needed, a clear section with that purpose is needed. 51 In the same way, hospital practitioners need adequate informative referral letters 30,69,70 with a clear reason for the referral. 37,43,44,[46][47][48][49][50][51] Adequate processes to prevent discontinuity of medication management in particular are needed.…”

“…The advent of electronic communications allowed more legible information, faster transfer and provision of an audit trail; it should have facilitated better care and quality improvement, but it was not necessarily the case. One of the reasons is the lack of training on written communications between professional colleagues 31 ; in this regard, it is of note that 20% of medical students considered that discharge summaries did not affect the care provided by a general practitioner 31 . Other factors are that current IT systems do not integrate well 32 and that coordination between primary and secondary care is poor, 33 perhaps, even more, when community services are considered 34,35 leaving the patient at the end with the responsibility for their own treatment 36…”

Primary health and emergency care network: interfaces in health regions in Brazil and Canada

“…Many factors can contribute to this situation. Vanelli et al (2018) suggest that compliance to clinical guidelines has not received adequate attention in the implementation of health care networks (Vanelli et al 2018). On the other hand, 43% of primary care physicians fail to follow clinical guidelines and/or use referral criteria to refer patients with chronic kidney disease to the secondary care level (Paula et al 2016).…”