Atenção integral à hipertensão arterial e diabetes mellitus: implementação da Linha de Cuidado em uma Região de Saúde do estado de São Paulo, Brasil

Abstract

Resumo: Objetivou-se avaliar a implementação da Linha de Cuidado (LC) em hipertensão arterial e diabetes mellitus em uma Região de Saúde do estado de São Paulo. Trata-se de uma pesquisa avaliativa desenvolvida em três etapas: caracterização das regiões para seleção da região-caso; entrevistas com gestores e profissionais de saúde que atuam na Atenção Básica, Média e Alta Complexidade e entrevistas com pacientes em Ambulatórios Médicos de Especialidades. A análise baseou-se em um modelo lógico que considera a influência da macro e micropolítica na construção da LC. De modo geral, insuficiências foram identificadas nas dimensões da macropolítica (organização da rede de serviços e utilização de protocolos) e micropolítica (coordenação do cuidado pela AB, vinculação e responsabilização do cuidador). Conclui-se que, apesar dos avanços alcançados, grandes desafios se impõem para o alcance da integralidade da atenção à hipertensão arterial e diabetes mellitus, sendo necessários investimentos nos processos da macro e micropolítica. Palavras-chave: hipertensão; diabetes mellitus; atenção integral à saúde; atenção primária à saúde; serviços de saúde.

Profile and performance of nutritionists in Primary Health Care

“…The proper use of these materials enables the correct diagnosis of the nutritional status and the identification of associated risks [25]. Problems related to the use of technical documents in the PHC framework were similarly pointed out in previous studies addressing their use by health professionals in different scenarios and objectives [25][26][27][28]. The adequate use of these technologies is fundamental to the standardization and systematization of care, enabling a multidisciplinary, comprehensive, more qualified and effective care [25][26][27].…”

Profile of nursing diagnoses in people with hypertension and diabetes

“…In type 2 diabetics, about 40% have already been hypertensive at the time of diagnosis. (1,5,6) However, despite the respective periods with the diseases, a considerable number of participants presented deficient knowledge about the meaning of the diseases, their complications, prognosis and treatment, mainly related to the use of insulin. The lack of information becomes an obstacle to user empowerment and to adherence to treatment.…”

“…Data from the literature show that long-term or chronic treatments generally have less adherence, since therapeutic regimens require discipline and a great commitment of the client who, at times, needs to modify their habits of life to fulfill their treatment. (1,5) For this reason, hypertensive and diabetic patients must have adequate answers to their doubts regarding the management of chronic diseases, such as care related to specific use of medications, the search for adequate diet, physical activity, among others. This will provide greater credibility around health professionals and therefore provide customers with real and individualized parameters for their self-care.…”

“…(1) Global data indicate that, in 2015, 415 million people between 20 and 79 years of age were living with DM and it is estimated that in 2040 there will be 642 million people with this disease, increasing by 65% in Central and South America. (2) Epidemiological studies indicate that diabetes and hypertension are commonly associated conditions.…”

“…(6,7) Therefore, it is essential that professionals maintain the provision of a comprehensive, effective and quality care. (1,3,4) In diagnóstica se realizó de acuerdo con la Taxonomía II de la NANDA-I. Resultados.…”