Evaluation of nutritional care of overweight adults from the perspective of comprehensive health care

Abstract

Objective: Describe and evaluate the nutritional care provided for overweight adults by the Primary and Secondary Health Care services of Santos, São Paulo, Brazil. Methods: This study was carried out between 2013 and 2015 integrating quantitative and qualitative approaches; it was divided into two phases: (1) characterization and (2) evaluation. In phase 1, a census of Primary Health Care Units (n=28) and Secondary Health Care Units (n=4) was conducted using interviews with health service managers and/or health professionals. Data were analyzed using exploratory data analysis. In phase 2, in-depth interviews were conducted with health service managers and/or health professionals investigating a sample of the Primary Health Care services and the totality of Secondary Health Care services provided. Thematic analysis was carried out using the theoretical framework for comprehensive health care proposed by Pinheiro & Mattos. Results: A total of 40 professionals were interviewed: 36 in the primary health care services and 4 in the secondary health care services. Nutritional care in the Primary Care services is focused on individual care and referrals to other services; nutrition diagnosis and health promotion occur only when overweight is associated with another disease. It was observed that the referral and counter-referral system and intersectorial collaborations were ineffective. In Secondary Care services, nutritional care is focused on clinical care using traditional approaches to nutrition education. Limiting factors for promoting comprehensive care were identified at the two levels of care: unproductive actions, lack of actions for health promotion and protection, and little dialogue between the Primary and Secondary care services. Conclusion: Overweight is not an outcome based on Primary and Secondary Care, but rather on prescriptive practices, which are not very effective in promoting users’ autonomy. It is necessary to guide the actions taken in these two levels of care to ensure the promotion of effective nutritional care.

Determinants of food and nutrition actions in primary healthcare clinics in the State of São Paulo, Brazil

“…There was no difference in the supply of FNA when there were one or more guidance documents (Food Guide for Brazilian Population, and other technical manuals) in the PHC. A similar finding was presented by Neves, Zangirolani and Medeiros, who showed that the use of technical manuals in PHC in a municipality of São Paulo state was unimportant 31 . The professionals interviewed by these authors emphasized the need for an adequate work space to carry out group activities and to favor multi-professional practice.…”

“…The professionals interviewed by these authors emphasized the need for an adequate work space to carry out group activities and to favor multi-professional practice. However, the current study found no influence of the PHC´s infrastructure, such as waiting room, yard, patio and/or attendance room in the provision of FNA 31 .…”

“…In a study carried out in Brazil between 2013 and 2015 it was found that actions related to food and nutrition in the Health Unit System focused on individual clinical care of the patient and was often performed by a nutritionist 31 . However, the integration of the nutritionist in PHC is not enough to satisfy demand 34,35 .…”

“…One of the ways to alleviate the low number of nutritionists in PHC is to intensify multi-professional practice in FNA. This requires adequate training in food and nutrition for all health system professionals and greater intersectoral dialogue 31 .…”

Nutricionistas Na Atenção Primária No Município De Santos: Atuação E Gestão Da Atenção Nutricional

“…Os processos de trabalho e as possibilidades de atuação interdisciplinar para o cuidado integral nas diferentes fases da vida, além da articulação de redes, constituem os aspectos mais frágeis e que necessitam ser enfrentados pela equipe de saúde para atender aos preceitos de integralidade na atenção à saúde no Brasil. 2,4,10,11 O nutricionista, inserido na equipe multiprofissional na Atenção Primária à Saúde, possui competências e atribuições para atuar em diferentes frentes de ação, de caráter universal e específico. 7,12 A formação deste profissional é a base para o direcionamento e o desempenho profissional na área de Saúde Coletiva.…”