Evaluation of Arterial Hypertension Care in FourBrazilian Metropoles| Stephy Publishers

 


SOJ Cardiology and Current Trends in Surgery - (SOJCCTS)| Stephy Publishers

Case Report

Hypertension (AH) is one of the most prevalent chronic diseases in Brazil, which, in 2018, affected about 24.5% of the adult population, reaching 59.3% of people aged 65 and over. (Ministry of Health 2020)1 These levels of prevalence and with an increasing trend have a major impact on morbidity and mortality, with high social cost. In this context, the Unified Health System (SUS) has been developing a strategic action plan based on conceptual bases that involve a comprehensive approach to chronic non-communicable diseases, especially AH, at all levels of activity (promotion, prevention and comprehensive care and organization health services for the care of patients with chronic diseases). The guidelines of the Strategic Action Plan recommend that the care offered should use, in addition to pharmacological therapy, educational actions to change lifestyle (encouraging the practice of physical activity, the consumption of healthy foods and the reduction of salt consumption), monitoring the disease by means of routine examinations and searching for damage to a target organ (ECG and Echocardiogram)2 in specific populations. In addition to this set of technically oriented resources and therapeutic measures, another aspect, fundamental to the effectiveness of the comprehensive care offered, is the bond or the ability of the Primary Health Care(PHC) team to be identified by the person living with AH as a regular source of care, as a place that it is possible to maintain the adherence; as well as the ability/qualification of the unit's staff to be recognized as a place for provide information between different services to meet that user's health needs.3,4 Thus, PHC, a gateway, must have the ability to guarantee access to the various points of care, following the rational organization of the system,5 to respond in a timely manner to a user's demand and to carry out a referral for appropriate and necessary care.6 In addition, the idea of access to ECG should include the system's organizational availability,7 or convenience,5 related to the waiting time for consultations or exams.

However, we understand that comprehensive and quality health care depends on the deliberate organization of different health care strategies, especially in PHC, which is considered the preferred gateway for the system, the organizer of the Health Care Network (RAS) and care coordinator. To evaluate AH care it was developed a cross-sectional study applying in a multiple analytical model by triangulating exploring different sources of information. IT was developed a comparative analysis of systemic arterial hypertension care in four Brazilian cities, with more than one million inhabitants. The municipalities of Campinas, Fortaleza, Porto Alegre and São Paulo were selected for their population magnitude and because their importance within the national health system. For the other hand, their heterogeneity composition and organization of health services was a variable to analyze the differences in PHC and in Specialized Care articulation. Secondary data were extracted from the official SUS information systems and the primary data were collected by questioning key informants from each municipality. IT was also applied a questionnaire to patients with AH living in the municipalities, that have been forwarded to the cardiologist by the PHC.

Keywords Hypertension, Echocardiogram, morbidity and mortality, pharmacological therapy, therapeutic measures, Health Care


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