Avaliação da atenção às condições crônicas na estratégia saúde da família de Sobral-CE: Hipertensão arterial sistêmica e diabetes mellitus como marcadores

Abstract

The current scenario of demographic and epidemiological transition experienced by Brazil is characterized by the predominance of chronic conditions, among them hypertension and diabetes that present high morbidity and mortality and represent a challenge for public health. In this context, the Family Health Strategy plays a fundamental role in the management and coordination of care for chronic conditions in health care networks. Thus, the objective was to evaluate the attention to the chronic conditions in the Family Health Strategy of the municipality of Sobral – CE, having systemic arterial hypertension and diabetes as markers. It is an evaluative study under quantitative and qualitative approaches. It was used the adaptation of a matrix of effectiveness evaluation of interventions to control and prevent Chronic Non-Communicable Diseases used in Latin America and proposed by De Salazar, where the following dimensions were investigated: Systematization of the Experience of attention to chronic conditions, Context Analysis , Structure Analysis and Process Analysis. The field of investigation was the municipality of Sobral whose locus for the development was represented by the territories of the headquarters of the municipality. Participants in the study were people with Hypertension and Diabetes assisted by the Family Health Strategy, health professionals and health managers. For the development of this research was used the triangulation of different sources of information and methods of data collection and analysis. Thus, for data collection, semi-structured interviews were conducted with managers, validated questionnaires were applied with health professionals and users with hypertension and diabetes, and consultations were done with documentary sources. In order to analyze the qualitative data, a content analysis was performed was the support of the software N Vivo11 and for the analysis of the quantitative data will be used statistical descriptive techniques, mapping and spatial analysis with the support of the software IBM SPSS Statistics 20, Quantum GIS 2.18.10 and TerraView 5.2.3. The study respected the ethical principles regarding research involving human beings in accordance with Resolution 466/2012 of the National Health Council and received a favorable opinion from the Research Ethics Committee of Vale do Acaraú State University, under the number of the Opinion: 2,054,329. From then on, an interest and investment of attention management is revealed in the implementation of a care model that fully meets the chronic conditions, through the development of strategies of organization and management of care, such as the institution of protocols, Risk Stratification, Development of Permanent Education processes and successful experiences of collective approaches. However, despite the efforts, the practice still reveals an approach to users centered on the renewal of revenues and the impediment in regulation and consequent difficulty in conformation of a network of attention to chronic conditions. The context of attention shows high prevalence rates and spatial dependencies between hypertension and diabetes. Regarding the structure, there is a reasonable capacity for attention to chronic conditions. In relation to the process, the user is not satisfied with attention, in front of this, it emphasizes the need of the modification of a prescriptive and disease-centered attention to the collaborative and with focus on the person. In which care is performed based on the cooperative mode, according to the needs of the users, with the sharing of responsibilities, support for autonomy and shared decision. Thus, attention to chronic conditions presents significant limitations, however, the local health system has been developing strategies to qualify care that may imply positive results in the medium and long term.