Análise da implementação de um instrumento de estratificação de risco para hipertensão e diabetes na estratégia saúde da família de sobral-ce

Abstract

Primary Health Care (PHC) has been configured as a fundamental strategy for the context of chronic non-communicable diseases (CNCD) and, in this way, the municipality of Sobral implemented in 2015 the Sobralense Protocol for Screening, Diagnosis and Treatm ent of Hypertension Arterial (HAS) and Diabetes Mellitus (DM) with the objective of consolidating the monitoring and follow-up actions of SAH and DM. The objective of the research was to analyze the completion of the "Instrument for risk stratification of hypertension and diabetes mellitus" by professionals of the Family Health Strategy of the municipality of Sobral-CE. This is a descriptive, cross-sectional and documentary study, with a quantitative approach, carried out at the 35 Family Health Centers (FHC) at Sobral headquarters and districts. A total of 139 nurses and physicians were responsible for completing the Risk Stratification Instrument (RSI) of SAH and DM, and the sample consisted of 82 professionals. Data collection was done through a semi-structured questionnaire and for analysis we used descriptive statistics, where the categorical data were presented by absolute numbers and respective percentages. The ethical principles were respected by Resolution 466/12 of December 2012 of the National Health Council that dispose on the Guidelines and Norms Regulating of research involving human beings and the participation of the subjects was confirmed through the Term of Free and Informed Consent. We identified in the results that 66% of the sample was made up of female professionals, with ages ranging from 30 to 40 years, most of them nurses with more than 10 years of training and experience in Primary Care and postgraduate in health family. About 66% of the professionals were trained to answer the questionnaire, of which 55% found the instrument easy to understand, but partially feasible. Regarding the difficulties pointed out, 79% reported the lack of data in the medical record and 88% lack of tests necessary for the identification of risk factors and for the identification of lesion in target organ. We saw that 87% of the professionals did not calculate the Glomerular Filtration Rate, 61% of which were nurses. We observed that 54% reported that they had identified patients with renal risk and that 81% referred directly to the specialist. Regarding the identification of prevention and early identification actions for chronic renal disease (CRD), 76% used health education groups as a space for the exchange of knowledge. About perception of changes after RSI implantation, 61% of professionals said they did not notice any changes in their CSF and only 34% realized significant changes. We conclude that the professionals have a fundamental role in the individual and collective actions of control of HAS and DM, su ch as health education actions, early diagnosis and therapeutic management. We show many difficulties pointed out by the professionals in the RSI fulfillment, so we perceive the transformative potential that the RSI can have in reducing the complications and in reducing the impact that the HAS and DM cause for the indicators of the municipality.