Estrategia saúde da familia: efetividade das ações de controle da hipertensão arterial
Arquivos
Data
2011
Autores
Moraes, Marilucia Mota 
Orientadores
Barbosa, Dulce Aparecida
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A Hipertensão Arterial Sistêmica e um importante problema de Saúde Pública, por atingir um grande número de pessoas, podendo resultar em graves complicações, se não tratada e controlada, necessitando de cuidados profissionais em todos os níveis de atenção a Saúde. A Estratégia Saúde da Família representa um dos principais modelos de atenção à Saúde, sendo fundamental para a detecção precoce da hipertensão. Avaliar o desempenho dos serviços e hoje uma importante necessidade para se aprimorar a qualidade dessa atenção. Objetivo: analisar a efetividade das ações da estratégia Saúde da família no controle da hipertensão arterial Material e método: foram comparadas as fichas do HIPERDIA 2001 com as fichas do recadastramento em 2009, em uma unidade de Saúde da família em Maceió. Foram incluídos: hipertensos com as fichas do HIPERDIA 2001/2009. Para o preenchimento e a realização das medidas foram utilizados os parâmetros do HIPERDIA, a PA foi verificada pelo método indireto. A variável primaria foi a efetividade das ações de controle da hipertensão arterial. As variáveis sociodemograficas e clinicas foram descritas por meio de suas distribuições de frequências (n e %) para os dois períodos do estudo, 2001 e 2009. A comparação entre os níveis pressóricos de 2001 e 2009 foi feita pelo teste qui-quadrado, e a verificação de mudança de situação de pressão entre 2001 e 2009 pelo teste de McNemar e para se verificar a associação utilizou-se do teste qui-quadrado de Pearson ou teste exato de Fisher. O Nível de significância foi de 0,05. O pacote estatístico foi o SPSS, versão 14.0. Os pacientes hipertensos estudados eram 72,0% do sexo feminino, mais de 60,0% tinham mais de 60 anos, mais de 90% com pouca ou nenhuma escolaridade e 70% não utilizavam fumo e derivados, tanto para 2001 quanto para 2009. Com relação ao risco cardiovascular: mais de 60% dos pacientes apresentavam risco alto ou muito alto, tanto em 2001 quanto em 2009. Os principais fatores de risco encontrados: sobrepeso/obesidade e sedentarismo. Conclusão: A efetividade foi alcançada. Os pacientes apresentaram 25,2% de pressão arterial controlada em 2001 e este controle foi ampliado para 29,0%, em 2009. Em relação aos riscos, os pacientes apresentaram as seguintes classificações: em 2001, risco baixo representava 12,1%, risco médio 29,9%, risco alto 2,1% e risco muito alto 45,8%; já em 2009, os mesmos pacientes encontravam-se: sem risco adicional 2,8%, risco baixo 13,1%, risco médio 16,8%, risco alto 13,1%, risco muito alto 54,25%. Quando se comparou os riscos: 45 pacientes com risco baixo ou médio em 2001, 16 (dezesseis) pacientes continuaram com o mesmo risco, no entanto 29 (vinte e nove) evoluíram para o risco alto ou muito alto, enquanto que dos 62 (sessenta e dois) pacientes que em 2001 apresentavam risco alto ou muito alto, 43 permaneceram com este mesmo risco, enquanto que 19 (dezenove) apresentaram risco baixo ou médio em 2009 (p=0,193). Verificou-se que 34 pacientes tiveram suas condições modificadas (p= 0,608). O Diabetes mellitus do tipo 2 (p=0,003) e a situação familiar (p=0,017) estiveram associadas a mudança da pressão arterial. O sedentarismo e a história de AVC apresentaram-se estatisticamente associadas a hipertensão (p=0,05) pelo teste de Fisher.
Introduction: Systemic Arterial Hypertension is a crucial public health predicament due to its aptitude to affect an excessive number of individuals, and furthermore, in view of the fact that without the necessary treatment and control, it commonly results in acute complications, making it necessary to reach to the support of all levels of healthcare professionals. Family Health Strategy is one of the main healthcare models and it is fundamental to an early recognition of hypertension. Evaluating the performance of healthcare assistance is currently a vital inevitability to enhance its quality. Objective: to analyze the effectiveness of family health strategy actions to control arterial hypertension. Methods and materials: throughout the study, the results of HIPERDIA 2001 were compared to the registration renewal that was undertaken in 2009, in a family health unity in Maceió. This research comprised hypertensive individuals registered in the HIPERDIA 2001/2009. HIPERDIA parameters were enforced in order to quantify and compute the data, and the measurement of the arterial blood pressure was taken through the indirect method. The primary variable was the effectiveness of arterial hypertension control actions. The socio-demographic and clinical variables were described by means of its frequency distributions (n and %) for the 2001 and 2009 study stages. The comparison among the 2001 and 2009 pressure levels were given by the chi-square test, the verification of the 2001 and 2009 pressure change situation was given by the McNemar test, and, finally, so as to substantiate the association, the Pearson's chi-square (χ2) test or the Fisher’s exact test were exploited. The significance level was 0.05. The Statistical Package was the SPSS (Statistical Package for the Social Sciences), version 14.0. The hypertensive patients studied in the assessments (both 2001 and 2009) were: 72% female, more than 60% over 60 years of age, more than 90% with insufficient or none schooling, and 70% were not addicted to Nicotine or its Derivatives. In addition, data revealed that (both in the 2001 and in the 2009 inquiry), more than 60% of patients presented a high or very high risk for cardiovascular diseases. Thus, the main risk factors found were overweight/obesity and sedentary behavior. Conclusion: effectiveness was attained. Patients presented 25.2% of controlled arterial pressure in 2001, and in 2009 this index was augmented to 29.0%. In relation to risks, patients presented the following classifications: in 2001, low risk was estimated in 12.1%, medium risk was 29.9%, high risk was 2.1%, and very high risk was 45.8%; however, in 2009 the same patients displayed very significant variations: non addition risk was 2.8%, low risk as 13.1%, medium risk was 16.8%, high risk was 13.1%, and very high risk was 54.25%. When both measurements were paralleled, results made known that: of the 45 patients with low or medium risk in 2001, in 2009 16 patients remained with the same risk level, though 29 progressed to high or very high; of the 62 patients that were classified among high or very high risk for cardiovascular diseases, 43 remained with the same index, while 19 shown low or medium risk in 2009 (p=0.193). It was also scrutinized that 34 patients had their conditions modified throughout the years (p=0.608). Type 2 Diabetes Mellitus (p=0.003) and family situation (p=0.017) were directly associated to the alteration in arterial pressure. Sedentary behavior and Cerebral Vascular Accident (CVA) depicted themselves statistically associated to hypertension (p=0.05) as a result of the Fisher’s test.
Introduction: Systemic Arterial Hypertension is a crucial public health predicament due to its aptitude to affect an excessive number of individuals, and furthermore, in view of the fact that without the necessary treatment and control, it commonly results in acute complications, making it necessary to reach to the support of all levels of healthcare professionals. Family Health Strategy is one of the main healthcare models and it is fundamental to an early recognition of hypertension. Evaluating the performance of healthcare assistance is currently a vital inevitability to enhance its quality. Objective: to analyze the effectiveness of family health strategy actions to control arterial hypertension. Methods and materials: throughout the study, the results of HIPERDIA 2001 were compared to the registration renewal that was undertaken in 2009, in a family health unity in Maceió. This research comprised hypertensive individuals registered in the HIPERDIA 2001/2009. HIPERDIA parameters were enforced in order to quantify and compute the data, and the measurement of the arterial blood pressure was taken through the indirect method. The primary variable was the effectiveness of arterial hypertension control actions. The socio-demographic and clinical variables were described by means of its frequency distributions (n and %) for the 2001 and 2009 study stages. The comparison among the 2001 and 2009 pressure levels were given by the chi-square test, the verification of the 2001 and 2009 pressure change situation was given by the McNemar test, and, finally, so as to substantiate the association, the Pearson's chi-square (χ2) test or the Fisher’s exact test were exploited. The significance level was 0.05. The Statistical Package was the SPSS (Statistical Package for the Social Sciences), version 14.0. The hypertensive patients studied in the assessments (both 2001 and 2009) were: 72% female, more than 60% over 60 years of age, more than 90% with insufficient or none schooling, and 70% were not addicted to Nicotine or its Derivatives. In addition, data revealed that (both in the 2001 and in the 2009 inquiry), more than 60% of patients presented a high or very high risk for cardiovascular diseases. Thus, the main risk factors found were overweight/obesity and sedentary behavior. Conclusion: effectiveness was attained. Patients presented 25.2% of controlled arterial pressure in 2001, and in 2009 this index was augmented to 29.0%. In relation to risks, patients presented the following classifications: in 2001, low risk was estimated in 12.1%, medium risk was 29.9%, high risk was 2.1%, and very high risk was 45.8%; however, in 2009 the same patients displayed very significant variations: non addition risk was 2.8%, low risk as 13.1%, medium risk was 16.8%, high risk was 13.1%, and very high risk was 54.25%. When both measurements were paralleled, results made known that: of the 45 patients with low or medium risk in 2001, in 2009 16 patients remained with the same risk level, though 29 progressed to high or very high; of the 62 patients that were classified among high or very high risk for cardiovascular diseases, 43 remained with the same index, while 19 shown low or medium risk in 2009 (p=0.193). It was also scrutinized that 34 patients had their conditions modified throughout the years (p=0.608). Type 2 Diabetes Mellitus (p=0.003) and family situation (p=0.017) were directly associated to the alteration in arterial pressure. Sedentary behavior and Cerebral Vascular Accident (CVA) depicted themselves statistically associated to hypertension (p=0.05) as a result of the Fisher’s test.
Descrição
Citação
MORAES, Marilúcia Mota. Estratégia saúde da família: efetividade das ações de controle da hipertensão arterial. 2011. 91 f. Dissertação (Mestrado) - Universidade Federal de São Paulo, São Paulo, 2011.