Avaliação da qualidade do atendimento ao portador de hipertensão arterial na atenção básica em Maringá-Paraná

Abstract

Introduction: Studies show that high blood pressure (hypertension) is on the rise and its negative impact on future populations will become more evident. When diagnosed early and treated adequately it is possible to prevent harm to patients, providing them with quality life, reducing hospital admissions due to cardiovascular complications and early deaths. The lack of evaluation studies on the quality of care given to hypertension patients in the primary health care may reflect the lack of evaluation in other services and programs offered to the public. This study sought to answer one question: Is it possible that after 14 years of the previous evaluative study, there were changes in the care given to hypertension patient in Maringá? Objectives: Evaluate the quality of care given to hypertension patients in primary health care; characterize the population of hypertension patients; know the records pertaining to the care of these patients in the primary health care, identify available resources in assisting these patients, and analyze the development of indicators related to hypertension from 1994 to 2008. Methodology: This was a descriptive, evaluative survey carried out in Maringá-Paraná; the sample consisted of 20 hypertension patients admitted for hypertensive crisis or heart disease, in a period of one month, in two hospitals accredited to the SUS. The patients were aged 45-65 years living in Maringá, were able to verbalize and treated in basic heath units. An interview with the hypertension patients admitted in the day of the research visit was carried out after the hospital diagnosis. After the hospital interview, a search for the medical records at the health facilities was carried out to verify the presence or absence of hospital records regarding the procedures considered essential to the hypertension treatment. Secondary data were used for the analysis of indicators and for the comments of the Field Log. Results and Discussion: From the verification of hospital diagnoses, 73 hypertension patients were found from all age groups, in the visited hospitals. Despite the downward trend of hospitalizations due to cardiovascular diseases in annual rates over the past three years, an increase of 23.7% on hospitalized hypertension patients was observed when compared to the earlier study, with an increase in admissions at the age range over 70 years and a decline in younger age groups; 53 patients (72.6%) were excluded from the study because they did not fit into the inclusion criteria. Therefore, 20 patients (27.4%) were interviewed who met the criteria established for the research, aged 45-65 years. Of these, 75% were male, 70% were married, 100% were affiliated to the SUS, although 20% also had a private health care plan of low coverage. The hospitalization records showed that 75% of patients were admitted with a hypertensive crisis and that others had associated diagnoses: six patients had congestive heart failure, three had Acute Myocardial Infarction and three had Cerebral Vascular Accident. Diabetes mellitus was the most prevalent co-morbidities, with 40% of cases. As for the admittance to the hospital, 40% reported having been referred by the Basic Health Units (BHU) and 30% was sent by the Mobile Service of the Emergency Service (SAMU). Therefore, only 30% sought the emergency service spontaneously, 65% used their own vehicles for transportation, 95% knew of their illness, 80% were in treatment, 50% followed the diet prescribed and 35% said they pursued regular physical activity. An increase in tobacco and alcohol consumption was observed in relation to the previous study and a decrease in the use of medication. The interviews allowed the identification of 17 BHU (68%) of the 25 units that provide care to these patients. At these BHUs, we located and searched 19 records and 70% of them were located with ease. 70% of these patients declared their satisfaction with the service received. The diagnosis was recorded in 14 records, different from the physical examination records which were found in four records. The clinical history was present in 12 records. The record of blood pressure assessing appeared in 89.4% of consultations, the weight record in eight records and no record of height verification of was found. In 94.7% the information was recorded by physicians, 84.2% by nursing assistants and 31.5% by nurses. There was an improvement in the recording of drug prescriptions in relation to the previous study, but the record of tests such as electrocardiogram, had fallen. Although patients have said in interviews that they received guidance on diet, regular practice of physical activities and not to use tobacco and alcohol, only one record was found recommending physical exercise and two records recommended an adequate diet for hypertension. No recommendations were recorded in the others. Conclusion: The structure of the network of primary health care in the Maringa offers favorable conditions for a process of proper care to hypertension patients. The decrease in admissions of patients in the age groups under 70 due to hypertension may indicate that primary health care is positively contributing to the lowering of hypertension indicators. There was a modification in the patients' profile, predominantly male. The level of satisfaction with the care received in primary health care was high, regardless of the quality of care received. The records in order, though not entirely appropriate, were important for the evaluation of some indicators of the care provided to hypertension patients.