ABSTRACT
Background: To reduce mortality of acute myocardial infarction, medical care must be provided within the first hours of the event. Objective: To identify the "front door" to medical care of acute coronary patients and the time elapsed between patients'admission and performance of myocardial reperfusion in the public health system of the city of Joinville, Brazil. Methods: The study was a retrospective analysis of the medical records of 112 consecutive patients diagnosed with acute myocardial infarction by coronary angiography. We identified the place of the first medical contact and calculated the time between admission to this place and admission to the referral hospital, as well as the time until coronary angiography, with or without percutaneous transluminal angioplasty. A descriptive analysis of data was made using mean and standard deviation, and a p < 0.05 was set as statistically significant. Results: Only 16 (14.3%) patients were admitted through the cardiology referral unit. Door-to-angiography time was shorter than 90 minutes in 50 (44.2%) patients and longer than 270 minutes in 39 (34.5%) patients. No statistically significant difference was observed in door-to-angiography time between patients transported directly to the referral hospital and those transferred from other health units (p < 0.240). Considering the time between pain onset and angiography, only 3 (2.9%) patients may have benefited from myocardial reperfusion performed within less than 240 minutes. Conclusion: Management of patients with acute myocardial infarction is not in conformity with current guidelines for the treatment of this condition. The structure of the healthcare system should be urgently modified so that users in need of emergency services receive adequate care in accordance with local conditions
Subject(s)
Humans , Male , Female , Middle Aged , Delivery of Health Care/methods , Failure to Rescue, Health Care , Myocardial Infarction/mortality , Myocardial Infarction/therapy , Therapeutics/methods , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/therapy , Angioplasty/methods , Coronary Angiography/methods , Critical Pathways/trends , Death, Sudden/prevention & control , Diagnostic Imaging/methods , Electrocardiography/methods , Emergency Medical Services/methods , Hospital Care/methods , Myocardial Reperfusion/methods , Retrospective Studies , Data Interpretation, Statistical , Thrombolytic Therapy/methods , Unified Health SystemABSTRACT
Fundamento: Um programa permanente de educação em serviço melhora o desempenho dos profissionais de saúde e aumenta os índices de controle da hipertensão arterial. Objetivo: Estimar a prevalência do controle da hipertensão arterial e da inércia terapêutica em adultos atendidos nas Unidades Básicas da Saúde após a implantação de um programa de apoio matricial em cardiologia. Métodos: Estudo transversal, com amostragem por conglomerados, mediante pesquisa em prontuários, em que foram avaliados 463 portadores de hipertensão arterial. Foram avaliados pressão arterial, medicamentos e incrementos terapêuticos em 2013, e comparados ao resultados obtidos em 2007. Resultados: Houve predomínio de pacientes das unidades de Estratégia Saúde da Família e do sexo feminino. A idade variou entre 24 e 92 anos (média de 61,7). Observaram-se redução das médias da pressão arterial (148,62/91,60±23,52/14,51mmHg para 137,60/84,03 ± 21,84/12,72 mmHg) entre o primeiro e o último registro, e controle em 58% dos pacientes, ou seja, superior aos 36,6% encontrados em 2007. No período analisado, houve incremento terapêutico de 39% das ocasiões e 52% dos pacientes, superior aos 12% e 29,5%, respectivamente, em 2007. A média de fármacos por paciente aumentou de 1,85 para 2,05, predominando diuréticos e inibidores da enzima de conversão da angiotensina. Conclusão: Houve redução da inércia clínica e aumento do controle da hipertensão arterial, comparados com os achados do estudo anterior. O resultado sugere que o programa de apoio matricial para os profissionais da saúde e outras medidas para melhorar o controle da doença nas Unidades Básicas da Saúde foram eficazes
Background: A continuing education program for health professionals improves their performance and increases hypertension control rates. Objective: To estimate the prevalence of hypertension control and therapeutic inertia among adults treated at Primary Health Care Units after a continuing education program focused on cardiology for health professionals. Methods: A cross-sectional study was carried out, which included cluster sampling and analysis of medical records. We evaluated 463 patients with high blood pressure and analyzed the blood pressure, medications, and therapeutic increments in 2013, which were compared to the data obtained in 2007. Results: There was prevalence of female patients and appointments at the Family Health Care Units. The age ranged between 24 and 92 years (mean of 61.7 years). There was a reduction in the mean blood pressure (148.62/91.60 ± 23.52/14.51 mmHg to 137.60/84.03 ± 21.84/12.72) between the first and last records, and BP control in 58% of the sample, that is, higher than the 36.6% found in 2007. In the analyzed period, there was a therapeutic increment of 39% in appointments, which benefited 52% patients with high blood pressure, higher than the 12% and 29.5%, respectively, found in 2007. The mean number of drugs per patient increased from 1.85 to 2.05, with a predominance of diuretics and angiotensinconverting-enzyme inhibitors. Conclusion: There was a reduction in the clinical inertia and increased control of arterial hypertension was observed, compared with the findings of the previous study. The result suggests that the matricial support program for health professionals and other measures to improve disease control in the Primary Health Care Units were effective
Subject(s)
Humans , Male , Female , Middle Aged , Adult , Health Education/methods , Hypertension/epidemiology , Hypertension/prevention & control , Medication Adherence , Prevalence , Primary Health Care/methods , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Calcium Channel Blockers/therapeutic use , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/physiopathology , Cross-Sectional Studies/methods , Drug Therapy/methods , Health Centers , Movement , Data Interpretation, Statistical , Treatment OutcomeABSTRACT
O apoio matricial é uma estratégia potente e inovadora para enfrentar o desafio de reorganizar e qualificar o processo assistencial das doenças crônicas não transmissíveis no Sistema Único de Saúde (SUS). Este artigo relata a implantação do Programa de Apoio Matricial em Cardiologia na rede básica de saúde de um município na Região Sul do Brasil e seus resultados iniciais. Trata-se de um estudo de pesquisa-ação no qual os pesquisadores em campo foram um cardiologista e uma enfermeira que participaram ativamente do delineamento do Programa de Apoio Matricial em Cardiologia. O material empírico foi constituído por anotações de campo, registros da Central de Regulação e depoimentos dos principais agentes envolvidos na implantação e realização do apoio matricial, obtidos em entrevistas semiestruturadas e reuniões. O programa foi implantado em 2010, em todas as 56 unidades básicas de saúde com os objetivos de expandir a educação permanente para os profissionais da rede e capacitar as equipes de saúde para a resolução de problemas cardiológicos que demandem menor densidade tecnológica. Os resultados evidenciam maior resolubilidade dos médicos da atenção primária, com consequente redução e qualificação dos encaminhamentos para os cardiologistas, acesso mais rápido aos cardiologistas e aos exames, além de importante redução da fila dessa especialidade. Propõe-se a continuidade desse programa, sua reprodução em outros locais e incorporação de outros profissionais que atuam nas equipes multidisciplinares da atenção primária...
Matrix support is a powerful and innovative strategy to face the challenge of reorganizing and qualifying the clinical process of chronic non-communicable diseases in the Brazilian National Health System. This article reports the deployment of the Matrix Support Program in Cardiology in primary health care services in a town in southern Brazil and its initial results. This is an action research study in which the field researchers were a cardiologist and a nurse who actively participated in designing the Matrix Support Program in Cardiology. The empirical material consisted of field notes, records from the Regulation Center, and accounts by key players involved in the deployment and execution of matrix support, obtained by means of semi-structured interviews and meetings. The program was deployed in 2010, in all of the 56 primary health centers aiming both to increase continuing education for professionals in the network and train the health teams to solve cardiologic problems requiring less technological resources. The results show better ability to solve problems on the part of the primary care physicians, with consequent decreased and qualified referrals to cardiologists, faster access to cardiologists and examinations, in addition to a significantly shorter queue for this specialty. We propose to continue this program, replicate it in other locations, and incorporate other professionals working in the multidisciplinary teams of primary care...
Subject(s)
Humans , Male , Female , Cardiology , Chronic Disease , Cardiovascular Diseases , Communicable Diseases , Education, Continuing , Education, Medical, Continuing , Health Planning , Unified Health System , Health Centers , Credentialing , Health Care Costs , Risk Factors , Indicators of Morbidity and MortalityABSTRACT
A hipertensão arterial é um problema de saúde pública e a literatura carece de um posicionamento direcionado ao tratamento odontológico ambulatorial do paciente hipertenso. O objetivo deste trabalho é verificar se existem limites pressóricos estabelecidos para a realização de procedimentos médicos e odontológicos ambulatoriais, mediante a revisão das Diretrizes de Hipertensão e de Avaliação Perioperatória. Como resultado, não foram encontradas evidências em cardiologia que fundamentem estabelecer limites pressóricos aos procedimentos médicos e odontológicos ambulatoriais e, portanto, inexistem motivos para implementar restrições baseadas na pressão arterial para a realização desses procedimentos.
Hypertension is a public health problem and the literature lacks an approach focused on the outpatient dental treatment of hypertensive patients. The purpose of this study is to ascertain wheter blood pressure limits have been set for medical and dental outpatient procedures, through a review of the Hypertension and Perioperative Cardiovascular Guidelines. As no evidence was found in cardiology that underpins the establishment of blood pressure limits for medical and dental outpatient procedures, there are thus no reasons to implement limits for these procedures, based on blood pressure.
Subject(s)
Humans , Dental Care for Chronically Ill/methods , Dental Care for Chronically Ill/standards , Dental Care for Chronically Ill/trends , Hypertension/complications , Hypertension/diagnosis , Dentistry/methods , Dentistry/standards , Public Health/methods , Public Health/trends , Risk FactorsABSTRACT
FUNDAMENTO: A importância do manejo adequado e do controle da hipertensão arterial (HA). OBJETIVO: Estimar a prevalência do controle da hipertensão arterial e da inércia terapêutica em adultos atendidos nas unidades básicas da saúde (UBS) do município de Joinville e dos fatores associados. MÉTODOS: Estudo transversal, com amostragem por conglomerados, mediante pesquisa em prontuários, em que foram avaliados 415 portadores de HA. Foram avaliados a pressão arterial (PA), os incrementos terapêuticos, os fatores de risco e as comorbidades associadas. RESULTADOS: Houve predomínio do sexo feminino e de consultas de enfermagem. A idade variou entre 28 e 90 anos (média de 61,5 anos). Observou-se redução das médias da PA (155,8 ± 20,8/95,7 ±10,6 mmHg para 140,3 ± 22/84,1 ± 12,4 mmHg) entre o primeiro e o último registro e a PA final normal em 36,6 por cento dos pacientes, semelhante para homens e mulheres. Nos últimos 12 meses, a PA esteve elevada em 1.295 ocasiões, ocorrendo incremento terapêutico em apenas 156 (12,0 por cento). Foram usados 1,85 fármacos por paciente, predominando diuréticos e IECA. Encontrou-se elevada prevalência de obesidade (40 por cento), diabete (41 por cento), LDL elevado (46 por cento) e de hipertrofia ventricular esquerda (25,5 por cento). CONCLUSÃO: A elevada inércia clínica, o baixo controle da HA e a elevada presença de comorbidades sugerem a necessidade de programas de educação permanente para os profissionais da saúde e de outras medidas para melhorar o controle da doença nas UBS.
BACKGROUND: The importance of adequate management and control of high blood pressure (HBP). OBJECTIVE: To estimate the prevalence of hypertension control and therapeutic inertia among adults treated at primary health care units (PHCU) in the city of Joinville, as well as the associated factors. METHODS: A cross-sectional study, which included cluster sampling and analysis of medical records, with the evaluation of 415 patients with high blood pressure. We evaluated the blood pressure (BP), increments of therapy, risk factors and comorbidities. RESULTS: There was prevalence of females and nursing appointments. The age ranged between 28 and 90 years (mean of 61.5 years). There was a reduction in the mean BP (155.8 ± 20.8/95.7 ± 10.6 mmHg to 140.3 ± 22/84.1 ± 12.4 mmHg) between the first and last record and the final normal BP in 36.6 percent of patients, with similar results for men and women. Over the past 12 months, the BP was high on 1,295 occasions, and there was a therapeutic increment on only 156 occasions (12.0 percent). 1.85 drugs were used per patient, mainly diuretics and ACE inhibitors. There was high prevalence of obesity (40 percent), diabetes (41 percent), high LDL (46 percent) and left ventricular hypertrophy (25.5 percent). CONCLUSION: The high therapeutic inertia, low control of high blood pressure and the large number of comorbidities suggest the need for continuing education programs for health professionals and other measures to improve the disease control in primary health care units.