Construction of a logical model of the line of care for people with chronic kidney disease / Construção de modelo lógico da linha de cuidado da pessoa com doença renal crônica

ABSTRACT OBJECTIVE To build and validate a logical model of the line of care for people with chronic kidney disease. METHODS This is a descriptive study with a qualitative approach, with documentary research and analysis of primary data collected in interviews with key informants, carried out from May to September 2019, in the Guarani Aquifer Health Region, belonging to the Regional Health Department 13. Based on the theoretical framework proposed by McLaughlin and Jordan, five stages were followed: collection of relevant information; description of the problem and context; defining the elements of the logical model; construction and validation. RESULTS The logical model was organized into three care dimensions - primary health care, specialized care and high complexity care - composed of structure, process and result components. CONCLUSION The constructed logical model has the potential to contribute to the assessment of the line of care for people with chronic kidney disease, in order to achieve better results in the management of this disease, something that favors both the patient and the health system.

RESUMO OBJETIVO Construir e validar um modelo lógico da linha de cuidado da pessoa com doença renal crônica. MÉTODOS Trata-se de um estudo de caráter descritivo e com abordagem qualitativa, sendo feitas pesquisa documental e análise de dados primários coletados em entrevistas com informantes-chave, realizadas de maio a setembro de 2019, na Região de Saúde do Aquífero Guarani, pertencente ao Departamento Regional de Saúde 13. A partir do referencial teórico proposto por McLaughlin e Jordan, foram seguidas cinco etapas: a coleta de informações relevantes; a descrição do problema e do contexto; a definição dos elementos do modelo lógico; e a construção e validação. RESULTADOS O modelo lógico foi organizado em três dimensões assistenciais - atenção primária à saúde, atenção especializada e atenção de alta complexidade - compostas pelos componentes de estrutura, processo e resultado. CONCLUSÃO O modelo lógico construído tem potencial para contribuir com a avaliação da linha de cuidado da pessoa com doença renal crônica, ao visar o alcance de melhores resultados no manejo dessa doença, o que favorece tanto o seu portador quanto o sistema de saúde.

Voice in chronic hemodialyzed individuals.

Objective: Chronic hemodialysis affects various body systems, one of which is the respiratory system. Since respiration is the prime source for speech, vocal dysfunctions are expected to be present in patients with chronic hemodialysis. The present study attempts to shed light on the changes in acoustic and aerodynamic characteristics of voice, if any, in patients with chronic hemodialysis. Materials and Methods: Phonation of sustained vowel/a/sample was subjected to acoustic analysis using VAGHMI software. Sustained duration of/a/,/s/, and/z/ was recorded for the purpose of aerodynamic analysis. The independent t test was employed to find the significant difference between the two groups. Results: Chronic hemodialyzed subjects showed significant deviation in frequency, perturbation, and aerodynamic measures when compared to normal subjects. These results are discussed with respect to the underlying pathophysiology. Conclusion: The results of the present study revealed that subjects with chronic hemodialysis exhibit clinical evidence of voice disorders. Vocal deviations in chronic hemodialyzed subjects are explained due to the influence of the renal system on the respiratory and the phonatory system and the negative fluid balance effect of hemodialysis.