Management of chronic kidney disease: perspectives of Brazilian primary care physicians.

AIM: To investigate primary care physicians' knowledge of and attitudes toward care for chronic kidney disease patients. BACKGROUND: In Brazil, care for chronic kidney disease, a global public health problem, is provided by the Brazilian National Health System, which is organized around primary care. The study aimed to investigate the knowledge and attitudes of primary care physicians about the management of chronic kidney disease. METHOD: This research is based on quantitative and qualitative data. The participants were 92 physicians from 81 primary care units located in eight cities of the São Paulo/Brazil health region, who answered a self-administered questionnaire. FINDINGS: Only 59% and 58% of the physicians recognized smoking and obesity, respectively, as risk factors for chronic kidney disease. Health appointments and drug therapy predominated as disease prevention strategies and less than 30% mentioned multiprofessional care and health education groups. For early diagnosis, isolated serum creatinine was the most used test and 64.6% stated they classified the disease stages. Exclusive follow-up in primary care decreased from 79% in stage 1 to 19.5% in stage 3B and the patients' monitoring in the healthcare network varied from 8.7% in stage 1 to 70.6% in stages 4 and 5ND, suggesting early referrals and lack of referral at the necessary stages. Access to information on the referred patient was, predominantly, through the patient's report and 74% of the physicians did not have matrix support regarding chronic kidney disease. CONCLUSION: The study showed that the healthcare teams need to update their knowledge and procedures to be able to provide a comprehensive and efficient approach to treating chronic kidney disease in primary care.

A abordagem da intersetorialidade para o ensino médico em atenção primária / The approach intersectoral for medical education in primary health care

Introdução: O processo de criação do Sistema Único de Saúde (SUS) como um modelo de atenção à saúde, mais humanizado, abrangente, eficaz e resolutivo tem a intersetorialidade como um de seus instrumentos para a transformação. No entanto, há escassez de artigos que abordem a intersetorialidade no contexto da educação médica e da organização das práticas, principalmente na atenção primária. Objetivo: Trazer à luz o conceito de intersetorialidade e o princípio da orientação comunitária na organização das práticas na realidade das equipes de saúde da família, no âmbito do SUS. Método: Análise documental realizada para discutir o conceito de intersetorialidade na obra de autores da Atenção Primária à Saúde (APS), na documentação oficial do Ministério da Saúde e em publicações selecionadas sobre a intersetorialidade. Discutiu-se também a orientação comunitária nas ações prestadas de APS segundo a percepção do médico e da equipe de saúde da família, no Brasil. Foi descrita a evolução do antigo Programa de Saúde da Família para a Estratégia de Saúde da Família como modelo de reorganização da atenção primária à saúde no SUS e no cenário de ensino das Unidades de Saúde da Família (USF) ligadas à Faculdade de Medicina de Ribeirão Preto- Universidade de São Paulo, no período de 1999 a 2014. Resultados: A documentação oficial e científica consultada mostrou avanço das transformações nos serviços de Saúde da Família, como modelo de organização da APS no país. O cenário das USF orientado para a APS vem contribuindo para a adequação da formação médica e dos profissionais de saúde nessa área. Considerações finais: Não obstante, percebendo-se as potencialidades das práticas intersetoriais e orientadas para a comunidade na mudança do paradigma da saúde, há muito o que fazer no sentido amplo da intersetorialidade, que compreende a abordagem dos determinantes sociais da saúde no planejamento integrado local. (AU)

Introduction: The process of creating the Unified Health System (SUS) as one health care model more humanized, comprehensive, effective and decisive has intersectorality as one of its tools for transformation. However, there are few articles that address the intersectoral approach in the context of medical education and organization of practices, especially in primary care. Objective: Bring forth the concept of intersectionality and the principle of community orientation in the organization of practices in the reality of family health staffs, under the SUS. Method: Analysis of documents held to discuss the concept of intersectionality in the work of authors of Primary Health Care (PHC), the official documentation of the Ministry of Health and selected publications on intersectionality. It also discussed the community orientation in the given actions of Primary Health Care in the perception of the physician and the family health staffs in Brazil. It described the evolution of the former Family Health Program to the Family Health Strategy as reorganization model of PHC in the SUS and in the education scenario of the Family Health Units (FHU) involved in the Ribeirão Preto Medical School - University of São Paulo in the period from 1999 to 2014. Results: Official and scientific documentation consulted showed advance of changes in family health services, such as the PHC model of organization in the country. The setting of FHU oriented to PHC has contributed to the adaptation of medical training and health professionals in this area. Final Considerations: Nevertheless, perceiving the potential of intersectoral and practices geared towards the community in the health paradigm change, there is plenty to do in the broad sense of intersectionality comprising addressing the social determinants of health in local integrated plan.(AU)