Dialogue between primary and secondary health care providers in a Brazilian hypertensive population

SUMMARY OBJECTIVE To describe clinical and epidemiological profiles of patients with hypertension referred to a secondary care unit and to assess the adequacy of the referral criteria. METHOD This descriptive transversal study analysed 943 hypertensive patients referred to a secondary healthcare unit from September 2010 to August 2012. Clinical and sociodemographic data as well as data regarding the liaison between secondary and primary care services were collected. RESULTS Patients' mean age was 59±13.1 years, and 61.3% were female. Sedentary lifestyle, alcohol consumption, and smoking were observed in 80.3%, 31.1%, and 18.1% of the patients, respectively. Uncontrolled blood pressure was observed in 72.5% of the sample, and 80.1% of individuals were overweight or obese. There was a high prevalence of dyslipidaemia (73.1%), cardiovascular disease (97.5%), and reduced glomerular filtration rate (49.9%). Thirty-eight percent of patients did not meet the referral criteria, of whom approximately 25% were not hypertensive. CONCLUSION Even in a universal-access healthcare system, poor control of hypertension and high prevalence of obesity and cardiovascular diseases were observed. Inadequate referrals and the presence of clinical complications suggest low efficiency of the assistance provided in primary care and reinforce the need for sharing care with the secondary level.

RESUMO OBJETIVO Descrever os perfis clínicos e epidemiológicos de pacientes hipertensos encaminhados para uma unidade de atendimento secundário e avaliar a adequação dos critérios de referência. MÉTODO Estudo transversal que analisou 943 pacientes hipertensos encaminhados a uma unidade de atenção secundária à saúde de setembro de 2010 a agosto de 2012. Foram coletados dados clínicos e sociodemográficos, bem como dados de interlocução entre os serviços de atenção primária e secundária. RESULTADOS A idade média dos pacientes era de 59 ± 13,1 anos e 61,3% eram do sexo feminino. O estilo de vida sedentário, o consumo de álcool e o tabagismo foram observados em 80,3%, 31,1% e 18,1% dos pacientes, respectivamente. A pressão arterial descontrolada foi observada em 72,5% da amostra, e 80,1% dos indivíduos apresentavam excesso de peso. Houve uma alta prevalência de dislipidemia (73,1%), doença cardiovascular (97,5%) e taxa de filtração glomerular estimada reduzida (49,9%). Trinta e oito por cento dos pacientes não atendiam aos critérios de encaminhamento, dos quais aproximadamente 25% não eram hipertensos. CONCLUSÃO Mesmo em um sistema de saúde de acesso universal, observou-se um controle insuficiente da hipertensão e uma alta prevalência de obesidade e doenças cardiovasculares. Encaminhamentos inadequados e a presença de complicações clínicas sugerem uma baixa eficiência da assistência prestada na atenção primária e reforçam a necessidade de compartilhar cuidados com o nível secundário.

Dialogue between primary and secondary health care providers in a Brazilian hypertensive population.

OBJECTIVE: To describe clinical and epidemiological profiles of patients with hypertension referred to a secondary care unit and to assess the adequacy of the referral criteria. METHOD: This descriptive transversal study analysed 943 hypertensive patients referred to a secondary healthcare unit from September 2010 to August 2012. Clinical and sociodemographic data as well as data regarding the liaison between secondary and primary care services were collected. RESULTS: Patients' mean age was 59±13.1 years, and 61.3% were female. Sedentary lifestyle, alcohol consumption, and smoking were observed in 80.3%, 31.1%, and 18.1% of the patients, respectively. Uncontrolled blood pressure was observed in 72.5% of the sample, and 80.1% of individuals were overweight or obese. There was a high prevalence of dyslipidaemia (73.1%), cardiovascular disease (97.5%), and reduced glomerular filtration rate (49.9%). Thirty-eight percent of patients did not meet the referral criteria, of whom approximately 25% were not hypertensive. CONCLUSION: Even in a universal-access healthcare system, poor control of hypertension and high prevalence of obesity and cardiovascular diseases were observed. Inadequate referrals and the presence of clinical complications suggest low efficiency of the assistance provided in primary care and reinforce the need for sharing care with the secondary level.

Quality of Care of Patients with Diabetes in Primary Health Services in Southeast Brazil.

Background: Diabetes management involves multiple aspects that go beyond drug therapy as a way of providing high quality care. The objective of this study was to describe quality of care indicators for individuals with diabetes in southeast Brazil and to explore associations among these indicators. Methods: In this cross-sectional, observational study, health care providers filled out a questionnaire addressing health care structure and processes at 14 primary health care units (PHCUs). Clinical and laboratory data of diabetic patients attending the PHCUs and from patients referred to a secondary health care (SHC) center were collected. Results: There was a shortage of professionals in 53.8% of the PHCUs besides a high proportion of problems regarding referrals to SHC. At the PHCU, glycated hemoglobin results were available only in half of the medical records. A low rate of adequate glycemic control was also observed. An association between structure and process indicators and the outcomes analyzed was not found. Conclusion: Major deficiencies were found in the structure and processes of the PHCUs, in addition to unsatisfactory diabetes care outcomes. However, no association between structure, process, and outcomes was found.