RESUMO
Resumo Este estudo tem como objetivo analisar os atributos da Atenção Primária à Saúde (APS) abrangente a partir da atuação das equipes de Saúde da Família com foco nas doenças crônicas não transmissíveis. Pesquisa qualitativa realizada entre agosto de 2018 a julho de 2019, na APS de Vitória da Conquista, Bahia, com 40 profissionais de saúde, por meio de grupos focais e entrevistas. A partir da análise temática, os temas centrais corresponderam aos sete atributos da APS abrangente. Como resultados, as potencialidades do trabalho das equipes relacionaram-se com a priorização do acesso, ao amplo leque de serviços oferecidos e o reconhecimento da realidade comunitária/familiar. Destacaram-se obstáculos relacionados a oferta, acessibilidade e cobertura dos serviços, fragmentação na coordenação assistencial e informacional, dificuldades de desenvolvimento de práticas inclusivas com a família e etnicamente situadas, bem como na continuidade da assistência, notadamente para o contexto rural. Espera-se que os resultados apresentados possam confirmar a necessidade de investimentos e a instituição de processos sistemáticos de avaliação do trabalho das equipes de saúde da família, a fim de acompanhar a trajetória de consolidação da APS no contexto do Sistema Único de Saúde brasileiro.
Abstract This study aims to analyze the attributes of comprehensive Primary Health Care (PHC) based on the work of the family health teams focused on non-communicable chronic diseases. Qualitative research conducted from August 2018 to July 2019, in primary health care in Vitória da Conquista, Bahia, Brazil, with 40 health professionals, through interviews and focus groups. From the thematic analysis, the central themes were defined, corresponding to the seven attributes of comprehensive PHC. As a result, the potentials work of the family health teams was related to prioritizing access, the wide range of services offered and the recognition of the community and family reality. The study highlighted obstacles related to service provision, accessibility, coverage, care fragmentation and in information coordination, challenges in developing practices with the family, in practices ethnically situated, and continuity of care, notably for the rural context. It is expected that the results presented may confirm the need for investments and the institution of systematic evaluation processes regarding the work of family health teams, in order to follow the trajectory of PHC consolidation in the context of the Brazilian Unified Health System.Resumo: Este estudo tem como objetivo analisar os atributos da Atenção Primária à Saúde (APS) abrangente a partir da atuação das equipes de Saúde da Família com foco nas doenças crônicas não transmissíveis. Pesquisa qualitativa realizada entre agosto de 2018 a julho de 2019, na APS de Vitória da Conquista, Bahia, com 40 profissionais de saúde, por meio de grupos focais e entrevistas. A partir da análise temática, os temas centrais corresponderam aos sete atributos da APS abrangente. Como resultados, as potencialidades do trabalho das equipes relacionaram-se com a priorização do acesso, ao amplo leque de serviços oferecidos e o reconhecimento da realidade comunitária/familiar. Destacaram-se obstáculos relacionados a oferta, acessibilidade e cobertura dos serviços, fragmentação na coordenação assistencial e informacional, dificuldades de desenvolvimento de práticas inclusivas com a família e etnicamente situadas, bem como na continuidade da assistência, notadamente para o contexto rural. Espera-se que os resultados apresentados possam confirmar a necessidade de investimentos e a instituição de processos sistemáticos de avaliação do trabalho das equipes de saúde da família, a fim de acompanhar a trajetória de consolidação da APS no contexto do Sistema Único de Saúde brasileiro.
RESUMO
Purpose: This study aims to assess self-care in patients with non-optimal diabetes management (HbA1c >7.0% for adults and >8.0 for those aged 60 or over) and the positive and negative experiences associated with it in the rural communities of a Brazilian municipality. Patient and Methods: This is a cross-sectional mixed-methods study. The data were collected from participants with high HbA1c through focus group discussions, subsequently performing thematic analysis, and through structured questionnaires (socioeconomic characteristics and the Summary of Diabetes Self-Care Activities (SDSCA)). Results: The mean HbA1c of the 156 study participants was 9.94% (95% confidence interval: 9.70-10.19%) and most participants (86.54%) had negative self-care behaviors, with an overall SDSCA mean score of 3.55. This mean was not positive for any of the socioeconomic characteristics. The self-care activities with the most satisfactory performance concerned non-smoking and the use of prescribed medications, and the poorest results were observed for the practice of specific physical activities. The qualitative data indicated that the study participants face many difficulties regarding self-care practices, especially those related to an adequate diet. Conclusion: The self-care assessment revealed unsatisfactory self-care behaviors as well as high HbA1c levels among the study participants and highlighted the various difficulties they encounter. This indicates the need for more attentive health teams to monitor patients, especially regarding actions focused on the non-pharmacological elements of self-care, such as lifestyle changes, which were found to be the dimensions with the most unsatisfactory results.
RESUMO
Background: Living in a rural or remote area is frequently associated with impaired access to health services, which directly affects the possibility of early diagnosis and appropriate monitoring of diseases, mainly non-communicable ones, because of their asymptomatic onset and evolution. Point-of-care devices have emerged as useful technologies for improving access to several laboratory tests closely patients' beds or homes, which makes it possible to eliminate the distance barrier. Objective: To evaluate the application of point-of-care technology for glycated hemoglobin (HbA1c) estimation in the assessment of glycemic control and identification of new diagnoses of diabetes in primary care among rural communities in a Brazilian municipality. Materials and Methods: We included individuals aged 18 years or older among rural communities in a Brazilian municipality. From September 2019 to February 2020, participants were assessed for anthropometrics, blood pressure, and capillary glycemia during routine primary care team activities at health fairs and in patient groups. Participants previously diagnosed with diabetes but without recent HbA1c test results or those without a previous diagnosis but with random capillary glycemia higher than 140 mg/dL were considered positive and were tested for HbA1c by using a point-of-care device. Results: At the end of the study, 913 individuals were accessed. Of these, 600 (65.7%) had no previous diagnosis of diabetes, 58/600 (9.7%) refused capillary glycemia screening and 542/600 (90.7%) were tested. Among tested individuals, 73/542 (13.5%) cases without a previous diagnosis of diabetes, were positive for capillary glycemia. Among positives, 31/73 (42.5%) had HbA1c levels that were considered indicative of prediabetes and 16/73 (21.9%) were newly diagnosed with diabetes. Among the participants, 313/913 (34.3%) were previously diagnosed with diabetes. Recent HbA1c results were unavailable for 210/313 (67.1%). These individuals were tested using point-of-care devices. Among them, 143/210 (68.1%) had HbA1c levels higher than target levels (>7% and >8% for adults and elderly individuals, respectively. Conclusion: The application of point-of-care devices for HbA1c level measurement improved the access to this test for people living in rural or remote areas. Thus, it was possible to include this technology in the routine activities of primary health care teams, which increased the rates of new diagnoses and identification of patients with uncontrolled glycemia.
