Pereira, Egle Sousa [1]
BARRETO, Genesson dos Santos [2]
Pereira, Egle Sousa; BARRETO, Genesson dos Santos – Routine account of creation to hypertensive group. Multidisciplinary Core scientific journal of knowledge. Year 1. Vol. 9. pp. 50-56, October/November 2016. ISSN. 2448-0959
Summary
The high morbidity and mortality associated with hypertension and the need to seek strategies that allow an early approach to treatment of this population, justifies the creation of hypertensive groups in basic health units. According to the survey on basic health Unit New Colorado II in April 2010 through the HIPERDIA, plug verified that over 6% of the population attended consisted of patients with Hypertension. Objective: to carry out a road map for creation and implementation of the hypertensive group. Methodology: Initially it was established the epidemiological profile of the population of hypertensive patients, to suit the needs and routine reality of the local population. Results and conclusion: hypertensive 140 use the UBS New Colorado II to purchase medication and medical follow-up. In the genre, females predominated (62%), age between 45 and 55 years, 20% are people not literate. The black hypertensive population in UBS reaches 23.57%. Blood pressure levels in about 70% of hypertensive patients, at the time of registration varied between normal blood pressure and hypertension Stage 1. About 80% of the registered patients were overweight or obese in different levels. It was subsequently established a sequence of activities to be performed in 2 hours in the morning period, once a week with the population of each micro area, making a new rotate every week, since they are 05 05 micro areas. After termination of activities, measured the blood pressure of hypertensive patients and as pressure level the patient was answered the same day or the following usual consultations-oriented every 03 months, alternating between medical care and Nurse. The whole routine was detailed in an organization chart for ease of deployment and service.
Keywords: epidemiology, hypertension, family health,
Introduction
Hypertension (SAH) is one of the most serious public health problems associated with high mortality and that can lead to serious consequences to some vital targets, when not set up adequate treatment (Ch F, Junior TR, JCCS, Axe 1998; Car MR, Pierin AMG, Aquinas VLA, 1991).
Finding measurement of systolic blood pressure greater than 140 mmHg and/or diastolic blood pressure greater than 90 mmHg, in two different measurements, defines the diagnosis of HAS for adults. Can be ranked 1 to 3 stages according to levels of systolic and diastolic pressure, or isolated Systolic hypertension sorted, if there is no change in diastolic pressure (Brazilian guidelines of hypertension, 2008)
According to the DATA-SUS in Brazil, in the period from January 2002 to April 2010, the number of hypertensive patients was 6,130,946,000,000. In Mato Grosso, in the same period, this number was 153,489,000 registered, most of hypertensive 40000, just in the city of Cuiabá. Is the most frequent cardiovascular diseases and the main risk factor for complications like stroke, acute myocardial infarction and chronic kidney disease (BRAZIL, Ministry of health, 2006).
The high prevalence of HAS demonstrated by several studies worldwide (Fuchs FD et. Al, 2001; DJ move, Pavlik VN, 2001) is also a reality in the basic health Unit (BHU) New Colorado II in Cuiabá-MT. Survey information system in the basic attention (SIAB) in April 2010 registered 196 receiving medication in hypertensive and 140 unit performing medical follow-up, which corresponds to more than 6% of the population served, justifying the need for an efficient approach on this population group.
Because of its magnitude, is part of the National Health Policy, the Integral attention to HAS, its risk factors and its complications. The basic network health professionals of the unified health system (SUS) have fundamental importance in hypertension control strategies both in clinical diagnosis, and the development of educational activities to promote health, individually or in groups that can promote adherence to treatment and reduce its impact. A strategy that has proved effective is the deployment of hypertensive groups (Brazilian guidelines of hypertension, 2008).
Despite the importance of the individual approach, increasingly proves the need for a collective approach to obtain more consistent results and long lasting of the factors that lead to HAS. One strengthens the other and are complementary. Evidence shows that strategies aimed at lifestyle modifications are most effective when applied to a larger number of people genetically predisposed and the fan community. The collective exposure to risk and as a result of the strategy, the reduction of this exhibition, has a multiplier effect when reached by measures of greater magnitude (Brazilian guidelines of hypertension, 2010).
Thus, it was proposed the elaboration of a routine for deployment of the hypertensive group at UBS New Colorado II and the account of the experience of its creation.
Goals
General objective: Elaborate routine for the hypertensive group from UBS New Colorado II and report on this experience.
Specific objectives: Meet the epidemiological profile of hypertensive patients attended at the UBS New Colorado II; Fit the New UBS hypertensive Colorado II in accordance with the guidelines proposed by the family health strategy of the Ministry of health; Clarify the hypertensive patients of UBS New Colorado II on the diagnosis, treatment and complications of HAS; Strengthen links between the health service and its users; Develop educational activities to promote health.
Type of study
This is a descriptive epidemiological study and sectional, performed from the primary database, collected through unstructured interview with the health team serving the hypertensive patients of UBS New Colorado II and secondary data obtained through the HIPERDIA chips from UBS New Colorado II.
Field of study
Basic health unit New Colorado II, New neighborhoods spanning Time, Amperco Park, green area and Accommodation Antarctica, in Western District, municipality of Cuiabá, in Mato Grosso, Brazil. This territory is divided into areas where they reside, micro 05 808 families, totaling a population of 2,937 inhabitants.
Population and data collection period
In the Constitution of the population of this study were considered all hypertensive patients residing in area of UBS New Colorado II, during the period from 30 March 2010 to 21 May 2010.
Inclusion criteria:
-Hypertensive patients residing in area of UBS New Colorado II HIPERDIA card registered.
Exclusion criteria:
-Hypertensive patients registered in the plug B HAS the Community Health Agents (ACS), which does not make monitoring on UBS New Colorado II, because they have access to other health services;
-Hypertensive patients registered at HIPERDIA sheet or that changed the deceased area of UBS New Colorado II
-Hypertensive patients registered by the plug the (family) in UBS New Colorado II, who receive medicines to HAS, however do not have a record on file B HAS and/or HIPERDIA data sheet.
-Hypertensive patients who do not reside in the area of UBS New Colorado II that remove medicines for HAS the pharmacy of UBS.
Procedure for obtaining data and ethical aspects
The data were collected through the analysis of the content of the HIPERDIA, filled by nursing techniques of UBS, which extracted the following variables: age, sex, color, education, BMI, blood pressure, abdominal waist, life habits (smoking and physical inactivity) and use of drug treatment for hypertension.
From these data, defined the epidemiological profile of the population of hypertensive patients who are accompanied on UBS New Colorado II.
Unstructured interview was conducted with the health team of UBS (doctor, nurse, nursing techniques, community health agents), to capture information about patient-care routines hypertensive that have been used and suggestions as to how I could work the hypertensive group.
With this data, was outlined a schedule for implementation and development of the hypertensive group from UBS New Colorado II, taking into consideration the profile of the population that will make use of the service and the opinion of the health team that will act directly with the patients.
Been complied with the ethical aspects of research involving human beings.
Submission and processing of data
After collecting the information by means of the HIPERDIA and interviews with the health team, the data were categorized and subsequently presented in discursive, considering proposed objectives.
For the tabulation and statistical analysis of the data was used the Minitab program version 14.2. It was considered a confidence interval of 95%.
Result and discussion
During the working period, it was possible to observe that the UBS New Colorado II is a unit, that despite four years of existence, still unable to deploy all health programs to its population according to the family health Strategy. Several obstacles have been encountered, such as the high turnover of health professionals or even his absence, mainly doctors, making it difficult and disperses.
After evaluating the high morbidity and mortality associated with HAS and its prevalence in UBS New Colorado II, noted the need to develop strategies that could improve the approach of these patients, not only in relation to treatment adherence, but also in disseminating information about the disease, to prevent complications. Was set so the creation and implementation of hypertensive groups.
Before establishing a routine for the hypertensive group, lifting the epidemiological profile of the population of hypertensive UBS New Colorado II, to suit the needs and routine reality of the local population.
The epidemiological profile analysis was performed using the HIPERDIA sheets of 140 hypertensive using UBS New Colorado II not only purchase medication, but also to medical follow-up.
As for the genre, there was a predominance of female, corresponding to more than 62% of the population of hypertensive individuals, therefore the operating hours of the group must take into account the time which is waived for domestic activities and care for the children. The prevalent age group was between 45 and 55 years and over 20% are people not literate, so the importance of illustrative stamps, showing timetables that medicines should be used.
The black hypertensive population in UBS reaches 23.57% and as studies show that hypertension in the black race has higher prevalence, worse and more serious complications, this group should be intensively monitored.
Blood pressure levels in about 70% of hypertensive patients, at the time of registration varied between normal blood pressure and hypertension Stage 1, at which point there is still no damage in target organs and a proper adhesion to the treatment will prevent future complications.
It is known that obesity is considered a risk factor for hypertension arterial5, a fact that can be proved, since 80% of the registered patients were overweight or obese in different levels.
After epidemiological profile analysis of hypertensive patients, was conducted interview with UBS's health team (doctor, nurse, nursing and community health agents) and established routine for deployment of the hypertensive group, which follows below.
When a family moves into a neighborhood within the territory of the unit, will receive a visit from an ACS to fill plug the family name. If there is a hypertension, will be filled the plug B HAS and the patient will be instructed to look for UBS to schedule medical consultation and be registered on the chart of HIPERDIA nursing technique.
Has been defined, that the doctor's appointments and fill the HIPERDIA will be held on Thursdays in the afternoon. Prior medical consultation will be held for nursing technique pre-query, when will be measured and recorded the following data: blood pressure, Abdominal waist, height and weight.
The hypertensive group meetings will be held on Fridays in the morning period, each week with hypertensive population of a micro area, in a space provided by the community itself. Since they are 05 micros areas, the meeting will happen every 05 weeks.
On Friday the health team of UBS will meet at 7:30 hours on the drive to get necessary equipment and move to the area. The meetings will be held from 8:00 to 10:00 with the following activities:
1. Activity: Physics
Muscle stretching activities will be carried out with varied Dynamics (use of ball games, among others), with a duration of 15 minutes.
Activity 2: Nutrition
Will be held Lectures lasting 30 minutes.
Themes: reuse of food, divided into two conferences, with the aim of family economy, nutritional knowledge of foods that were discarded for redirection of food needed in the diet; How to make hipossódicas and hipolipídicas recipes, but tasty and at the fourth meeting will be promoted the distribution of seeds or seedlings of food, which can be planted at home to be used in food, as well as guidance about food hipossódica diet and hipolipídica.
third activity: Hypertension
Will be held Talks lasting 15 minutes, when they will be portrayed the pathological aspects on Hypertension and its implications.
Themes: diagnosis of Hypertension and risk factors; Pharmacological and non-Pharmacological treatment of Hypertension; Complications of Hypertension and the fourth meeting, will be presented aspects of diseases that are being disseminated in the media and/or diseases related to age of the group, and must be defined previously by the health team.
fourth activity: case studies of the patient in relation to the diagnosis of Hypertension.
Lasting 1 hour, is a time reserved for patients stop Exchange experiences about how they're dealing with the disease, ask questions and express an opinion on the future activities of the group.
Themes: acceptance of the diagnosis; How to live with chronic disease; Pharmacological and non-pharmacological treatment and Family Participation in the control of the disease.
At the end of the meeting, the patients ' blood pressure is checked.
Patients who submit blood pressure equal to or greater than 180 X 110 mmHg, should receive medical assistance on the same day.
Patients with blood pressure equal to or greater than 160 X 100 mmHg and less than 180 X 110 mmHg should be investigated as the regularity of the use of the medication. If you're making regular use of medication for HAS, should receive medical assistance on the same day. If not, receive advice as to the proper use by nursing and is scheduled return on UBS for recalibration in 48 hours. At UBS, after 48 hours, if they're still with blood pressure equal to or greater than 160 X 100 mmHg should be scheduled for medical consultation.
Patients with blood pressure equal to or less than 159 X 99 mmHg, must have schedule for each query 3 months, turns the day of care between the nurse and the physician.
The health team from UBS New Colorado II be liable for its own displacement and transporting the material needed to carry out the activities of the hypertensive group.
THANKS
All family health Team of the new Colorado II, especially the nurse Claudia Aparecida Becker for the encouragement and unconditional support, nursing techniques Elmaz Gattass and Eva Oliveira, Receptionist Vanda Tony, to Sports, to Angelica Community Health Agents Dadiana Curlan Schefer, Hosanna Gloria Iracema Maria da Silva Santos, Maristela Z and Roseli de Souza Aguiar the receptiveness , inspiration and support.
Bibliographical References
1) Ch F, Junior TR, Machado JCCS. An anthropological research in the third age: conceptions of the hypertension. Notebook public health 1998; 14:617-21.
2) Car MR, Pierin AMG, Aquinas VLA. Study on the influence of the educational process in the control of hypertension. Rev Esc Nurses USP 1991; 25:259-69.
3) SAW Brazilian guidelines of hypertension. ARQ Bras Cardiol 2010; 95 (1 Suppl. 1): 1-51
4) Ministry of health. Systemic Hypertension. Schedules of basic care 2006; No.: 15.
5) Fuchs FD, Moreira LB, Mathur SR, Neves JM, PK, Velvet Vine RS, et al. Prevalence of hypertension in the urban population of Catanduva, in the state of São Paulo, Brazil. ARQ Bras Cardiol 2001; 77:9-21.
6) DJ and associate, Pavlik VN. Characteristics of patients with uncontrolled hypertension in the United States. N Engl J Med 2001; 345:479-486.
7) Lamb G, On, Son FFR, Guimarães, Lerário D, Ferreira SRG, et al. Influence of body fat distribution on the prevalence of hypertension and other cardiovascular risk factors in obese subjects. Brazilian Medical Association Rev Jul-Sep 2003; 49.
8) number of Diabetics, hypertension and Diabetics with hypertension for sex, type, and risk, on 28 April 2010. Available at: http://hiperdia.datasus.gov.br/hiperelhiperrisco.asp
Organization chart of care of patients.
ource: Author
Epidemiological profile of the population of hypertensive patients of basic health unit New Colorado II, for the period from 30 March 2010 to 21 May 2010.
| SEX | ||||||
| Male | 37.14% | |||||
| Female | 62.85% | |||||
| AGE | ||||||
| 15 – 19 years | 0.71% | |||||
| 25-29 years | 2.85% | |||||
| 30 – 34 years | 3.57% | |||||
| 35-39 years | 5.71% | |||||
| 40 – 44 years | 7.14% | |||||
| 45-49 years | 15% | |||||
| 50-54 years | 15% | |||||
| 55-59 years | 14.28% | |||||
| 60 – 64 years | 10.71% | |||||
| 65-69 years | 11.42% | |||||
| 70 – 74 years | 5.71% | |||||
| 75 – 79 years | 2.85% | |||||
| Over 80 years | 5% | |||||
| RACE-COLOR | ||||||
| White | 10% | |||||
| Black | 23.57% | |||||
| Yellow | 1.42% | |||||
| Parda | 63.57% | |||||
| BODY MASS INDEX (BMI) | ||||||
| Normal (18.5 -24.9) | 20% | |||||
| Overweight (25.0 -29.9) | 36.42% | |||||
| Obese class I (30.0 -34.9) | 27.14% | |||||
| Obese class II (35.0 -39.9) | 11.42% | |||||
| Obese Class III (≥ 40) | 5% | |||||
| Blood pressure (mmHg) | ||||||
| Normal blood pressure (SBP: ≤ 139 or PAD: ≤ 89) | 35% | |||||
| Stage 1 hypertension (140-159 or PAS: PAD 90-99) | 34.28% | |||||
| Stage 2 (PAS: 160-179 or PAD: 100-109) | 21.42% | |||||
| Stage 3 (PAS: ≥ 180 or PAD: ≥ 110) | 9.28% | |||||
| SCHOOLING | ||||||
| Cannot read/write | 21.42% | |||||
| Literate | 20.71% | |||||
| Essential Incomplete | 33.57% | |||||
| Full Key | 10.71% | |||||
| Medium Incomplete | 3.57% | |||||
| Complete Medium | 7.14% | |||||
| Full Top | 1.42% | |||||
[1] Lecturer In The Dept. Of Medical Clinic, HUJM, UFMT
[2] Lecturer in the Dept DCBS, UFMT
