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Tanaka OY, Akerman M, Louvison MCP, Bousquat A, Pinto NRDS, Meira ALP, Godoi LPDS, Pereira APCEM, Spedo SM, de Oliveira MB, Eshriqui I, Paresque MAC. Challenges to implementing planning processes in Brazilian health regions. Rev Saude Publica 2024; 57Suppl 3:2s. [PMID: 38629666 PMCID: PMC11037912 DOI: 10.11606/s1518-8787.2023057005138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 02/15/2023] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE To recognize elements that facilitated or hindered the PlanificaSUS implementation stages. METHODS A multiple case study was carried out in four pre-selected health regions in Brazil-Belo Jardim (PE), Fronteira Oeste (RS), Sul-Mato-Grossense (MT) and Valença (BA) using systemic arterial hypertension and maternal and child care as tracer conditions. Participant observation (in regional interagency commissions) and in-depth interviews with key informants from state and municipal management and primary health care and specialized outpatient care service professionals within the project were carried out in these four regions. Analysis was built according to political, technical-operational, and contextual dimensions. RESULTS The political dimension evinced that the regions found the project an opportunity to articulate states and municipalities and an important political bet to build networks and lines of care but that there remained much to be faced in the disputes related to building the Unified Health System (SUS). In the technical operational dimension, it is important to consider that primary health care stimulated a culture of local planning and favored traditional tools to organize and improve it, such as organizing registrations, agendas, and demands. However, centralized training and planning-inducing processes fail to always respond to local needs and can produce barriers to implementation. CONCLUSIONS It is worth considering the central and regional role of state managers in the commitment related to the project and the effect of mobilizing primary health care and expanding its power. There remains much to be faced in the disputes at stake in bullring SUS.
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Affiliation(s)
- Oswaldo Yoshimi Tanaka
- Universidade de São PauloFaculdade de Saúde PúblicaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. São Paulo, SP, Brasil
| | - Marco Akerman
- Universidade de São PauloFaculdade de Saúde PúblicaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. São Paulo, SP, Brasil
| | - Marília Cristina Prado Louvison
- Universidade de São PauloFaculdade de Saúde PúblicaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. São Paulo, SP, Brasil
| | - Aylene Bousquat
- Universidade de São PauloFaculdade de Saúde PúblicaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. São Paulo, SP, Brasil
| | - Nicanor Rodrigues da Silva Pinto
- Universidade Federal de São PauloPrograma de Pós-Graduação em Saúde da FamíliaSão PauloSPBrasilUniversidade Federal de São Paulo. Programa de Pós-Graduação em Saúde da Família. São Paulo, SP, Brasil
| | - Ana Lígia Passos Meira
- Universidade de São PauloFaculdade de Saúde PúblicaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. São Paulo, SP, Brasil
| | - Lídia Pereira da Silva Godoi
- Universidade de São PauloFaculdade de Saúde PúblicaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. São Paulo, SP, Brasil
| | - Ana Paula Chancharulo e Morais Pereira
- Universidade do Estado da BahiaDepartamento de Ciências da VidaSalvadorBABrasilUniversidade do Estado da Bahia. Departamento de Ciências da Vida. Salvador, BA, Brasil
| | - Sandra Maria Spedo
- Universidade Federal de São PauloPrograma de Pós-Graduação em Saúde da FamíliaSão PauloSPBrasilUniversidade Federal de São Paulo. Programa de Pós-Graduação em Saúde da Família. São Paulo, SP, Brasil
| | - Monique Batista de Oliveira
- Universidade de São PauloFaculdade de Saúde PúblicaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. São Paulo, SP, Brasil
| | - Ilana Eshriqui
- Hospital Israelita Albert EinsteinCentro de Estudos Pesquisa e Prática em Atenção Primária à Saúde e RedesSão PauloSPBrasilHospital Israelita Albert Einstein. Centro de Estudos Pesquisa e Prática em Atenção Primária à Saúde e Redes. São Paulo, SP, Brasil
| | - Marcio Anderson Cardozo Paresque
- Hospital Israelita Albert EinsteinCentro de Estudos Pesquisa e Prática em Atenção Primária à Saúde e RedesSão PauloSPBrasilHospital Israelita Albert Einstein. Centro de Estudos Pesquisa e Prática em Atenção Primária à Saúde e Redes. São Paulo, SP, Brasil
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Guimarães MCDLP, Coelho JC, da Silva GV, Drager LF, Gengo e Silva Butcher RDC, Butcher HK, Pierin AMG. Blood Pressure Control and Adherence to Drug Treatment in Patients with Hypertension Treated at a Specialized Outpatient Clinic: A Cross-Sectional Study. Patient Prefer Adherence 2021; 15:2749-2761. [PMID: 34916785 PMCID: PMC8670885 DOI: 10.2147/ppa.s336524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/21/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To evaluate and identify variables associated with the control of hypertension and adherence to antihypertensive drug treatment in a group of patients with hypertension monitored in a specialized, highly complex outpatient service. METHODS A prospective, cross-sectional study was carried out in the hypertension unit of a tertiary teaching hospital. Patients diagnosed with hypertensive aged 18 years and over and accompanied for at least six months were included in the study. Patients with secondary hypertension and pregnant women were excluded. The sample consisted of 253 patients. Adherence/concordance to antihypertensive treatment was assessed using the Morisky Green Levine Scale. Blood pressure control was set for values less than 140/90 mmHg. Variables with p≤0.20 in univariate analysis were included in multiple logistic regression. The level of significance adopted was p ≤0.05. RESULTS Most of patients were white, married and women, with a mean age of 65 (13.3) years old, low income, and education levels. Blood pressure control and adherence were observed in 69.2% and 90.1% of the patients, respectively. Variables that were independently associated with blood pressure control were (OR, odds ratio; CI, 95% confidence interval): married marital status (OR 2.3; CI 1.34-4.28), use of calcium channel blockers (OR 0.4; CI 0.19-0.92) and number of prescribed antihypertensive drugs (OR 0.78; CI 0.66-0.92). Adherence was not associated with any of the variables studied. CONCLUSION There was a high frequency of patients with satisfactory adherence to antihypertensive drug treatment. Blood pressure control was less frequent and was associated with social and treatment-related factors.
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Affiliation(s)
| | - Juliana Chaves Coelho
- Graduate Program in Adult Health Nursing (PROESA), University of São Paulo Nursing School, São Paulo, SP, Brazil
| | - Giovanio Vieira da Silva
- Hypertension Unit, Renal Division, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Luciano Ferreira Drager
- Hypertension Unit, Renal Division, University of São Paulo Medical School, São Paulo, SP, Brazil
- Hypertension Unit, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, SP, Brazil
| | | | - Howard K Butcher
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Angela Maria Geraldo Pierin
- Graduate Program in Adult Health Nursing (PROESA), University of São Paulo Nursing School, São Paulo, SP, Brazil
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Curado DDSP, Gomes DF, Silva TBC, Almeida PHRF, Tavares NUL, Areda CA, da Silva EN. Direct cost of systemic arterial hypertension and its complications in the circulatory system from the perspective of the Brazilian public health system in 2019. PLoS One 2021; 16:e0253063. [PMID: 34111216 PMCID: PMC8191920 DOI: 10.1371/journal.pone.0253063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/28/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Systemic arterial hypertension (SAH), a global public health problem and the primary risk factor for cardiovascular diseases, has a significant financial impact on health systems. In Brazil, the prevalence of SAH is 23.7%, which caused 203,000 deaths and 3.9 million DALYs in 2015. OBJECTIVE To estimate the cost of SAH and circulatory system diseases attributable to SAH from the perspective of the Brazilian public health system in 2019. METHODS A prevalence-based cost-of-illness was conducted using a top-down approach. The population attributable risk (PAR) was used to estimate the proportion of circulatory system diseases attributable to SAH. The direct medical costs were obtained from official Ministry of Health of Brazil records and literature parameters, including the three levels of care (primary, secondary, and tertiary). Deterministic univariate analyses were also conducted. RESULTS The total cost of SAH and the proportion of circulatory system diseases attributable to SAH was Int$ 581,135,374.73, varying between Int$ 501,553,022.21 and Int$ 776,183,338.06. In terms only of SAH costs at all healthcare levels (Int$ 493,776,445.89), 97.3% were incurred in primary care, especially for antihypertensive drugs provided free of charge by the Brazilian public health system (Int$ 363,888,540.14). Stroke accounted for the highest cost attributable to SAH and the third highest PAR, representing 47% of the total cost of circulatory diseases attributable to SAH. Prevalence was the parameter that most affected sensitivity analyses, accounting for 36% of all the cost variation. CONCLUSION Our results show that the main Brazilian strategy to combat SAH was implemented in primary care, namely access to free antihypertensive drugs and multiprofessional teams, acting jointly to promote care and prevent and control SAH.
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Affiliation(s)
| | - Dalila Fernandes Gomes
- Graduate Program in Public Health, University of Brasilia, Brasilia, Federal District, Brazil
| | | | | | | | - Camila Alves Areda
- Faculty of Ceilandia, University of Brasilia, Brasilia, Federal District, Brazil
| | - Everton Nunes da Silva
- Graduate Program in Public Health, University of Brasilia, Brasilia, Federal District, Brazil
- Faculty of Ceilandia, University of Brasilia, Brasilia, Federal District, Brazil
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Coelho JC, Guimarães MCDLP, de Campos CL, Florido CF, da Silva GV, Pierin AMG. Blood pressure control of hypertensive patients followed in a high complexity clinic and associated variables. J Bras Nefrol 2021; 43:207-216. [PMID: 33617623 PMCID: PMC8257288 DOI: 10.1590/2175-8239-jbn-2020-0133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/02/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Arterial hypertension is a disease that has a high impact on cardiovascular mortality and morbidity; however, it is still insufficiently controlled. OBJECTIVES To assess hypertension control in patients seen at a specialized clinic and to identify associated variables. METHOD Cross-sectional study involving the analysis of medical records from 782 patients treated in a highly complex outpatient clinic. Inclusion criteria: age ≥18 years, diagnosed with hypertension, in treatment ≥6 months. Patients with secondary hypertension (104) and incomplete data (64) were excluded. The main outcome was blood pressure control (systolic <140 and diastolic <90 mmHg). The independent variables studied were: sociodemographic and clinical characteristics (use of drugs, comorbidities and laboratory tests). Pearson's χ2 tests, Fisher's test, Student's t and Wilcoxon-Mann-Whitney tests were performed in the bivariate analysis and logistic regression in the multiple analyses, adopting p≤0.05. RESULTS The prevalence of hypertensive control was 51.1%. It was associated with a lack of control: body mass index (OR = 1.038; 95% CI = 1.008 - 1.071), history of stroke (OR = 0.453; 95% CI = 0.245 - 0.821), left ventricular hypertrophy (OR = 1.765; 95% CI = 1.052 - 3.011), and number of medications (OR = 1.082; 95% CI = 1.033 - 1.136). CONCLUSION About half of the hypertensive patients had their blood pressure controlled; clinical variables and target organ damage were associated with the control.
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Jardim TV, Souza ALL, Barroso WKS, Jardim PCBV. Blood Pressure Control and Associated Factors in a Real-World Team-Based Care Center. Arq Bras Cardiol 2020; 115:174-181. [PMID: 32876180 PMCID: PMC8384292 DOI: 10.36660/abc.20180384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/17/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although team-based care is recommended for patients with hypertension, results of this intervention in a real-world setting are missing in the literature. OBJECTIVE To report the results of a real-world long-term team-based care for hypertensive patients we conducted this study. METHODS Data of hypertensive patients attending a multidisciplinary treatment center located in the Midwest region of Brazil in June 2017 with at least two follow-up visits were retrospectively assessed. Anthropometric, blood pressure (BP), follow-up time, pharmacological treatment, diabetes and lifestyle data were collected from the last visit to the service. BP values < 140 x 90 mmHg in non-diabetics and < 130 x 80 mmHg in diabetics were considered controlled. A logistic regression model was built to identify variables independently associated to BP control. Significance level adopted p < 0.05. RESULTS A total of 1,548 patients were included, with a mean follow-up time of 7.6 ± 7.1 years. Most patients were female (73.6%; n=1,139) with a mean age of 61.8 ±12.8 years. BP control rates in all the sample, and in non-diabetics and diabetics were 68%, 79%, and 37.9%, respectively. Diabetes was inversely associated with BP control (OR 0.16; 95%CI 0.12-0.20; p<0.001) while age ≥ 60 years (OR 1.48; 95%CI 1.15-1.91; p=0.003) and female sex (OR 1.38; 95%CI 1.05-1.82; p=0.020) were directly associated. CONCLUSIONS A BP control rate around 70% was found in patients attending a multidisciplinary team care center for hypertension. Focus on patients with diabetes, younger than 60 years and males should be given to further improve these results. (Arq Bras Cardiol. 2020; 115(2):174-181).
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Affiliation(s)
- Thiago Veiga Jardim
- Universidade Federal de Goiás - Programa de Pós-Graduação em Ciências da Saúde , Goiânia , GO - Brasil.,Universidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia , GO - Brasil
| | - Ana Luiza Lima Souza
- Universidade Federal de Goiás - Programa de Pós-Graduação em Ciências da Saúde , Goiânia , GO - Brasil.,Universidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia , GO - Brasil
| | - Weimar Kunz Sebba Barroso
- Universidade Federal de Goiás - Programa de Pós-Graduação em Ciências da Saúde , Goiânia , GO - Brasil.,Universidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia , GO - Brasil
| | - Paulo Cesar B Veiga Jardim
- Universidade Federal de Goiás - Programa de Pós-Graduação em Ciências da Saúde , Goiânia , GO - Brasil.,Universidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia , GO - Brasil
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Znyk M, Polańska K, Bąk-Romaniszyn L, Kaleta D. Correlates of Blood Pressure and Cholesterol Level Testing Among a Socially-Disadvantaged Population in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2123. [PMID: 32210004 PMCID: PMC7142992 DOI: 10.3390/ijerph17062123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 12/29/2022]
Abstract
As part of cardiovascular disease prevention, the performance of BMI determination, blood pressure measurement, biochemical tests, as well as a lifestyle-related risk assessment are recommended. The aim of this study was to evaluate the correlates of blood pressure and cholesterol level testing among a socially-disadvantaged population in Poland. This cross-sectional study was performed between 2015 and 2016 among 1710 beneficiaries of government welfare assistance. Face-to-face interviews conducted by trained staff at each participant's place of residence allowed for completion of questionnaires that covered socio-demographic, health and lifestyle-related information. Sixty-five percent of the participants declared a blood pressure and 27% of them cholesterol level testing at least once within the year proceeding the study. A higher chance of having blood pressure testing was observed among the women (OR = 1.5; p = 0.002) and people with high blood pressure (OR = 3.9; p < 0.001). The women (OR = 1.4; p = 0.04) and older people (OR = 1.9; p = 0.02; OR = 2.6; p < 0.001, OR = 2.7; p = 0.002, for the following age groups: 30-39, 40-49, 50-59 years respectively), the respondents who declared health problems such as heart attack (OR = 3.0; p = 0.04), high blood pressure (OR = 2.3; p < 0.001) and type 2 diabetes (OR = 3.3; p = 0.004) and those with a family history of chronic diseases (OR = 1.5; p = 0.03) had a higher chance of cholesterol level checking. Higher healthy lifestyle index, indicating that the study participants have followed almost all of the studied lifestyle-related recommendations, was a significant correlate of cholesterol level testing (OR = 1.7; p = 0.006). Actions that promote lifestyle changes, blood pressure, and cholesterol level testing should take into account the needs of the disadvantaged population and should especially target men, people with existing chronic diseases, and those with unfavorable lifestyle characteristics. With respect to the socially-disadvantaged population, the social assistance institutions and outpatient clinics are the best places to conduct activities promoting a healthy lifestyle. The most commonly applied strategies to promote lifestyle changes can cover risk assessment, increasing awareness, emotional support and encouragement, as well as a referral to specialists.
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Affiliation(s)
- Małgorzata Znyk
- Department of Hygiene and Epidemiology, Medical University of Lodz, 90-647 Lodz, Poland; (K.P.); (D.K.)
| | - Kinga Polańska
- Department of Hygiene and Epidemiology, Medical University of Lodz, 90-647 Lodz, Poland; (K.P.); (D.K.)
| | - Leokadia Bąk-Romaniszyn
- Department of Nutrition in Digestive Tract Diseases, Medical University of Lodz, 93-338 Lodz, Poland;
| | - Dorota Kaleta
- Department of Hygiene and Epidemiology, Medical University of Lodz, 90-647 Lodz, Poland; (K.P.); (D.K.)
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Oliveira IM, Duarte YADO, Zanetta DMT. Prevalence of Systemic Arterial Hypertension Diagnosed, Undiagnosed, and Uncontrolled in Elderly Population: SABE Study. J Aging Res 2019; 2019:3671869. [PMID: 31565434 PMCID: PMC6745120 DOI: 10.1155/2019/3671869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 08/16/2019] [Indexed: 02/05/2023] Open
Abstract
Systemic arterial hypertension is the most prevalent chronic noncommunicable disease among older people. This study aimed to estimate the prevalence of hypertension in the elderly and to analyze factors associated with diagnosed, undiagnosed, and uncontrolled hypertension. This is a cross-sectional study of data from the SABE study-Health, Well-Being, and Aging Survey-a multiple-cohort study, obtained in 2010, composed of a probabilistic sample representative of the population of the São Paulo city aged ≥60 years. Hypertension was self-reported or defined by increased blood pressure. Multinomial regression assessed factors associated with diagnosis and lack of diagnosis of hypertension (reference: no hypertension), and logistic regression assessed factors associated with uncontrolled hypertension (reference: controlled). The prevalence of hypertension was 79.5%, and in 51% of individuals with the condition, hypertension was uncontrolled. Undiagnosed hypertension was associated with nonwhite skin color (OR: 1.89, CI: 1.11-3.19), being uninsured (OR: 1.77, CI: 1.04-3.03), overweight (OR: 2.38, CI: 1.09-5.19), higher education (OR: 0.46, CI: 0.22-1.94), and ≥1 chronic disease (OR: 0.28; CI: 0.13-0.58). Diagnosed hypertension was associated with age between 70 and 79 years (OR: 2.02, CI: 1.34-3.05), age ≥80 (OR: 2.73, CI: 1.72-4.31), nonwhite skin color (OR: 1.48, CI: 1.01-2.18), being uninsured (OR: 1.70, CI: 1.18-2.47), at least one medical consultation in the last year (OR: 1.86, CI: 1.06-3.25), obesity (OR: 2.50, CI: 1.61-3.88), and ≥1 chronic disease (OR: 2.81, CI: 1.94-4.08). Among those with hypertension, being uncontrolled was associated with widowhood (OR: 1.73, CI: 1.23-2.43), being uninsured (OR: 1.38, CI: 1.02-1.87), and female gender (OR: 0.61, CI: 0.43-0.87). The prevalence of hypertension was high in this population, and its diagnosis and control were associated with socioeconomic, demographic, and healthcare access factors.
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Malachias MVB, Franco RJS, Forjaz CLM, Pierin AMG, Gowdak MMG, Klein MRST, Matsudo V. 7th Brazilian Guideline of Arterial Hypertension: Chapter 6 - Non-pharmacological treatment. Arq Bras Cardiol 2017; 107:30-34. [PMID: 27819385 PMCID: PMC5319467 DOI: 10.5935/abc.20160156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Novello MF, Rosa MLG, Ferreira RT, Nunes IG, Jorge AJL, Correia DMDS, Martins WDA, Mesquita ET. Compliance with the Prescription of Antihypertensive Medications and Blood Pressure Control in Primary Care. Arq Bras Cardiol 2017; 108:135-142. [PMID: 28327875 PMCID: PMC5344658 DOI: 10.5935/abc.20170009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 10/18/2016] [Indexed: 01/13/2023] Open
Abstract
Background Hypertension is the most prevalent risk factor for cardiovascular disease,
and its proper control can prevent the high morbidity and mortality
associated with this disease. Objective To assess the degree of compliance of antihypertensive prescriptions with the
VI Brazilian Guidelines on Hypertension and the blood pressure control rate
in primary care. Methods Cross-sectional study conducted between August 2011 and November 2012,
including 332 adults ≥ 45 years registered in the Family Doctor
Program in Niteroi and selected randomly. The analysis included the
prescribed antihypertensive classes, doses, and frequencies, as well as the
blood pressure (BP) of the individuals. Results The rate of prescription compliance was 80%. Diuretics were the most
prescribed medications, and dual therapy was the most used treatment. The
most common non-compliances were underdosing and underfrequencies. The BP
goal in all cases was < 140/90 mmHg, except for diabetic patients, in
whom the goal was set at < 130/80 mmHg. Control rates according to these
goals were 44.9% and 38.6%, respectively. There was no correlation between
prescription compliance and BP control. Conclusions The degree of compliance was considered satisfactory. The achievement of the
targets was consistent with national and international studies, suggesting
that the family health model is effective in BP management, although it
still needs improvement.
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Affiliation(s)
- Mayra Faria Novello
- Departamento de Medicina Clínica - Universidade Federal Fluminense, Niterói, RJ - Brazil
| | - Maria Luiza Garcia Rosa
- Departamento de Epidemiologia e Bioestatística - Universidade Federal Fluminense, Niterói, RJ - Brazil
| | - Ranier Tagarro Ferreira
- Departamento de Epidemiologia e Bioestatística - Universidade Federal Fluminense, Niterói, RJ - Brazil
| | - Icaro Gusmão Nunes
- Departamento de Epidemiologia e Bioestatística - Universidade Federal Fluminense, Niterói, RJ - Brazil
| | | | - Dayse Mary da Silva Correia
- Departamento de Fundamentos de Enfermagem e Administração - Universidade Federal Fluminense, Niterói, RJ - Brazil
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de Campos CL, Pierin AMG, de Pinho NA. Hypertension in patients admitted to clinical units at university hospital: post-discharge evaluation rated by telephone. EINSTEIN-SAO PAULO 2017; 15:45-49. [PMID: 28444088 PMCID: PMC5433306 DOI: 10.1590/s1679-45082017ao3862] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/20/2017] [Indexed: 11/21/2022] Open
Abstract
Objective To characterize hypertensive patients after admission to hospital considering the current status, compliance to treatment, habits and lifestyle, and knowledge and beliefs about the disease. Methods This was an exploratory study with 265 hypertensive patients admitted to a medical inpatients unit of a university hospital. Data were collected in an interview over the telephone. The level of significance was set as p<0.05. Results It was found that 32% of hypertensive patients had died. One hundred patients were interviewed, mean age of 64.15 (13.2) years, 51% were women, 56% non-white, 51% with primary education, 52% were retired, 13% were smokers, 38% used alcohol, 80% did not perform physical exercise, and the mean body mass index was 35.9 (15.5) kg/m2. The comorbidities were heart problem (52%), diabetes (49%) and stroke (25%). As to antihypertensive treatment, 75% were on use, 17.3% stopped taking them and 21.3% missed visits. The treatment sites were the primary care unit (49%) and hospital (36%). As for knowledge and beliefs, 25% believed hypertension is curable, 77% that treatment should last for the rest of their lives, and hypertension brings complications (84%). A total of 46.7% were controlled. The lack of control was associated (p<0.05) with non-white ethnicity and absence of heart problems. Conclusion There were significant deaths occurred after hospitalization and poor control of blood pressure, probably due to inadequate habits and lifestyles and non-compliance to antihypertensive treatment.
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Affiliation(s)
| | | | - Natalia Alencar de Pinho
- Centre d’Epidémiologie et Santé des Populations, Institut National de la Santé et de la Recherche Médicale Unité 1018, Villejuif, France
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Mengue SS, Bertoldi AD, Ramos LR, Farias MR, Oliveira MA, Tavares NUL, Arrais PSD, Luiza VL, Pizzol TDSD. Access to and use of high blood pressure medications in Brazil. Rev Saude Publica 2016; 50:8s. [PMID: 27982380 PMCID: PMC5157910 DOI: 10.1590/s1518-8787.2016050006154] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 03/12/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To analyze the access to and use of medicines for high blood pressure among the Brazilian population according to social and demographic conditions. METHODS Analysis of data from Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), a nationwide cross-sectional, population-based study, with probability sampling, carried out between September 2013 and February 2014 in urban households in the five Brazilian regions. The study evaluated the access and use of medicines to treat people with high blood pressure. The independent variables were gender, age, socioeconomic status and Brazilian region. The study also described the most commonly used drugs and the percentage of people treated with one, two, three or more drugs. Point estimations and confidence intervals were calculated considering the sample weights and sample complex plan. RESULTS Prevalence of high blood pressure was 23.7% (95%CI 22.8-24.6). Regarding people with this condition, 93.8% (95%CI 92.8-94.8) had indication for drug therapy and, of those, 94.6% (95%CI 93.5-95.5) were using the medication at the time of interview. Full access to medicines was 97.9% (95%CI 97.3-98.4); partial access, 1.9% (95%CI 1.4-2.4); and no access, 0.2% (95%CI 0.1-0.4). The medication used to treat high blood pressure, 56.0% (95%CI 52.6-59.2) were obtained from SUS (Brazilian Unified Health System), 16.0% (95%CI 14.3-17.9) from Popular Pharmacy Program, 25.7% (95%CI 23.4-28.2) were paid for by the patients themselves and 2.3% (95%CI 1.8-2.9) were obtained from other locations. The five most commonly used drugs were, in descending order, hydrochlorothiazide, losartan, captopril, enalapril and atenolol. Of the total number of patients on treatment, 36.1% (95%CI 34.1-37.1) were using two medicines and 13.5% (95%CI 12.3-14.9) used three or more. CONCLUSIONS Access to medicines for the treatment of high blood pressure may be considered high and many of them are available free of charge. The most commonly used drugs are among those recommended as first-line treatment for high blood pressure control. The percentage of people using more than one drug seems to follow the behavior observed in other countries. OBJETIVO Analisar o acesso e a utilização de medicamentos para a hipertensão na população brasileira segundo condições sociais e demográficas. Análise dos dados da Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos, estudo nacional de delineamento transversal de base populacional, com amostra probabilística, realizado entre setembro de 2013 e fevereiro de 2014 em domicílios urbanos nas cinco regiões do Brasil. Avaliou-se o uso e acesso aos medicamentos para os cuidados com pessoas que apresentam hipertensão arterial. As variáveis independentes utilizadas foram sexo, idade, nível socioeconômico e região do País. Também foram descritos os fármacos mais utilizados e a proporção de pessoas tratadas com um, dois, três ou mais fármacos. As estimativas de ponto e os intervalos de confiança foram calculados considerando os pesos amostrais e o plano complexo da amostra. A prevalência de hipertensão arterial foi de 23,7% (IC95% 22,8-24,6). Das pessoas com a condição, 93,8% (IC95% 92,8-94,8) tinham indicação de tratamento com medicamentos e, destes, 94,6% (IC95% 93,5-95,5) estavam usando os medicamentos no momento da entrevista. O acesso total aos medicamentos foi de 97,9% (IC95% 97,3-98,4); o acesso parcial, de 1,9% (IC95% 1,4-2,4); e o acesso nulo, de 0,2% (IC95% 0,1-0,4). Dos medicamentos utilizados para tratar a hipertensão, 56,0% (IC95% 52,6-59,2) foram obtidos no SUS, 16,0% (IC95% 14,3-17,9), no Programa Farmácia Popular, 25,7% (IC95% 23,4-28,2) pago do próprio bolso e 2,3% (IC95% 1,8-2,9) em outros locais. Os cinco fármacos mais utilizados foram, em ordem descrente, hidroclorotiazida, losartana, captopril, enalapril e atenolol. Do total de tratados, 36,1% (IC95% 34,1-37,1) estavam usando dois fármacos e 13,5% (IC95% 12,3-14,9) utilizavam três ou mais fármacos. CONCLUSÕES : O acesso aos medicamentos para tratamento da hipertensão pode ser considerado elevado e grande parte desses medicamentos é obtida gratuitamente. Os fármacos mais utilizados estão entre os preconizados como de primeira linha para o controle de hipertensão arterial. A proporção de pessoas utilizando mais de um fármaco parece seguir o comportamento observado em outros países.
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Affiliation(s)
- Sotero Serrate Mengue
- Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Andréa Dâmaso Bertoldi
- Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil
| | - Luiz Roberto Ramos
- Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. São Paulo, SP, Brasil
| | - Mareni Rocha Farias
- Departamento de Ciências Farmacêuticas. Centro de Ciências da Saúde. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Maria Auxiliadora Oliveira
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Noemia Urruth Leão Tavares
- Departamento de Farmácia. Faculdade de Ciências da Saúde. Universidade de Brasília. Brasília, DF, Brasil
| | - Paulo Sergio Dourado Arrais
- Departamento de Farmácia. Faculdade de Farmácia, Odontologia e Enfermagem. Universidade Federal do Ceará. Fortaleza, CE, Brasil
| | - Vera Lucia Luiza
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Tatiane da Silva Dal Pizzol
- Departamento de Produção e Controle de Medicamentos. Faculdade de Farmácia. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
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Kuhmmer R, Lazzaretti RK, Guterres CM, Raimundo FV, Leite LEA, Delabary TS, Caon S, Bastos GAN, Polanczyk CA. Effectiveness of multidisciplinary intervention on blood pressure control in primary health care: a randomized clinical trial. BMC Health Serv Res 2016; 16:456. [PMID: 27581760 PMCID: PMC5006538 DOI: 10.1186/s12913-016-1703-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 08/24/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hypertension is a public health problem and a major risk factor for cardiovascular disease. The purpose of this study is to compare the effectiveness of a multidisciplinary program based on group and individual care versus group-only care, to promote blood pressure control in hypertensive patients in primary health care. METHODS Randomized controlled clinical trial. The study was conducted within the primary health care, in two units of the Family Health Strategy, covering 11,000 individuals, in Porto Alegre, Brazil. Two hundred and 56 patients, older than 40 years old and with uncontrolled hypertension, systolic blood pressure (BP) ≥140 mmHg and/or diastolic BP ≥90 mmHg or ≥130 mmHg and/or diastolic BP ≥80 mmHg for individuals with diabetes. Eligible patients were randomly assigned to a health care program aiming for blood pressure control, with the multidisciplinary program group or with the multidisciplinary program plus personalized care group. Primary outcome measures were reduction in systolic BP from baseline to 6 months. Secondary measures included proportion of patients with systolic or diastolic BP controlled. Student t test, Pearson's chi-squared test, Fisher's exact test, Mann-Whitney U test, Wilcoxon signed-ranks test and generalized estimating equation (GEE) model were used in the analysis. RESULTS The baseline characteristics of participants were similar between groups. After 6 months of follow-up, systolic BP decreased markedly in both groups (Δ - 11.8 mmHg [SD, 20.2] in the multidisciplinary program group and Δ - 12.9 mmHg [SD, 19.2] in the personalized care group; p < 0.001). Similarly, we noted a significant change in diastolic BP over time in both groups (Δ - 8.1 mmHg [SD, 10.8] in the multidisciplinary program group and Δ - 7.0 mmHg [SD, 11.5] in the personalized care group; p < 0.001). CONCLUSIONS The study demonstrates similar effectiveness of a group intervention in comparison to a personalized education program in hypertension patients to achieve BP control. These findings indicate that the intervention can be for all hypertensive patients assisted in primary health care. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01696318 (May 2013).
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Affiliation(s)
- Regina Kuhmmer
- Institute for Education and Research, Hospital Moinhos de Vento, Rua Ramiro Barcelos 910, Bloco D, Porto Alegre, RS 90035-001 Brazil
- Graduate Program in Cardiology and Cardiovascular Science, Universidade Federal do Rio Grande do Sul. National Institute for Health Technology Assessment - IATS/CNPq, Porto Alegre, Brazil
| | - Rosmeri Kuhmmer Lazzaretti
- Institute for Education and Research, Hospital Moinhos de Vento, Rua Ramiro Barcelos 910, Bloco D, Porto Alegre, RS 90035-001 Brazil
- Graduate Program in Cardiology and Cardiovascular Science, Universidade Federal do Rio Grande do Sul. National Institute for Health Technology Assessment - IATS/CNPq, Porto Alegre, Brazil
| | - Cátia Moreira Guterres
- Institute for Education and Research, Hospital Moinhos de Vento, Rua Ramiro Barcelos 910, Bloco D, Porto Alegre, RS 90035-001 Brazil
| | - Fabiana Viegas Raimundo
- Institute for Education and Research, Hospital Moinhos de Vento, Rua Ramiro Barcelos 910, Bloco D, Porto Alegre, RS 90035-001 Brazil
- Department of Public Health, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Leni Everson Araújo Leite
- Institute for Education and Research, Hospital Moinhos de Vento, Rua Ramiro Barcelos 910, Bloco D, Porto Alegre, RS 90035-001 Brazil
| | - Tássia Scholante Delabary
- Institute for Education and Research, Hospital Moinhos de Vento, Rua Ramiro Barcelos 910, Bloco D, Porto Alegre, RS 90035-001 Brazil
| | - Suhelen Caon
- Institute for Education and Research, Hospital Moinhos de Vento, Rua Ramiro Barcelos 910, Bloco D, Porto Alegre, RS 90035-001 Brazil
| | - Gisele Alsina Nader Bastos
- Institute for Education and Research, Hospital Moinhos de Vento, Rua Ramiro Barcelos 910, Bloco D, Porto Alegre, RS 90035-001 Brazil
- Department of Public Health, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Carisi Anne Polanczyk
- Institute for Education and Research, Hospital Moinhos de Vento, Rua Ramiro Barcelos 910, Bloco D, Porto Alegre, RS 90035-001 Brazil
- Graduate Program in Cardiology and Cardiovascular Science, Universidade Federal do Rio Grande do Sul. National Institute for Health Technology Assessment - IATS/CNPq, Porto Alegre, Brazil
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Rodrigues MTP, Moreira TMM, Andrade DFD. Elaboration and validation of instrument to assess adherence to hypertension treatment. Rev Saude Publica 2015; 48:232-40. [PMID: 24897044 PMCID: PMC4206136 DOI: 10.1590/s0034-8910.2014048005044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 11/29/2013] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE To elaborate and validate an instrument of adherence to treatment for
systemic arterial hypertension, based on Item Response Theory. METHODS The process of developing this instrument involved theoretical, empirical and
analytical procedures. The theoretical procedures included defining the
construct of adherence to systemic arterial hypertension treatment,
identifying areas involved and preparing the instrument. The instrument
underwent semantic and conceptual analysis by experts. The empirical
procedure involved the application of the instrument to 1,000 users with
systemic arterial hypertension treated at a referral center in Fortaleza,
CE, Northeastern Brazil, in 2012.. The analytical phase validated the
instrument through psychometric analysis and statistical procedures. The
Item Response Theory model used in the analysis was the Samejima Gradual
Response model. RESULTS Twelve of the 23 items of the original instrument were calibrated and
remained in the final version. Cronbach’s alpha coefficient (α) was
0.81. Items related to the use of medication when presenting symptoms and
the use of fat showed good performance as they were more capable of
discriminating individuals who adhered to treatment. To ever stop taking the
medication and the consumption of white meat showed less power of
discrimination. Items related to physical exercise and routinely following
the non-pharmacological treatment had most difficulty to respond. The
instrument was more suitable for measuring low adherence to hypertension
treatment than high. CONCLUSIONS The instrument proved to be an adequate tool to assess adherence to treatment
for systemic arterial hypertension since it manages to differentiate
individuals with high from those with low adherence. Its use could
facilitate the identification and verification of compliance to prescribed
therapy, besides allowing the establishment of goals to be achieved.
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