Avaliação da atenção primária à saúde de pessoas com doença renal crônica

• Ano de defesa: 2019
• Autor(a) principal: Lílian Kelen de Aguiar
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; Brasil; ENFERMAGEM - ESCOLA DE ENFERMAGEM; Programa de Pós-Graduação em Enfermagem; UFMG
• Palavras-chave em Português: Doença crônica; Estudos transversais; Insuficiência renal crônica; Inquéritos epidemiológicos; Avaliação em saúde; Avaliação em saude; Dissertação acadêmica
• Link de acesso: http://hdl.handle.net/1843/32332

This study aims to evaluate the quality of primary health care for patients with Chronic Renal Disease (CKD). This is a cross-sectional study, analyzing the national epidemiological survey and health care assessment for patients with CKD. The study was carried out in 02 stages: characterization of patients with self-reported CKD, based on the National Health Survey (PNS) and a study of the evaluation of Basic Care for patients with CKD, through interviews with medical professionals and nurses of the family health strategy and managers of the Basic Health Units. The PNS is a national survey, conducted by the Brazilian Institute of Geography and Statistics (IBGE), in partnership with the Ministry of Health, conducted in 2013. The sample consisted of 64,348 households, of which 60,202 were individuals, who carried out a specific interview on the state of health, lifestyle and chronic diseases. The prevalence for CKD, stratified according to the variables, was calculated. We performed a bivariate and multivariate analysis, Odds Ratio calculation, indicating an association between factor exposure and CKD and Regression Analysis to evaluate the relationship between the variables with CKD. The evaluation of the quality of primary health care for the DRC patient was developed in the city of Belo Horizonte, Minas Gerais. We selected 03 to 04 Health Centers in each Regional, totaling 30 CS visited. In each CS the manager and at least one doctor and a nurse from the ESF Team were selected. The interviews were conducted between December 2017 and April 2018, using the Assessment of Chronic Illness Care (ACIC) instrument. The ACIC score for Chronic Diseases and CKD was used using the Wilcoxon test to compare the results, using the Kruskal Wallis, Mann-Whitney and Spearman correlation tests to compare the ACIC domains with characterization variables. The analysis of the scores for the Health Regionals occurred through the perceptual maps via Principal Components Analysis. It was also verified the Convergent Validity, Reliability and Dimensionality of the instrument. We verified, in the analysis of PNS data, that 1.42% of the 60,202 interviewees reported being carriers of CKD. The associated variables were increased age and aging, low schooling, health insurance, brown skin color, smoking, hypertension, percholesterolemia, and regular or poor health status. The OR increased progressively with age, being 2.68 among the elderly with 65 years or more. Having higher education and brown color were protective factors for CKD. Health plans were also associated with CKD, as well as smoking, hypertension and high cholesterol, and poor self-rated health showed a greater chance of CKD. The analysis of the data of evaluation of the quality of the primary health care to the patient of CKD showed that the score obtained for evaluation of the Basic Attention to the patient of chronic disease, in general, was of 6.26, "reasonably good support", and the total CKD score was 4.51, "basic support". The total chronic disease score was significantly higher. The domains with the best evaluation were 'Support for Self Care' and 'Care for Care'. The largest difference between chronic disease and CKD evaluations was recorded in the field of Support for Clinical Decisions.