Feiras de saúde como uma estratégia de rastreamento e monitoramento de hipertensão arterial e diabetes mellitus no âmbito da Atenção Primária à Saúde

Abstract

Objective: To describe the tracking and monitoring of people with Hypertension (AH) and Diabetes Mellitus (DM) through health fairs within the scope of Primary Health Care in the city of Vitória da Conquista-Bahia. Methods: a cross-sectional study, part of the HealthRise project, with data collected at 23 health fairs in Family Health Units and Basic Health Units, from May/2017 to April/2018. People with AH, DM and their family members were included. In data collection, an interview was conducted and blood pressure, capillary blood glucose, glycated hemoglobin and anthropometric measurements were collected. For the analysis of article 1, a stratification by the gender variable was carried out, and descriptive analyzes of the population were carried out. A bivariate analysis was also carried out between the presence of comorbidities and the variables under study. Then, the analysis was divided into two groups: one for tracking AH and DM and one for monitoring these conditions. For the second article, a descriptive analysis of the risk score and an assessment of its internal consistency were performed. Sensitivity and specificity were calculated for three different compositions in the patient group. The Positive (PPV) and Negative (NPV) Predictive Values were also calculated. Results: 23 health fairs were held, with the participation of 3,254 volunteers, most of whom were women (70.0%). Of the participants, 43.6% had only AH, 3.9% only DM and 18.2% had both diseases. Screening showed a large number of alterations suggestive of DM and AH, since 81.8% of men with AH referred for glycated hemoglobin (HbA1c) collection showed altered values, and among men with DM, 75.5% had altered BP values. In the analysis of DM monitoring in men, 65.6% of those with DM only did not have HbA1c control, and in females, there was no control in 66.0% of users with DM. In the monitoring of AH in males, it was observed that more than 60% of participants did not have control of blood pressure levels, and in the female stratum, more than 58% of users did not have this control. According to the test result, the risk of developing DM2 was present in 62.6% of the participants. Sensitivity was 86.2% when using HbA1c with values covering pre-diabetes, and specificity was 39.7% when using self-reported information. The PPV was 79.1% when considering pre-diabetes levels in the patient group, and the NPV was 68.8% when considering only DM values in the patient group. Conclusions: With the good number of participants in health fairs, and with the identification of several users with alterations in blood pressure and glycated hemoglobin, with or without prior knowledge of the disease, it is possible to confirm the importance and usefulness of health fairs. It was possible to identify users chosen for prevention and treatment measures, in a single place and time, with better management of the resources available in the SUS. It was also observed that the application of a type 2 diabetes mellitus risk test is a good tool for screening in collective approaches, such as in participants of health fairs in Primary Care. It was observed that they can identify individuals at greater risk and refer them to biochemical measurements.