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Previous issue date: 2017-08-16 / A Aten??o Prim?ria ? Sa?de (APS) configura-se como o primeiro contato do usu?rio com o sistema de sa?de, destacando-se com tr?s fun??es essenciais: resolutividade, comunica??o e responsabiliza??o. Apesar do seu fortalecimento, interna??es por agravos que sob sua a??o poderiam ser controlados, continuam ocorrendo, a exemplo da hipertens?o. Da? justifica-se a constru??o de um protocolo para atendimento interprofissional a hipertensos na APS. Objetivou-se construir uma estrat?gia que oriente a gest?o de um cuidado integral ao usu?rio com hipertens?o arterial assistido na APS. Para tanto realizou-se uma revis?o de integrativa, um estudo ecol?gico, um estudo de valida??o e um estudo transversal. Adotou-se, para o estudo ecol?gico e transversal, estat?stica anal?tica com regress?o linear e multivariada; para a valida??o adotou-se o m?todo Delphi, desenvolvido em 4 fases: 1. Leitura pr?via dos referenciais te?ricos, 2. Constru??o do instrumento e apresenta??o a banca de ju?zes, 3. Valida??o por Experts, 4. Reprodutibilidade. A valida??o foi analisada, utilizando uma escala de Likert, pelo ?ndice de concord?ncia (IC) entre os experts, ?ndice de Validade de Conte?do (IVC), Correla??o de Pearson; a an?lise da reprodutibilidade se deu pelos Coeficientes Kappa (?) e o de Correla??o Intraclasse (CCI). A pesquisa envolveu 20 experts (nove m?dicos e 11 enfermeiros) e 160 usu?rios hipertensos alocados por conveni?ncia. A coleta ocorreu de julho/2015 a agosto/2016. O estudo seguiu ?s recomenda??es da Resolu??o 466/2012 que trata de pesquisa com seres humanos, aprovado pelo Comit? de ?tica da Universidade Federal do Rio Grande do Norte, sob n? 1.144.406. Protocolos s?o ferramentas utilizadas para verificar ades?o ao tratamento, sua utiliza??o na gest?o de doen?as cr?nicas, seu impacto no controle da hipertens?o e a satisfa??o do usu?rio com o servi?o. As interna??es por hipertens?o se associam com o percentual de condi??es sens?veis as a??es da APS, renda e ?ndice de desenvolvimento humano. O protocolo revelou-se muito importante - Escala de Likert >4 -, O IC entre os experts foi de 98,1%, o IVC > 0,90, a correla??o de Pearson se mostrou de moderada a forte (p <0,001). Kappa de > 75 e o CCI >0,80; os fatores determinantes para o controle da press?o foram dieta hiposs?dica e interrup??o do tratamento; para a interrup??o do tratamento foram risco metab?lico, estresse e controle da press?o. Apesar da alta cobertura e resolutividade da APS as interna??es por hipertens?o continuam ocorrendo, principalmente na popula??o com vulnerabilidade social. O instrumento mostrou evid?ncias robustas de validade e confiabilidade, bem como de reprodutibilidade. Isso o torna prop?cio para sua utiliza??o na APS. Al?m de constituir-se um guia para a consulta e acompanhamento do usu?rio hipertenso, permite maior di?logo entre o profissional e o paciente. Tamb?m ? um espa?o para que os registros aconte?am de forma mais efetiva, garantindo atendimento mais personalizado, voltado para as necessidades individuais de cada um. O conhecimento dos determinantes do controle da press?o e da interrup??o do tratamento favorece o planejamento das a??es da APS. / Primary Health Care (PHC) is the first contact with the health system, highlighting three essential functions: resolution, communication and accountability. Despite its strengthening, hospitalizations for diseases that could be controlled under its action, continue to occur, such as hypertension. Hence the construction of a protocol for interprofessional care for hypertensive patients in PHC is justified. The objective was to build a strategy that guides the management of comprehensive care to the user with arterial hypertension assisted in PHC. For the ecological and cross-sectional study, we used analytical statistics with linear and multivariate regression. For the validation, the Delphi method was developed in four phases: 1. Preliminary reading of the theoretical references 2. Construction of the instrument and presentation to the judge's bench 3. Validation by Experts 4. Reproducibility. The validation was analyzed using a Likert scale, by the Index of concordance (CI) among experts, Content Validity Index (IVC), Pearson's Correlation; The reproducibility analysis was performed by Kappa (?) and Intraclass Correlation (ICC) coefficients. The research involved 20 specialists (nine physicians and 11 nurses) and 160 hypertensive users allocated for convenience. The collection occurred from July / 2015 to August / 2016. The study followed the recommendations of Resolution 466/2012 that deals with research with human beings, approved by the Ethics Committee of the Federal University of Rio Grande do Norte, under No. 1.144.406. Protocols are tools used to verify adherence to treatment, its use in the management of chronic diseases, its impact on the control of hypertension, and user satisfaction with the service. Hypertension hospitalizations are associated with the percentage of conditions that are sensitive to the actions of Primary Care, income and human development index. The protocol was very important - Likert scale> 4 -, CI among experts was 98.1%, CVI> 0.90, Pearson's correlation was moderate to strong (p <0.001). Kappa of> 75 and CCI> 0.80; The determinant factors for the control of the pressure were hyposodic diet and treatment interruption; For treatment interruption were metabolic risk, stress and pressure control. Despite the high coverage and resolution of PHC, hospitalizations for hypertension continue to occur, especially in the population with social vulnerability. The instrument showed robust evidence of validity and reliability as well as reproducibility. This makes it suitable for use in APS. In addition to constituting a guide for consultation and follow-up of the hypertensive user, it allows a greater dialogue between the professional and the patient. It is also a space for records to happen more effectively, ensuring a more personalized service, focused on the individual needs of each one. Knowledge of the determinants of pressure control and discontinuation of treatment favors the planning of PHC actions
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.ufrn.br:123456789/24157 |
| Date | 16 August 2017 |
| Creators | Dantas, Rosimery Cruz de Oliveira |
| Contributors | 42313384420, Souza, Dyego Leandro Bezerra de, 00902557475, Vasconcelos, Cipriano Maia de, 07421648453, Fernandes, Marcelo Costa, 03019955327, Moreira, Thereza Maria Magalh?es, 50593145372, Oliveira, ?ngelo Giuseppe Roncalli da Costa |
| Publisher | PROGRAMA DE P?S-GRADUA??O EM SA?DE COLETIVA, UFRN, Brasil |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Source | reponame:Repositório Institucional da UFRN, instname:Universidade Federal do Rio Grande do Norte, instacron:UFRN |
| Rights | info:eu-repo/semantics/openAccess |
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