Estratégias de redução das complicações e controle em portadores de hipertensão arterial sistêmica e diabetes mellitus da ESF Novo Delfino

Abstract

Montes Claros is one of the five largest city in Minas Gerais with 361,915 inhabitants in a total area of 568.94 km ². Located in important area at upstate, it is reference for other municipalities. Among the health programs of the city, the staff of the Family Health Strategy Novo Delfino is responsible for monitoring the health of 782 registered families, with a total of 3627 inhabitants. Predominantly young population, low income. With 334 hypertensive patients and 77 diabetics registered, the unit features underreporting of these diseases (12.7% hypertension versus 32.5% national for and 2.9 % diabetics versus 12% national) with a high rate of cardiovascular complications in the last year. The current monitoring is ineffective without risk classification. The Family Health Program Strategy has proved to be effective in the control and awareness about chronic diseases. So, this paper aims to create a plan to get low rates of complications on hypertensive and diabetic patients, proposing improvements in monitoring with risk classification, active search and awareness of the entire population with consequent improvement in quality of life and reducing complications of both diseases. The intervention plan it´s based in dynamic and continuous operations with results direct and indirect on the patient's life.