Avaliação da efetividade de uma intervenção educativa no conhecimento de profissionais da atenção primária à saúde que acompanham pessoas com doença falciforme

Abstract

Introduction: Sickle cell disease (SCD) in Minas Gerais, Brazil, has an incidence of 1:1,400 in newborns and is a public health problem. Patient care at the primary level of health is essential and little valued worldwide. Training programs for primary care professionals are imperative to have quality in comprehensive care of patients. Objective: To evaluate the effectiveness of an educational intervention for community health workers and nursing technicians about the care and monitoring of person with SCD in primary care. Methods: This is an educational intervention with training on the care and monitoring of children and adolescents with SCD directed to primary care professionals of the Family Health Strategy in three municipalities from north of Minas Gerais (Montes Claros, Janaúba and Pirapora). The intervention occurred in basic health units of the Family Health Strategy that had patients with SCD living on the coverage area. Active methods were used in workshops with workload of 40 hours. The evaluation of the intervention was carried out by means of pre and post-tests of knowledge that addressed issues about epidemiological, clinical and management of patients with SCD. In Montes Claros, the training group (n= 82) was compared with a control group (n= 75). The control group received no educational intervention about SCD during the same period. Previously and after the intervention, qualitative studies were undertaken to assess the perception of professionals on the health care provided to patients with SCD. Prior to the intervention, two focus groups with undergraduate professionals of primary care and community health workers were set. After the educational intervention, there were two focus groups with community health workers, addressing the following topics: evaluation of educational workshops, which occurred after training; home visits, access by people with SCD to the health unit, and care to person with SCD. The statements were tape recorded and transcribed later on. Qualitative data were subjected to content analysis and empirically organized into two categories. Quantitative data were submitted to descriptive, univariate and multivariate analysis. The present study met the national and international standards of ethics in research involving human beings. Results: A total of 188 professionals participated in the educational intervention. There was a significant increase of correct answers after the educational intervention in all three municipalities (p<0.001). This increase was statistically significant in all cognitive domains of the questionnaire. In multivariate analysis, difference of scores between post-test and pre-test in the intervention group was 8.7 times higher than that for the control group (95% CI: 7.8-9.6). The duration of working in primary care had a modest positive influence on the score difference (p= 0.046). Changes in the health care practices of community health workers were observed after the educational intervention. The prioritization of health care services for patients with sickle cell disease and monitoring of clinical warning signs in health care units were observed. Furthermore, changes were observed in the profile of home visits to patients, which were performed using a script provided in the educational intervention. 13 Conclusion: The educational intervention was effective, because knowledge of the professionals on the care and monitoring of people with SCD in primary care have increased. In the perception of professionals, the educational intervention significantly changed the work process of community health workers with regard to patient monitoring in primary health care. The results should stimulate new educational activities that promote increased knowledge of health professionals.