Assistência prestada a crianças com Doença Falciforme na rede de atenção à saúde de Belo Horizonte, com ênfase nos eventos clínicos e na adesão aosprotocolos assistenciais

Abstract

Introduction: The Sickle Cell Disease (SCD) is considered a public health problem in Brazil. Once it is an inherited disease of chronic course it is important to be well known to health services for comprehensive care to these patients. Objective: Know the occurrence of clinical events, demands of assistance, adherence to treatment and care in municipal health to the SCD patients. Methods: Were analyzed the records in hemocenter of Belo Horizonte and basic network of municipal health, for the care of 121 children with SCD, born between 2007 and 2014.Results:The most frequent clinical events were the painful crises (49.9%) and infections (37.1%) leading to hospitalization in (42.1%) and (55.4%) cases, respectively. There was an association between the occurrence of the painful crisis (p <0.01), splenic sequestration (p <0.01) and dactylitis (p = 0.03) and the hemoglobin profile, being the majority of the occurences observed in children with hemoglobin SS. The median age calculated regarding the beginning of the clinical events was 10 months and there was no difference when hemoglobin profiles were compared (p = 0.51). 184 referrals were made to interconsultation, being (37.2%) of them for cardiology and (26.6%) for ophthalmology. The most orderedexams were Transcranial Doppler (47.4%) and Abdominal Ultrasonography (34.4%). Regarding to the indicated surgeries, splenectomy was indicated for (53.3%) of the cases while tonsillectomy responded for (23.3%). Regarding to the treatment in Primary HealthCare (PHC), 37,4% of the patients attended at least 80% of the appointments from the proposed calendar. In HBH, 86% of the patients achieved more than 80% adherence to the analyzed topics. The chance of the patients with severity signs adhered to the protocols of thePHC and the HBH is 5.6 times higher than those without severity signs (CI 1.23 to 22.5). Of 2028 attendances registered in the PHC, (47.8%) were conducted by pediatricians, followed in second place by the nurses (32%) and at last the family doctors and the community (20.2%).The main reason for the pediatrician appointment was the child care, while family doctors and nurses were responsible for the upper respiratory tract infections. The only events directly related to SCD registered in the medical record of the PCH were painful crisis, corresponding to 3.5% of the cases. The health monitoring programs represented 5.6% of the total attendances. The hospitalization records, surgeries and therapeutic regimens inclusions were underestimated in PHC records compared to the HBH. Conclusion: The PHCs assistance has weaknesses regarding to the complete care of people with SCD, especially related to the approach of the peculiarities of the disease and the establishment of practices based on the PHC essential attributes. This may be related to work process of the teams does not consider the care demands of these people.