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Abstract(s)
Introdução- A hipertensão arterial é uma patologia crónica muito frequente, e mesmo sob
tratamento, pode apresentar episódios de descontrolo que podem evoluir para
descompensação de órgão alvo de gravidade variável. A gestão destas crises hipertensivas no
sistema de saúde português encaminha os doentes para os serviços de urgência sendo a
abordagem muito heterogénea e o acompanhamento subsequente pouco efetivo. A
heterogeneidade desta abordagem nos serviços de urgência, e o insuficiente
acompanhamento destes doentes, põe em causa a sua saúde, não prevenindo de maneira
eficaz a recorrência destas crises, representando um risco acrescido de eventos
cardiovasculares adversos, e uma gestão de baixa eficiência na dicotomia custo-efetividade
da alocação de recursos em saúde.
Objetivos – Esta dissertação analisa a abordagem e gestão da hipertensão arterial e da crise
hipertensiva no âmbito dos serviços de urgência, como uma problemática decorrente do
descontrolo da hipertensão arterial, esclarecendo e perspetivando com base nas evidências,
o papel da implementação de um regime de consulta aberta especializada de HTA poderá
desempenhar, na abordagem e tratamento destes utentes, para obtenção de maiores ganhos
em saúde e melhor eficiência na gestão de recursos.
Materiais e Métodos – A presente dissertação constitui uma revisão de literatura, e para
sua elaboração, foi realizada uma pesquisa da literatura científica na base de dados Pubmed,
de artigos que contivessem os termos ''arterial hypertension'', ''hypertensive crisis'' e ''walkin appointment'', primeiro isoladamente, e depois miscigenando os termos. Procedeu-se
também à pesquisa por sinónimos do termo ''walk-in appointment'', tais como, ''open access''
e ''same-day access''. Para artigos referentes a estudos de ensaios clínicos e estudos de caso
controlo, a pesquisa foi limitada a resultados publicados nos últimos 20 anos, elaborados em
Inglês, referentes exclusivamente a Humanos. No caso de artigos contendo revisões, revisões
sistemáticas e meta-análises de literatura, a pesquisa limitou-se a resultados publicados nos
últimos 5 anos, em Inglês. Foram também incluídos dados estatísticos de relatórios de
instituições governamentais. A seleção dos artigos atendeu à relevância e pertinência perante
o tema, à análise do seu resumo, métodos, desenvolvimento e conclusões. Foram incluídos
segundo estes critérios um total de 60 artigos. Desenvolvimento – O desenvolvimento desta revisão bibliográfica foi divido em quatro
capítulos, sendo que o primeiro capítulo – O controlo da HTA – aborda a problemática do
mau controlo da HTA em Portugal, sob o prisma da saúde pública, referindo estatísticas e
características populacionais que lhe estão associadas. O segundo capítulo – A Crise
Hipertensiva– pretende avaliar o estado da arte da crise hipertensiva, evidenciando as
dificuldades subjacentes à homogeneização de uma abordagem diagnóstica e terapêutica,
assim como, sublinhar a questão da sobremedicação e erros terapêuticos comuns, que põe
em causa a segurança dos doentes. O terceiro capítulo – A abordagem da HTA em contexto
de SU – desenvolve-se em torno da abordagem ao utente com HTA no âmbito dos serviços
de urgência, salientando a menor vocação destes serviços para diagnosticar, aconselhar,
tratar e acompanhar esta patologia. No quarto capítulo – A Consulta Aberta – pretendeu-se
caracterizar o conceito deste regime de consulta, expondo o seu contributo para os sistemas
de saúde, prevendo as vantagens em relação ao SU, na gestão dos utentes com HTA e crise
hipertensiva. O capítulo da discussão, equaciona a partir das dificuldades aferidas na revisão
da bibliografia, o papel da consulta aberta especializada em HTA, na gestão da doença e na
superação das barreiras e dificuldades que esta impõe na sua gestão no SNS.
Background – Arterial hypertension is a very common chronic pathology which may lead, even under treatment, to episodes of lack of control that can evolve to decompensation of a target organ of varying severity. Portuguese Heatlh System manages this hypertensive crisis sending patients to the emergency services, being the approach very heterogeneous and the follow-up ineffective. The heterogeneity of this approach in the emergency services, and the insufficient follow-up of these patients, don’t effectively prevent the recurrence of these crises, representing an increased risk of adverse cardiovascular events, and low efficiency management in cost-effectiveness dichotomy in the allocation of health resources. Objective – This dissertation analyzes the approach and management of arterial hypertension and hypertensive crisis in the context of emergency services, as a problem arising from the lack of control of arterial hypertension, clarifying the role that an open consultation regime specialized in arterial hypertension will be able to perform, in the approach and treatment of these users, in order to obtain greater gains in health and a better efficiency in the management of resources. Materials and Methods – The present dissertation constitutes a literature review, and for its elaboration, a search of the scientific literature was carried out in the Pubmed database, of articles that contained the terms ''arterial hypertension '', ''hypertensive crisis'' and ''walkin appointment'', first in isolation, and then mixing the terms. It has been searched for synonyms of the term ''walk-in appointment'', such as ''open access'' and ''same-day access''. For articles referring to clinical trial studies and case control studies, the research was limited to results published in the last 20 years, prepared in English, referring exclusively to Humans. In the case of articles containing reviews, systematic reviews and meta-analyzes of literature, the search was limited to results published in the last 5 years, in English. Statistical data from government institutions' reports were also included. The selection of articles took into account the relevance and pertinence to the theme, the analysis of its abstract, methods, development and conclusions. According to these criteria, a total of 60 articles were included. Discussion – The development of this bibliographic review was divided into four chapters, the first of which - ''the control of hypertension'' - addresses the problem of poor control of hypertension in Portugal, from the perspective of public health, referring to statistics and associated population characteristics to the lack of hypertension control. The second chapter - ''The Hypertensive Crisis'' - aims to assess the state of the art of the hypertensive crisis, highlighting the difficulties underlying the homogenization of a diagnostic and therapeutic approach, as well as to underline the issue of over-medication and common therapeutic errors, which calls into question safety of the sick. The third chapter - ''The approach to arterial hypertension in the context of emergency room (ER)'' - develops around the approach to the patient with arterial hypertension in the context of emergency services, highlighting the lower vocation of these services to diagnose, advise, treat and monitor this pathology. In the fourth chapter - ''The Open Consultation'' - it was intended to characterize the concept of this consultation regime, exposing its contribution to the health systems, foreseeing the advantages in relation to the ER, in the management of users with hypertension and hypertensive crisis. The ''Discussion'' chapter intends to address, based on the difficulties assessed in the literature review, the role of open consultation specialized in arterial hypertension, in the management of the disease and in overcoming the barriers and difficulties that it imposes in its management in the national health system (NHS).
Background – Arterial hypertension is a very common chronic pathology which may lead, even under treatment, to episodes of lack of control that can evolve to decompensation of a target organ of varying severity. Portuguese Heatlh System manages this hypertensive crisis sending patients to the emergency services, being the approach very heterogeneous and the follow-up ineffective. The heterogeneity of this approach in the emergency services, and the insufficient follow-up of these patients, don’t effectively prevent the recurrence of these crises, representing an increased risk of adverse cardiovascular events, and low efficiency management in cost-effectiveness dichotomy in the allocation of health resources. Objective – This dissertation analyzes the approach and management of arterial hypertension and hypertensive crisis in the context of emergency services, as a problem arising from the lack of control of arterial hypertension, clarifying the role that an open consultation regime specialized in arterial hypertension will be able to perform, in the approach and treatment of these users, in order to obtain greater gains in health and a better efficiency in the management of resources. Materials and Methods – The present dissertation constitutes a literature review, and for its elaboration, a search of the scientific literature was carried out in the Pubmed database, of articles that contained the terms ''arterial hypertension '', ''hypertensive crisis'' and ''walkin appointment'', first in isolation, and then mixing the terms. It has been searched for synonyms of the term ''walk-in appointment'', such as ''open access'' and ''same-day access''. For articles referring to clinical trial studies and case control studies, the research was limited to results published in the last 20 years, prepared in English, referring exclusively to Humans. In the case of articles containing reviews, systematic reviews and meta-analyzes of literature, the search was limited to results published in the last 5 years, in English. Statistical data from government institutions' reports were also included. The selection of articles took into account the relevance and pertinence to the theme, the analysis of its abstract, methods, development and conclusions. According to these criteria, a total of 60 articles were included. Discussion – The development of this bibliographic review was divided into four chapters, the first of which - ''the control of hypertension'' - addresses the problem of poor control of hypertension in Portugal, from the perspective of public health, referring to statistics and associated population characteristics to the lack of hypertension control. The second chapter - ''The Hypertensive Crisis'' - aims to assess the state of the art of the hypertensive crisis, highlighting the difficulties underlying the homogenization of a diagnostic and therapeutic approach, as well as to underline the issue of over-medication and common therapeutic errors, which calls into question safety of the sick. The third chapter - ''The approach to arterial hypertension in the context of emergency room (ER)'' - develops around the approach to the patient with arterial hypertension in the context of emergency services, highlighting the lower vocation of these services to diagnose, advise, treat and monitor this pathology. In the fourth chapter - ''The Open Consultation'' - it was intended to characterize the concept of this consultation regime, exposing its contribution to the health systems, foreseeing the advantages in relation to the ER, in the management of users with hypertension and hypertensive crisis. The ''Discussion'' chapter intends to address, based on the difficulties assessed in the literature review, the role of open consultation specialized in arterial hypertension, in the management of the disease and in overcoming the barriers and difficulties that it imposes in its management in the national health system (NHS).
Description
Keywords
Consulta Aberta Crise Hipertensiva Hipertensão Arterial