Resolutividade da assistência a saúde de pessoas com úlceras vasculares atendidas na atenção básica

Abstract

INTRODUCTION: Vascular ulcers are a major public health problem, affecting around 1% of the general population, with a higher prevalence among the aged. Treatment is time consuming and costly, they can cause physical, social, economic and emotional problems. They are considered complex and difficult to heal, have a high number of relapses, and most of them are critically colonized or infected. Service to people with vascular ulcers is challenging to both health professionals and the public administration by virtue of its complexity, including the absence of public policies for this population, structuring services, access to care, professional qualification, and appropriate resources. GENERAL OBJECTIVE: To analyze the outcomes of healthcare for people with vascular ulcers treated in the examination rooms of the primary care system from the perspective of the evolution of healing over a period of six months. METHODOLOGY: Analytic longitudinal study with nested cross-sectional studies, in the examination rooms of the public health service of the city of Aparecida de Goiania, Goias, Brazil, from August 2012 to October 2013. Population consists of users receiving treatment by nurses, and professionals who provided nursing care in the study setting. Data collection occurred through structured nonparticipant observation, interview, physical examination, and use of Pressure Ulcer Scale for Healing (PUSH), planigraphy of ulcers, and photographic record. Absolute frequencies and percentages were used for data collection. The study complies with guidelines for research ethics, being approved under protocol 085/2012. RESULTS: The three rooms designed to care for people with vascular ulcers in the studied scenario showed non-washable walls, windows not screened, without adequate hand hygiene resources, without proper procedures for cleaning and disinfection of the environment, and lack of essential resources and inconsistent supply thereof. As for users, there was gender parity, prevalence among 60 years or older, and social and economic conditions in the lower middle class and below. The majority had lesions for more than one year, which were usually painful. Microbiological examination showed predominantly Gram-negative rods, including Pseudomonas aeruginosa. Among professionals, most were females, aged between 18 and 36 years and "reasonable experience" in treating people with vascular ulcers. CONCLUSION: Conditions were inadequate for serving people with vascular ulcers and contribute to care not compliant with current recommendations, which creates a discontinuity of care and diminished capacity to resolve these issues. Therefore, it is necessary to structure the service with respect to people with chronic ulcers, and maintain supplies and appropriate resources for care.