Situational analysis of hypertension management at primary health care level in São Paulo, Brazil: population, healthcare professional and health system perspectives

Government-led, population-wide initiatives are crucial for advancing the management of hypertension - a leading cause of cardiovascular disease (CVD) morbidity and mortality. An urban population health initiative was conducted against this backdrop, focussing on hypertension in the primary health s...

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Bibliographic Details
Published in:	BMC health services research Vol. 24; no. 1; p. 668
Main Authors:	Palmeirim, Marta S, Baxter, Yara C, Silveira, Mariana, Maggion, Rafael V, Aquino, Beatriz, Avezum, Álvaro, Saric, Jasmina, Morgan, Louise, Drager, Luciano F, Bortolotto, Luiz A, Rollemberg, Suely Miya S, de Lima, Marcia M C, Albuquerque, Edmir P R, Jones, Olivia, Steinmann, Peter, Reiker, Theresa, Boch, Johannes
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 28-05-2024 BioMed Central BMC
Subjects:	Adult Brazil Brazil - epidemiology Cardiovascular diseases Chronic illnesses Cities Collaboration Design thinking Female Health aspects Health care Health care industry Health care reform Health Personnel - statistics & numerical data Humans Hypertension Hypertension - diagnosis Hypertension - epidemiology Hypertension - therapy Infectious diseases Low income groups Male Medical personnel Medical research Medicine, Experimental Middle Aged Mortality Patient compliance Primary care Primary Health Care Professionals Public health Risk factors Situational analysis Urban health Brazil Hypertension Brazil Cardiovascular diseases Primary health care Situational analysis Design thinking
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Summary:	Government-led, population-wide initiatives are crucial for advancing the management of hypertension - a leading cause of cardiovascular disease (CVD) morbidity and mortality. An urban population health initiative was conducted against this backdrop, focussing on hypertension in the primary health system in São Paulo, Brazil. Within the frame of the initiative and under the supervision and leadership of the municipal health authorities, a situational analysis was conducted on the needs in hypertension management, marking the first phase of a Design Thinking process. This article describes the situational analysis process and presents the identified elements to be strengthened considering hypertension diagnosis, treatment and control. First, a mixed-methods approach was used, starting with a literature review of municipal hypertension data followed by meetings (N = 20) with the local public health administration to assess health system level components. To investigate activities on hypertension diagnosis, treatment and control, nine primary healthcare units were selected from two districts of São Paulo city- Itaquera and Penha- which received an online form addressed to managers, participated in conversation circles of staff and patients, and underwent shadowing of community health agents. Data gave rise to two main outputs: (i) a patient care journey map; and (ii) a matrix summarizing the identified needs at patient, healthcare professional and health system level for diagnosis, treatment and control of hypertension. Patient awareness and knowledge of hypertension was found to be insufficient and its management needs to be improved. For health professionals, disease awareness, technical training, more time dedicated to patients, and simplified guidelines and clinical decision-making tools for hypertension management were identified as principal needs. The situational analysis found that the healthcare systems efficiency might be improved by establishing defined treatment and care delivery goals with a focus on outcomes and implemented through action plans. This situational analysis identified several needs related to hypertension control in São Paulo that are in line with global challenges to improve the control of CVD risk factors. Findings were also confirmed locally in an expansion phase of this situational analysis to additional primary care facilities. As a consequence, solutions were designed, promptly taken up and implemented by the municipal health secretariat.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1472-6963 1472-6963
DOI:	10.1186/s12913-024-10978-1