Family Health Strategy in the National Health System in Brazil (SUS):

social, epidemiological and clinical context analysis for the cardiovascular risk intervention

19 th WONCAWORLD CONFERENCE19 – 23 May, 2010, Cancun - Mexico

Authors: Catherine M. F. Pinto (Gesaworld), Diego da Silveira, Roberson J. Kanamura, Juliana Vasconcelos, Gisele C. M. Sugai, Rosimeire R. Oliveira, Dalia

A. Nogueira, Angela M. B. de Oliveira, Rodrigo F. M. Leite (OS ACSC)

Speaker: Catherine M. F. Pintocmoura@gesaworld.com.br

Family Health Strategy: PHC

ESF/ACS/SB

ESF/ACS

ACSSEM ESF, ACS E ESB

0% 0 a 25%25 a 50%50 a 75%75 a 100%

Population : 10.940.311 inhabitants

•Area – 1.523 km²

•Population density– 7.113 inhabitants/km²

STATE OF SÃO PAULO

BRAZIL

CITY OF SÃO PAULO

City of São Paulo: South SideMunicipality of São Paulo, South side

• Population 2.486.258 inhabitants

• Largest population living in substandard residences (slum) -

21,4%

•Largest cluster of children under 10 years old -19%

•Second cluster in numbers of teenage pregnancies - 16,2%

•Fountainhead area with two Indian villages

• Highest rate of homicides in Sao Paulo (25,4 deaths/1000.00

inhabitants)

Management Contract: Public sector + Social Health Organizations

• Jointly responsible for managing health services

in many territories of the city of São Paulo

(hospitals, emergency services, primary

healthcare services and specialized healthcare

services)

Local scenarium – Partnership Model

In the management model adopted by the municipality is the partnership model with Social Health Organizations (OS), nonprofit organizations - that meets the requirements of municipal legislation for this purpose, which requires its rules and qualifications to manage health care services.

The management model determines territorial integration between the different levels of care.

The work is developed on the basis on the health needs of the population in a given area and observing the relationship between the different health care services.

The focus is the effectiveness of public health policies to expand access, resolution and quality of services and health actions.

The model is regulated and controlled by a “Management Agreement” outlining the commitments of partnership between the government (municipality or state) and the OS.

Cidade Ademar - Microregion

20 Primary Health Care services, with 11

services with the Family Health Strategy

implemented

06 Emergency services

01 Psychosocial support centers

01 Home Care

01 Specialist support team to family healthcare

strategy

02 Support services of diagnostic imaging

01 Dentistry specialized service

02 Medical specialized services

Hypertension and Diabetes Mellitus Cardiovascular Risk

Hypertension and Diabetes mellitus Cardiovascular Risk

Hypertension and Diabetes mellitus Cardiovascular Risk

Project: Cardiovascular Risk Guideline

An approach for the

identification of cardiovascular

risk parameters based on

epidemiological, clinical and

social factors.

Identification and classification

flowchart with cardiovascular risk

parameters based on social,

epidemiological and clinical studies

(Framingham scale).

Consider cardiovascular risk through programs of diagnosis and treatment of hypertension and diabetes mellitus using clinical, epidemiological and social data.

Cardiovascular Risk Guideline

Family Health Workers Team

Interface between population and health system

FAMILY SOCIAL RISK RATING Escore -6 a < 6 Low risk

Escore ≥ 6 a < 12 Moderate risk

Escore ≥ 12 a 18 High risk

Example of Therapeutic Plan

Expected Results

Conclusions

Greater identification of high risk cases influenced by the social factor

Provide a greater treatment for patients with cardiovascular risk, according to the level of social, epidemiological and clinical risks

Promote a holistic care of patients covering the social, epidemiological and clinical parameters

Organize the services (PHC) and the family health workers teams in order to increase the quality of the assistance to the population in this micro region of the city of São Paulo

Contribute for the family health development