Universidade Federal de São Paulo, São Paulo, Brasil.
Escola de Administração de Empresas, Fundação Getulio Vargas, São Paulo, Brasil.
Cad Saude Publica. 2022 Mar 14;38(2):e00090821. doi: 10.1590/0102-311X00090821. eCollection 2022.
Complications of chronic kidney disease (CKD) can be avoided when promptly diagnosed and treated. The objective was to describe quality indicators of CKD detection and health care in the primary care public service of a city in the State of São Paulo, Brazil. This retrospective study analyzed charts of patients who attended primary care in the public service between November 2019 and February 2020. We selected 10 health quality indicators based on their scientific relevance and availability from the medical records that could express how CKD was identified and managed in primary health care. We estimated the adequate percentage of health indicators with data from 1,066 individuals who had ≥ one risk factor for CKD: hypertension, diabetes, or > 60 years old. Among patients, 79.4% had information on serum creatinine, whereas 58.8% were investigated for proteinuria. Blood pressure data were found in 98.9% of the records. The percentage of patients with blood pressure < 140x90mmHg, glycosylated hemoglobin < 6.5% and LDL-cholesterol < 100mg/dL was 79.2%, 49.2%, and 33.3%, respectively. Renin-angiotensin system blockers were prescribed to 82.8% of the patients with hypertension and CKD. Serum potassium was measured in 35.7% for those who were using renin-angiotensin system blockers. Among those people with CKD, 16.7% had CKD assigned in the medical records as a diagnose. Among those participants at higher risk for CKD, the referral rate to a nephrologist was 31.6%. This study confirmed some missed quality indicators of CKD in primary healthcare. Our results may help administrators develop public policies that improve health care for individuals at high risk for CKD. Long-term follow-up of the health indicators we proposed here will be useful to assess the impact of policy intervention.
当慢性肾脏病 (CKD) 得到及时诊断和治疗时，可以避免其并发症。本研究的目的是描述巴西圣保罗州某城市基层医疗公共服务中 CKD 检测和医疗保健的质量指标。这是一项回顾性研究，分析了 2019 年 11 月至 2020 年 2 月期间在公共服务中接受初级保健的患者的图表。我们根据记录中 CKD 在初级保健中的识别和管理的科学相关性和可用性，选择了 10 个健康质量指标。我们从有≥1 个 CKD 风险因素（高血压、糖尿病或>60 岁）的 1066 个人的数据中估计了健康指标的适当百分比：高血压、糖尿病或>60 岁。在患者中，79.4%的人有血清肌酐信息，而 58.8%的人进行了蛋白尿检查。98.9%的记录中有血压数据。血压<140x90mmHg、糖化血红蛋白<6.5%和 LDL-胆固醇<100mg/dL 的患者百分比分别为 79.2%、49.2%和 33.3%。高血压和 CKD 患者中有 82.8%使用了肾素-血管紧张素系统阻滞剂。正在使用肾素-血管紧张素系统阻滞剂的患者中有 35.7%检测了血清钾。在被诊断为 CKD 的患者中，有 16.7%的人在医疗记录中被诊断为 CKD。在有 CKD 风险的患者中，转诊至肾病科的比例为 31.6%。本研究证实了初级保健中一些未被发现的 CKD 质量指标。我们的研究结果可能有助于管理人员制定改善高风险 CKD 患者医疗保健的公共政策。对我们提出的这些健康指标进行长期随访，将有助于评估政策干预的影响。
