Perfil de pacientes atendidos em serviço de nefrologia e itinerário terapêutico de doentes renais crônicos estrangeiros em região de fronteira

• Autor(a) principal: Pereira, Ederson
• Data de Publicação: 2019
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações do UNIOESTE
• Texto Completo: http://tede.unioeste.br/handle/tede/4754
• topic: Assistência à saúde; Sistemas de saúde; Perfil de saúde; Paraguai; Nefrologia; Diálise; Delivery of health care; Health systems; Health profile; Paraguay; Nephrology; Dialisys; Prestación de atención de salud; Sistemas de salud; Perfil de salud; Paraguay; Nefrologia; Diálisis; CLINICA MEDICA::NEFROLOGIA

The health system in Paraguay does not guarantee full coverage in treatment for people with chronic kidney disease (CKD). There is an important demand from foreign patients with CKD who seek health care in Brazil. Thus, questions arose as to how this access was and in which places these subjects passed to reach the nephrology service in Brazil. The purpose of this study was: To characterize the epidemiological profile of patients of Paraguayan origin in hemodialysis treatment in Foz do Iguaçu - Pr; and Describe the course taken by the foreign chronic renal patient in search of access to treatment of CKD by SUS in Brazil, in the border region. The research was characterized as exploratory and descriptive, which used quantitative and qualitative analysis procedures of the data collected. The epidemiological profile of the patients was identified based on information obtained from the service database. The trajectory was identified through semi-structured interviews, and analyzed from the Kleinman framework that advocates the interference of three subsystems in the Therapeutic Itinerary traveled by people in search of a solution to health problems: family, popular and professional. Total of 23 Paraguayan patients: 73.9% of males; 65.2% are married, 56.5% live with children and 65.2% with their spouse, 26.1% incomplete elementary school, 43.45% between 40 and 59 years and 47.85% with age ≥ 60 years , 52.1% presented with 2 to 5 years of dialysis, the use of catheter as first access occurred in 73.9% of Paraguayans, and 78.3% of them performed the first session of emergency hemodialysis, DM and SAH were the major underlying diseases, 39.2% were not under the care of the nephrologist specialist in the non-dialysis phase. In the family subsystem the subjects and their relatives showed little perception about their disease, and the support and support at the time the subject received the diagnosis of kidney disease is demonstrated by the relatives. In the popular subsystem there was demand for other unconventional care of traditional medicine. In the professional subsystem the subject in the search for his treatment demonstrates throughout his journey how lost and manipulated he is in the health system of his country, often directing him to territories where there is no assistance that he needs or makes it impossible for him to adhere to the treatment. It was concluded that although the hemodialysis clinic was the most frequent site of the first hemodialysis session, the first type of vascular access was the catheter and the hemodialysis session occurred as an emergency in a significant percentage among the Paraguayan patients. In the light of the above, the chronic renal patients traveled in search of care through health care subsystems according to Kleinman's theoretical framework. It should be emphasized that in Brazil there is a public health system based on the principles of universality, completeness, and equity, while in Paraguay the public health system is precarious with low coverage of health care.