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    Rede de cuidado ao portador de doença cardiovascular no município de Praia Grande-SP. Que circuito é esse?
    (Universidade Federal de São Paulo (UNIFESP), 2016-02-17) Ozawa, Carolina [UNIFESP]; Gomes, Mara Helena de Andrea [UNIFESP]; http://lattes.cnpq.br/3533859151215382; http://lattes.cnpq.br/1485886534535867; Universidade Federal de São Paulo (UNIFESP)
    Rethinking effective strategies for prevention and control of chronic non-communicable diseases (NCD) has been a challenge for health care systems. According to the WHO, NCDs account for 73% of deaths worldwide, especially cardiovascular diseases (31.3%). In Brazil, cardiovascular diseases (CVD) are the leading cause of death in all Brazilian regions. This study’s research field was the municipality of Praia Grande -São Paulo, and its goal was to evaluate the performance of the health care network for the patient with CVD. The survey was conducted in two phases. The first, of quantitative character, sought to identify the evolution of mortality rates from cardiovascular diseases (ischemic heart disease, cerebrovascular disease and hypertensive disease) in the period between 1996 and 2012, before and after the creation of Regional Coroner's Service in Praia Grande’s municipality. The second part of the study, qualitative, sought to know, through collecting oral information, the path along the service network of the person seeking health services on the Praia Grande’s municipality in the perspective of the patient with cardiovascular disease until death occurred, in order to reconstruct the forms of access to health services and the continuity of care. The authors conducted a random selection of 17 CVD deaths of residents in Praia Grande that occurred in the period from January to May 2013. The records were located on the Family Health Units and used for data collection, carried out through semi-structured questionnaire. Family members and health services’ professionals that had been accessed during the event that led to the death were interviewed to recompose the service network. Results: We found a strong positive correlation between increased proportional cardiovascular mortality and number of deaths investigated by necropsy in the Coroner's Service suggesting that the investigation of the cause of death and the correct completion of death certificates may have been an important factor in mortality profile modification of Praia Grande municipality in the period 2006-2012. The behavioral observation using mirror of the trends of proportional mortality from ill-defined causes and cardiovascular disease suggests that the increase in participation in recent obituary occurred at the expense of the decline of the first. In the year 2013, this study indicated that the quantitative increase of teams of the Family Health Strategy alone was not enough to manage effectively and continuously the CVDs, although the primary care network of Praia Grande municipality had more than 56% of the local population covered with the Family Health Strategy. The knots within the health care circuit in the city of Praia Grande are the challenge to network, to communicate between peers, to transpose local walls and the fundamental role of the Community Health Agent in the matter of knowledge, monitoring and surveillance of the population living in his territory, whether SUS user or of the private healthcare services. At the time of the survey, the primary care units did not seem to be an open door at the moment that their chronic health condition worsens. This lead the user to look first for urgency and emergency services, continuing the flow for inpatient services, whose highly complex procedures are also hindering for a good outcome instead the occurrence of death from CVD.