Impacto da hipertensão arterial sobre os custos da atenção primária e secundária à saúde: papel da atividade física
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2021-03-08
Autores
Santos, Lionai Lima dos
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Universidade Estadual Paulista (Unesp)
Resumo
A hipertensão arterial (HA) é problema de saúde mundial que atinge mais de um bilhão de pessoas em todo o mundo, e é responsável por mais de nove milhões de mortes por ano, no entanto, ainda é necessário expandir as pesquisas sobre o impacto da HA nos custos da atenção primaria e secundária, assim como a relação da atividade física sobre esses custos. Dessa forma, o objetivo desse estudo é estimar o impacto da HA isolada e associada a outras morbidades sobre os custos com serviços de saúde da atenção primária e secundária do SUS, bem como identificar o papel da prática de atividades física nesta relação. Os custos com serviços de saúde foram verificados por meio de prontuários médicos, cedidos pela Secretaria de Saúde de Presidente Prudente e pelo Hospital Regional da cidade. O nível de atividade física habitual foi avaliado por meio de questionário, para fins estatísticos o escore foi dividido em quartil, a partir disso foram considerados ativos os indivíduos classificados no mais alto quartil p≥75 e abaixo, considerados como IA (insuficientemente ativos). As análises estatísticas foram expressas em média, desvio padrão, mediana e intervalo interquartil. Foi utilizada a análise General Linear Model (GLM), e marginal effect que interpreta os dados de log gerado pela GLM e faz a estimativa em dados monetários. As análises foram realizadas pelo software Stata/MP4 16 - Student – Perpetual, o p-valor foi estabelecido em menor que 5%. Os resultados dessa pesquisa foram organizados em dois artigos científicos. No primeiro estudo, a amostra foi composta por 306 pacientes, com idades de 30 a 65 anos, dos quais 66,4% da população eram hipertensos. Foi possível observar que o grupo HA IA apresentou estimativas maiores que o grupo Normotenso ATIVO nos valores das variáveis de custos (serviços de atendimento US$ 20,00 (IC= 9,90; 30,2), medicamentos US$ 34,20 (IC= 18,9; 49,5) e total da atenção primária US$ 51,60 (IC= 30,2; 72,9)), diferentemente do HA ATIVO que apresentou diferença significativa somente nos serviços de atendimento (US$ 13,40 (IC= 1,34; 25,4), não apresentando diferença na atenção secundária e terciária. Já no segundo artigo, a amostra foi composta por 280 pacientes, também com idade entre 30 e 65 anos. É possível observar que todos os grupos de morbidades apresentaram estimativas mais altas de custos com saúde do que o grupo referência (grupo sem diagnóstico de hipertensão, diabetes, colesterol e infarto) nos anos de 2018 e 2019 na atenção básica, e o grupo fisicamente ativo apresentou uma redução de custos de US$ 20,40 (IC=-39,3; -1.52) comparado ao grupo menos ativo, porém na atenção secundaria e terciaria apenas os grupos com HA US$ 426,7 (IC= 61,0; 792,5), e o grupos que possuía todas as morbidades US$ 816,20 (IC= 59,8; 1572,6) e HA + CHO + infarto US$ 614,40 (IC=51,6; 1177,1) apresentaram diferença significativa. E ainda foi possível observar que o grupo mais ativo apresentou 4,12 (IC=-11,6; 3,41) menos dias em hospitalização do que o grupo IA. Concluímos assim que a HA apresenta um forte impacto nos custos com serviços de saúde, tanto na atenção primaria, como na secundaria e terciaria, e a atividade física associada a HA possibilita economia nos custos com serviços de saúde.
Arterial hypertension is a global health problem that affects more than one billion people worldwide, and is responsible for more than nine million deaths per year, however, it is still necessary to expand research on the impact of arterial hypertension in costs of primary and secondary care, as well as the relationship between physical activity and these costs. Thus, the objective of this study is to estimate the impact of isolated arterial hypertension and associated with other morbidities on the costs of health services in primary and secondary care in SUS, as well as to identify the role of physical activity in this relationship. The costs of health services were verified through medical records, provided by the Health Department of Presidente Prudente and by the Regional Hospital of the city. The level of habitual physical activity was assessed by means of a questionnaire, for statistical purposes the score was divided into quartiles, from which individuals classified in the highest quartile p≥75 and below were considered active, considered as IA (insufficiently active). Statistical analyzes were expressed as mean, standard deviation, median and interquartile range. The General Linear Model (GLM), and marginal effect analysis was used, which interprets the log data generated by GLM and estimates it in monetary data. The analyzes were performed using the software Stata / MP4 16 - Student - Perpetual, the p-value was established at less than 5%. The results of this research were organized into two scientific articles. In the first study, the sample consisted of 306 patients, aged 30 to 65 years, of which 66.4% of the population were hypertensive. It was possible to observe that the HA IA group had higher estimates than the Normotensive ACTIVE group in the values of the cost variables (care services US $ 20.00 (CI = 9.90; 30.2), medicines US $ 34.20 ( CI = 18.9; 49.5) and total primary care US $ 51.60 (CI = 30.2; 72.9)), unlike HA ACTIVE, which showed a significant difference only in care services (US $ 13 , 40 (CI = 1.34; 25.4), with no difference in secondary and tertiary care. In the second article, the sample consisted of 280 patients, also aged between 30 and 65 years. It is possible to observe that all groups of morbidities had higher estimates of health costs than the reference group (group without diagnosis of hypertension, diabetes, cholesterol and hearth attack) in the years 2018 and 2019 in primary care, and the physically active group presented a cost reduction of US $ 20.40 (CI = -39.3; -1.52) compared to the less active group, however in secondary and tertiary care only the groups with AHU $ 426.7 (CI = 61.0 ; 792.5), and the group that had all morbidities US $ 816.20 (CI = 59.8; 1572.6) and HA + CHO + infarction US $ 614.40 (CI = 51.6; 1177, 1) showed a significant difference. And it was also possible to observe that the most active group had 4.12 (CI = -11.6; 3.41) fewer days in hospital than the IA group. We conclude that HA has a strong impact on health care costs, both in primary, secondary and tertiary care, and the physical activity associated with HA enables savings in health care costs.
Arterial hypertension is a global health problem that affects more than one billion people worldwide, and is responsible for more than nine million deaths per year, however, it is still necessary to expand research on the impact of arterial hypertension in costs of primary and secondary care, as well as the relationship between physical activity and these costs. Thus, the objective of this study is to estimate the impact of isolated arterial hypertension and associated with other morbidities on the costs of health services in primary and secondary care in SUS, as well as to identify the role of physical activity in this relationship. The costs of health services were verified through medical records, provided by the Health Department of Presidente Prudente and by the Regional Hospital of the city. The level of habitual physical activity was assessed by means of a questionnaire, for statistical purposes the score was divided into quartiles, from which individuals classified in the highest quartile p≥75 and below were considered active, considered as IA (insufficiently active). Statistical analyzes were expressed as mean, standard deviation, median and interquartile range. The General Linear Model (GLM), and marginal effect analysis was used, which interprets the log data generated by GLM and estimates it in monetary data. The analyzes were performed using the software Stata / MP4 16 - Student - Perpetual, the p-value was established at less than 5%. The results of this research were organized into two scientific articles. In the first study, the sample consisted of 306 patients, aged 30 to 65 years, of which 66.4% of the population were hypertensive. It was possible to observe that the HA IA group had higher estimates than the Normotensive ACTIVE group in the values of the cost variables (care services US $ 20.00 (CI = 9.90; 30.2), medicines US $ 34.20 ( CI = 18.9; 49.5) and total primary care US $ 51.60 (CI = 30.2; 72.9)), unlike HA ACTIVE, which showed a significant difference only in care services (US $ 13 , 40 (CI = 1.34; 25.4), with no difference in secondary and tertiary care. In the second article, the sample consisted of 280 patients, also aged between 30 and 65 years. It is possible to observe that all groups of morbidities had higher estimates of health costs than the reference group (group without diagnosis of hypertension, diabetes, cholesterol and hearth attack) in the years 2018 and 2019 in primary care, and the physically active group presented a cost reduction of US $ 20.40 (CI = -39.3; -1.52) compared to the less active group, however in secondary and tertiary care only the groups with AHU $ 426.7 (CI = 61.0 ; 792.5), and the group that had all morbidities US $ 816.20 (CI = 59.8; 1572.6) and HA + CHO + infarction US $ 614.40 (CI = 51.6; 1177, 1) showed a significant difference. And it was also possible to observe that the most active group had 4.12 (CI = -11.6; 3.41) fewer days in hospital than the IA group. We conclude that HA has a strong impact on health care costs, both in primary, secondary and tertiary care, and the physical activity associated with HA enables savings in health care costs.
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Palavras-chave
Hipertensão arterial, Custos, Economia, Serviços de saúde, Atividade física, Arterial hypertension, Costs, Economy, Health services, Physical activity