We observed that the blood pressure control was better among the men studied at PHUs. However, we were unable to explain this finding, taking into account the size of the sample.
The attendance model proposed for the FHP aims towards health promotion through team actions relating to quality of life, with interventions applied to factors that place this quality of life at risk. This is to be achieved through knowing the clientele better, not only at the units but also in their homes, and through detecting these people’s real needs and encouraging them to recognize that their health and quality of life are citizens’ rights. With this model in mind, it was expected that when the HiperDia program was implemented within SUS, the FHP units would be more effective in controlling blood pressure, compared with the traditional model of the PHUs. The teams at PHUs are not multidisciplinary and they act only in the PHUs: there are no consultations at patients’ homes and no active searches for missing patients are conducted. However, what we found was that the blood pressure control at the FHP units was inferior to the control achieved at the traditional PHUs.
Our study compared populations that were very similar, formed by individuals who sought primary healthcare through SUS and who therefore were of comparable socioeconomic level. Furthermore, the groups were similar in terms of gender and age distribution. Access to medications at the two types of unit (FHP units and PHUs) is identical, since both types form part of the Ministry of Health’s HiperDia program. The medications provided are supplied by the city health authorities and the state government. The HiperDia manual, containing guidance relating to diagnosing and managing high blood pressure, was available at all the units evaluated.
With regard to the medical professionals working in the two types of unit, we observed that they presented different characteristics, such as the length of time since graduation and the different specialties represented. Differences in specialties lead to the hypothesis that the results encountered might have been influenced by this factor, but in this respect, not only the physicians’ original training but also their continuing training would have to be taken into account. Davis and Taylor-Vaisey10 suggested that continuing education among physicians leads to better performance in relation to treatment for cardiovascular disease and in relation to dealing with its risk factors. Schneider et al.11 showed through a questionnaire answered by emergency department physicians and general clinicians that only 36% correctly knew the levels that define high blood pressure. The latter study took high blood pressure to be > 140/90 mmHg.
Data from evaluations in 167 countries published by the World Health Organization (WHO) in 200312 showed that general physicians were unaware of national consensuses on hypertension in 61% of the countries and that in 45% of them professionals were not trained to manage hypertension. Data from the Brazilian Ministry of Health13 published in 2004 showed that between 2001 and 2002, the introductory training provided by the ministry, which ought to be given before or immediately after setting up the teams at the FHP units, reached averages of 61.9% of the physicians and 69.4% of the nurses working within the FHP nationwide. Specific training for these teams in relation to managing hypertension reached averages of only 42.4% of the physicians and 44.5% of the nurses, nationally. In the State of Rio de Janeiro, these averages went up to 50.5% and 51.6%, respectively.13
In the city of Petrópolis, the introductory course was given at the time of implementing the program in 1997, but the Ministry of Health’s specialization course on Family Medicine was only given