Promoting integrated care for people with Diabetes Mellitus and Arterial Hypertension in the Tauá Health Region in Ceará, Brazil

Objectives

Non-communicable diseases are a major health problem and account for more than 70% of deaths in Brazil.
People with diabetes have a 25% risk of developing ulcers on their feet throughout their lives. This complication is responsible for between 40% and 70% of the non-trauma amputations of the lower limbs.

Another diabetes complication, diabetic retinopathy, is the top cause of blindness acquired after puberty. 20 years after a diabetes diagnosis, more than 60% of people with type 2 diabetes have some form of retinopathy.

Yet another NCD with severe consequences is high blood pressure. Pregnancy-induced hypertension is the most common disorder during pregnancy and is responsible for a significant portion of cases of maternal and perinatal mortality.

Diabetes and hypertension, as chronic conditions, are likely to increase among the population, given changes in lifestyle and eating habits taking place in Brazil.



Objectives

This project aims to implement a pilot phase of a state level diabetes and hypertension programme in Cará State, by establishing care for people with diabetes and hypertension, implementing clinical guidelines, training health care professionals, equipping basic units and outpatient hospitals, and designating of a referral centre for retinal assessment.

Approach

The total population of Tauá health region is 112,000 with currently 2,200 known cases of diabetes and 11,000 people with hypertension.

The project’s activities to improve access to care and screening for complications include:

Preparation of primary care units within the region via sensitisation and coordination of local municipalities and health authorities.

Capacity building of the targeted primary health care units through comprehensive and differentiated training of different HCP categories. Training will cover screening and provision of care for diabetes and hypertension, foot care and eye care, and include a pregnancy and diabetes/hypertension-oriented component.

All units will be provided with the necessary basic equipment. In this process, two larger units will be selected as specialised units within foot care, two more within eye care, and will be provided with the necessary special equipment.

Awareness, health promotion and screening activities will also be part of the project, and will mobilise the surrounding communities, schools etc.

Finally, a cross-referral system with focus on foot and eye complications will be established between the units, and with the specialised centre in Fortaleza capital.

Results at completion

426 HCPs trained
48 primary care units equipped and providing screening and comprehensive improved access to care for diabetes and hypertension
1 secondary referral centre for retinal assessment designated and equipped
1 diabetic foot ambulatory care centre implemented
More than 2,100 new cases diagnosed with diabetes
In total, close to 4,000 patients with diabetes respectively more than 14,000 patients with hypertension provided improved care