Point-of-care measures for glycated hemoglobin in Brazilian primary health care: cost-effectiveness analysis
The proposed project will start in March 2019 and end in March 2020 (one year duration). It will be conducted in the Mucuri Valley, an underserved and remote area in the State of Minas Gerais, SouthEast Brazil, in where the HRTO program is running. The HRTO was conducted in Teófilo Otoni, a middle-size city that is a regional reference center, and 9 small and underserved municipalities, with human development index <0.6 and a population <20,000 inhabitants. Diabetes is a major health threat in Brazil and patients from underserved areas are particularly susceptible to inadequate control and higher frequency of complications. The main goal of the HRTO project (2016-2018) was to implement a multidimensional intervention, including extensive training of primary health care (PHC) teams, empowerment of patients through education, and improvements in health management. To accomplish this goal, we developed, tested and implemented two softwares for registration and clinical management of patients, both including a decision support system. The project identified 18,375 people of a target population of 43,304 (30-69 years). Screening for hypertension and diabetes was performed in 6,735 individuals. There are 1,028 diabetic subjects currently being monitored by the project. Of these, 358 (35%) have good diabetes control (HbA1c <8%). For the period of 2018-2020, the Ministry of Health is financially supporting the maintenance of the 34 points of care already established. In the last year, in a supplementary project, we were able to test the accuracy and the feasibility of use of a Point-of-Care (POC) device for measuring glycated hemoglobin (HbA1c) in the primary care setting, being able to demonstrate both the accuracy and usability. The present project intends to expand the use of the POC HbA1c for all municipalities of the project, making possible to improve the control for diabetes in all the territory covered by the HRTO program. The target population includes the diabetic individuals already monitored by the HealthRise Brasil program (1,000 patients) and we expect to train 80 health professionals on the use of the POC device, including medical doctors, nurses and community health workers.
Kenya Valeria Micaela de Souza Noronha - Integrante / Monica Viegas Andrade - Coordenador / Michelle Nepomuceno Souza - Integrante / Andre Soares Santos - Integrante / Antonio Ribeiro - Integrante / Junia Xavier - Integrante.