Cantinho Cuidando de Todos l NCD Screening Corners
The epidemic of Chronic Noncommunicable Diseases (NCDs) is worldwide; morbidity, sequelae and mortality are clearly worrisome in Health Management, but invisible to the eyes of the population. There is a large gap between the prevalence and the number of patients being treated in the Primary Care Clinics. It is urgent to identify patients not yet diagnosed in the territory of each clinic. Cantinho Cuidando de Todos is an attractive space, equipped with a focus on tracking patients with NCDs within the Primary Care Clinics. It generates engagement of the health team and users with NCDs and their risk factors, promotes self-care and patient autonomy. It has already impacted 33.000 people.
The Cantinho Cuidando de Todos l NCD Screening Corners contributes to prevention, promotion, diagnosis and monitoring in the process of confronting NCDs. It provides an attractive and educational place where self-care and screening for NCDs is stimulated, such as blood pressure measurement, obesity control, diabetes and others. The health education materials are strategically placed, in addition to a management panel in sight, alerting to the need to find patients with NCDs still undiagnosed in the area covered by that UBS. Patients identified with any of the risk factors are promptly referred for care.
This action is part of the Cuidando de Todos program of the Municipal Health Secretariat of São Paulo as a strategy in Primary Care in confronting NCDs and meeting the 2030 agenda. It aims to reduce early morbidity and mortality rates by adopting prevention, awareness, screening, adherence to care, control of NCDs and their risk factors. It is the result of partnerships between public service and other institutions. The program is accelerated by the Cuidando do seu Coração initiative, with the Novartis Foundation as its creator and supporter and the Tellus Institute as its implementing partner
It should be noted that this solution presented here was co-created from the interaction via exploratory interviews, understanding workshops and co-creation dynamics with the Municipal Health Secretariat of São Paulo managers, specific departments, specialists, professionals and including the users of the primary care clinics. This methodology was based on the Design Thinking approach, whose three fundamental principles are: focus on the user, collaboration and experimentation. Here are the steps: 1) NCD scenario and risk factors in SP and research and survey of public data; 2) Pilot: Selection of 6 primary care clinics of the Technical Health Supervisions of Itaquera, representing the different management models; 3) Field Study: Observation and visits to primary care clinics; 4) Interaction, interviews and workshops, as described above. The guiding question of the creative processes was: "How can we promote active search actions in the internal environment of the primary care clinics?" In this context, the solution Cantinho Cuidando de Todos was conceived. Cantinho evolved from a prototype (experimentation and concept testing in 2 primary care clinics) to all primary care clinics in the territories of Itaquera and Penha, covering 45 primary care clinics. Monitoring is carried out mainly via the number of pressures measured in the self-checking chair installed in each corner and the percentage of altered measures. These data are registered in the system by primary care clinics and monitored by managers and staff. Financial resources from sponsoring partners such as Novartis Foundation and Umane. Tellus Institute responsible for the design and implementation of the solution in the primary care clinics.
Simplicity. Using the installed capacity of the primary care clinics, a small area close to the reception, making it coherent, structured and visually attractive for the NCDs theme. In the first 4 months of implementation, more than 30.000 arterial pressures were registered in the 45 primary care clinics in Itaquera and Penha. Expansion of the solution to 25 primary care clinics in another 24 supervisions, over 2.500 people were served. 33% of people with abnormal arterial pressure were identified, who were promptly inserted into the line of care. Cantinho was designed in a model of supported self-care, being perceived as an important ally in the period of the pandemic, relevant for the screening and monitoring of people with NCDs. Long-term impact on reducing early morbidity and mortality rates due to NCDs and increasing self-care is expected, with a focus on the prevention and control of NCDs. Received the Brasil Design Awards.
There was a change in the culture of confrontation with NCDs. Taking advantage of the primary care clinics entrance space, creating an attractive structure generated an impact. Users take responsibility for their self-care; encourages the health team itself, making it more and more engaged. The technical assistance of the equipment was guaranteed for 5 years by its investors. The sustainability of the solution is under constant evaluation with the Health Secretariat, protagonist and director of the entire initiative. The process of accelerating was carried out by the investing and implementing partners, based on a cooperation agreement.
Sustainability and replicability are ensured by the main protagonist of the solution, which is the Municipal Health Secretariat of SP, which is promoting Cantinho as a catalyst for tracking and engaging in NCDs in Primary Care. For other locations, the concept is highly replicable: space with equipment and communication materials already tested and approved, adapted to the installed capacity. It will require engagement with the concept that permeates the action: self-care, prevention, promotion and monitoring, generating engagement and responsibilities agreed between the team and users. The initiative supported active search actions. The goal of 2021 is to consolidate the model implemented in the 70 Primary Care Clinics in the city of São Paulo with lower costs and enhance their results. Future assessments of the impact on morbidity and mortality rates and avoided health costs will further ensure the sustainability of this solution.
The implementation took place during the pandemic and was preceded by concerns about the worsening cases of people with NCDs infected by COVID19. The pandemic generated more awareness about NCDs, their prevention and care. It has become imperative to identify people with risk factors for NCDs in a context of social isolation. Health teams are guided and supported at a distance during the pandemic. The concept of assisted self-care decreased the risk of both professionals and users, while promoting screening and self-care, being favorable in the control of those already diagnosed with a view to reducing the potential complications due to NCDs. Solutions like this will be even more fundamental for achieving SDG target 3.4.
Deliverables & Timeline
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Sub-national level, in the municipality of São Paulo, Brazil.