Atendimento ambulatorial no cárcere: o papel da medicina de família

Angelica Campos Cintra  Volpe; Renata Moreira  Serra; Luciana Cisoto Ribeiro; Janise; Luciane Loures dos Santos

doi:10.5712/rbmfc18(45)3862

Authors

Angelica Campos Cintra Volpe Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas – Ribeirão Preto (SP), Brasil.
Renata Moreira Serra Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto – Ribeirão Preto (SP), Brasil.
Luciana Cisoto Ribeiro Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto – Ribeirão Preto (SP), Brasil. https://orcid.org/0000-0002-1830-7153
Janise Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto – Ribeirão Preto (SP), Brasil. https://orcid.org/0000-0001-7480-937X
Luciane Loures dos Santos Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Medicina Social – Ribeirão Preto (SP), Brasil. https://orcid.org/0000-0002-2585-1544

DOI:

https://doi.org/10.5712/rbmfc18(45)3862

Keywords:

Prisons, Ambulatory Care, Primary health care, Brazil.

Abstract

In Brazil, people deprived of liberty are subjected to inappropriate conditions of imprisonment, with difficulties in accessing health services, even though this right is reiterated by national and international policies. This article aimed to present the health care of people deprived of liberty for general crimes treated from July to December 2019. Observational, cross-sectional, quantitative, survey-type study of a random and representative sample of a male penitentiary, with application of a questionnaire about health conditions, whose diagnoses were categorized by the International Classification of Primary Care and their associations analyzed by the chi-square test and analysis of variance. The majority of the 200 participants were between 30 and 49 years old (73%), brown or black, single, with low education, incarcerated in an overcrowded unit (227%), smokers (49%), and sedentary (75%). It represented the first consultation for 40% of users, 74.5% had up to two health problems, the main ones being related to endocrine and metabolic problems, such as obesity, dyslipidemia, and high blood pressure. Eutrophy was the most common diagnosis and 65% rated their health as good or very good. There was an association between the number of diagnoses among those who were older (p<0.01) and medication prescription (p<0.01). Sedentarism was more significant among smokers with a prevalence ratio of 1.65 (95%CI 1.12–2.43). About two orientations were carried out for each service, predominating orientation on food and physical activity. Medications were prescribed for half of the prisoners assisted (52.5%) and transfer to other services for 5% of those assisted. The study revealed the presence of risk factors for non-communicable chronic diseases and that clinical care in the prison unit by family doctors is feasible and resolving, reducing extramural visits, reducing costs, and increasing the safety of workers and users.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Author Biographies

Angelica Campos Cintra Volpe, Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas – Ribeirão Preto (SP), Brasil.

Graduated in Pharmacy - Generalist from the University of Franca (2008-2011), former CI student with a scholarship granted by the São Paulo Research Foundation - FAPESP. Developed research in the area of natural products: isolation, identification, synthesis and biological assays in the Research Group on Natural Products at UNIFRAN (GPNUF - UNIFRAN). He studied Medicine at the Faculty of Medicine of Franca and did a residency in Family and Community Medicine at the Hospital das Clínicas of the Faculty of Medicine of Ribeirão Preto, University of São Paulo

Luciana Cisoto Ribeiro, Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto – Ribeirão Preto (SP), Brasil.

Graduated in Nutrition from the University of São Paulo (1996), Master's Degree in Nutrition from the Federal University of São Paulo (2001) and PhD in Sciences from the Federal University of São Paulo (2005). She is currently Professor at the Department of Social Medicine in the Nutrition and Metabolism course at the Faculty of Medicine of Ribeirão Preto, University of São Paulo. Participates in the Multidisciplinary Residency in Comprehensive Health Care at FMRP-USP. She has experience in the area of Nutrition, with emphasis on Primary Health Care, working mainly on the following topics: food and nutrition security, nutritional assessment, vulnerable populations.

Janise, Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto – Ribeirão Preto (SP), Brasil.

Associate Professor, Department of Social Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo. PhD in Public Health from the University of São Paulo (2007), Master in Medical Sciences from the University of São Paulo (2000). Medical Residency in Preventive and Social Medicine - USP (1995-1996) and in Anesthesiology/HCSL-MG (1991-1992) and graduation in Medicine from the University of Vale do Sapucaí - MG (1990). Coordinator of the Family Health Center 5 at FMRP-USP, since November 2018 and NSF 4 from May 2020 to April 2021. Coordinator of the Health Management area of the Health Information and Informatics Center at FMRP-USP. He has experience in Public Health, with an emphasis on Public Health, working mainly on the following topics: Primary Health Care/Family Health; Health planning, management and evaluation; Vulnerable population.

Luciane Loures dos Santos, Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Medicina Social – Ribeirão Preto (SP), Brasil.

Possui graduação em Medicina pela Universidade Federal de Juiz de Fora (1998) Residência Médica em Medicina de Família e Comunidade, fez Mestrado em Saúde na Comunidade (2003) e Doutorado em Ciências Médicas pela Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (2010). Atualmente é docente colaborador da FMRP-USP. Tem experiência na área de Medicina de Família, atuando principalmente com os seguintes temas: Medicina de Família e Comunidade, Atenção Primária à Saúde e Prevenção de Doenças e Promoção da Saúde.

Currículo Lattes: http://lattes.cnpq.br/0732219870902709

References

Valim EMA, Daibem AML, Hossne WS. Atenção à saúde de pessoas privadas de liberdade. Rev Bioét 2018;26(2):282-90. https://doi.org/10.1590/1983-80422018262249 DOI: https://doi.org/10.1590/1983-80422018262249

Brasil. Lei nº 7.210, de 11 de julho de 1984. Institui a Lei de Execução Penal. Diário Oficial da União. Seção I, 13 de julho de 1984, p. 10227.

Brasil. Plano Nacional de Saúde no Sistema Penitenciário. 2. ed. Brasília: Editora do Ministério da Saúde; 2005.

Brasil. Política Nacional de Atenção Integral à Saúde das Pessoas Privadas de Liberdade no Sistema Prisional. Brasília: Ministério da Saúde; 2014.

Oliveira MAC, Pereira IC. Atributos essenciais da Atenção Primária e a Estratégia Saúde da Família. Rev Bras Enferm 2013;66:158-64. https://doi.org/10.1590/S0034-71672013000700020 DOI: https://doi.org/10.1590/S0034-71672013000700020

Silva M. Saúde penitenciária no Brasil: plano e política. Brasília: Verbena Editora; 2015.

Barbosa ML, Celino SDM, Oliveira LV, Pedraza DF, Costa GMC. Atenção básica à saúde aos apenados no sistema penitenciário: subsídios para a atuação da enfermagem. Esc Anna Nery Rev Enferm 2014;18(4):586-92. https://doi.org/10.5935/1414-8145.20140083 DOI: https://doi.org/10.5935/1414-8145.20140083

Soares-Filho MM, Bueno PMMG. Demografia, vulnerabilidades e direito à saúde da população prisional brasileira. Ciênc Saúde Colet 2016;21(7):1999-2010. https://doi.org/10.1590/1413-81232015217.24102015 DOI: https://doi.org/10.1590/1413-81232015217.24102015

Fernandes LH, Alvarenga CW, Santos LL, Pazin-Filho A. Necessidade de aprimoramento do atendimento à saúde no sistema carcerário. Rev Saúde Pública 2014;48(2):275-83. https://doi.org/10.1590/S0034-8910.2014048004934 DOI: https://doi.org/10.1590/S0034-8910.2014048004934

Bitencourt CR. Falência da pena de prisão: causas e alternativas. 3ed. São Paulo: Saraiva; 2004.

World Health Organization. Prisons and health. Copenhagen: WHO Regional Office for Europe; 2014.

Minayo MCS, Ribeiro AP. Condições de saúde dos presos do estado do Rio de Janeiro, Brasil. Ciênc Saúde Colet 2016;21(7):2031-40. https://doi.org/10.1590/1413-81232015217.08552016 DOI: https://doi.org/10.1590/1413-81232015217.08552016

Alves JP, Brazil JM, Nery AA, Vilela ABA, Martins-Filho IE. Perfil epidemiológico de pessoas privadas de liberdade. Rev Enferm UFPE 2017;11(Supl.10):4036-44.

Cordeiro EL, Silva TM, Silva LSR, Pereira CEA, Patricio FB, Silva CM. Perfil epidemiológico dos detentos: patologias notificáveis. Av Enferm 2018;36(2):170-8. https://doi.org/10.15446/av.enferm.v36n2.68705 DOI: https://doi.org/10.15446/av.enferm.v36n2.68705

Almeida Filho N, Rouquayrol MZ. Elementos de Metodologia Epidemiológica. In: Rouquayrol MZ, Almeida Filho N, eds. Epidemiologia & Saúde. Rio de Janeiro: Editora Medsi; 2003. p.149-77.

Serra RM. Prevalência de doenças crônicas não transmissíveis e perfil sociodemográfico das pessoas privadas de liberdade na Penitenciária I de Serra Azul, Brasil [dissertação]. Ribeirão Preto: Universidade de São Paulo; 2020.

World Organization of National Colleges, Academies, and Academic Associations of General Practitioners. Classificação internacional de atenção primária (CIAP 2). 2. ed. Florianópolis: Sociedade Brasileira de Medicina de Família e Comunidade; 2009.

Universidade Federal do Ceará. Guia farmacoterapêutico da MEAC 2017-2018. 2. ed. Fortaleza: Ministério da Educação; 2016.

Montgomery DC. Design and Analysis of Experiments. 5. ed. Nova Iorque: John Wiley & Sons; 2000.

Cary NC. The SAS system for Windows. Release 9.4. SAS Institute Inc. 2013.

R Core Team. R: A language and environment for statistical computing [Internet]. Vienna: R Foundation for Statistical Computing; 20202018 [acessado em 18 out. 2022]. Disponível em:https://www.R-project.org/.

Wolff H, Sebo P, Haller DM, Eytan A, Niveau G, Bertrand D, et al. Health problems among detainees in Switzerland: a study using the ICPC-2 classification. BMC Public Health 2011;11:245. https://doi.org/10.1186/1471-2458-11-245 DOI: https://doi.org/10.1186/1471-2458-11-245

Barros AJK, Cascaes AM, Wehrmeister FC, MartÍnez-Mesa J, Menezes AMB. Tabagismo no Brasil: desigualdades regionais e prevalência segundo características ocupacionais. Ciênc Saúde Colet 2011;16(9):3707-16. https://doi.org/10.1590/S1413-81232011001000008 DOI: https://doi.org/10.1590/S1413-81232011001000008

Vera-Remartínez EJ, Borraz-Fernández JR, Domínguez-Zamorano JA, Mora-Parra LM, Casado-Hoces SV, González-Gómes JA, et al. Prevalencia de patologías crónicas y factores de riesgo en población penitenciaria española. Rev Esp Sanid Penit 2014;16(2):38-47. https://doi.org/10.1590/1413-812320222712.10072022 DOI: https://doi.org/10.4321/S1575-06202014000200003

Muakad, IB. Tabagismo: maior causa evitável de morte do mundo. Rev Fac Direito Univ São Paulo 2014;109:527-58. https://www.revistas.usp.br/rfdusp/article/view/89244 DOI: https://doi.org/10.11606/issn.2318-8235.v109i0p527-558

Conselho Nacional de Justiça. Regras de Mandela: regras mínimas das nações unidas para o tratamento de presos. Brasília: Conselho Nacional de Justiça; 2016.

Australian Institute of Health and Welfare. The health of Australia’s prisoners [Internet]. Canberra: Australian Institute of Health and Welfare; 2018 [acessado em 18 out. 2022]. Disponível em: https://doi.org/10.25816/5ec5c381ed17a

Green S, Foran J, Kouyoumdjian FG. Access to primary care in adults in a provincial correctional facility on Ontario. BMC Res Notes 2016;9(131). https://doi.org/10.1186/s13104-016-1935-4 DOI: https://doi.org/10.1186/s13104-016-1935-4

Sanchez A, Leal MC, Larouzé B. Realidade e desafios da saúde nas prisões. Ciênc Saúde Colet 2016;21(7):1996. https://doi.org/10.1590/1413-81232015217.08682016 DOI: https://doi.org/10.1590/1413-81232015217.08682016

Maruschak LM. Medical problems of jail inmates [Internet]. Bureau of Justice Statistics. Special Reports. 2006 [acessado em 18 out 2022]. Disponível em:. https://bjs.ojp.gov/content/pub/pdf/mpji.pdf DOI: https://doi.org/10.1037/e500022007-001

Oliveira LGD, Natal S, Camacho LAB. Análise da implantação do Programa de Controle da Tuberculose em unidades prisionais no Brasil. Cad Saúde Pública 2015;31(3):543-54. https://doi.org/10.1590/0102-311X00042914 DOI: https://doi.org/10.1590/0102-311x00042914

Minayo MCS, Constantino P, organizadoras. Deserdados Sociais: condições de vida e saúde dos presos do estado do Rio de Janeiro. Rio de Janeiro: Editora Fiocruz; 2015. DOI: https://doi.org/10.7476/9788575415313

Dourado JLG, Alves RSF. Panorama da saúde do homem preso: dificuldades de acesso ao atendimento de saúde [Internet]. Bol Acad Paul. Psicol 2019;39(96)47-57 [acessado em 18 out. 2022]. Disponível em: http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S1415-711X2019000100006&lng=pt&nrm=iso DOI: https://doi.org/10.5935/2176-3038.20190005

Fazel S, Baillargeon J. The health of prisoners. Lancet 2011;377(9796):956-65. https://doi.org/10.1016/S0140-6736(10)61053-7. DOI: https://doi.org/10.1016/S0140-6736(10)61053-7