ABC | Volume 113, Nº2, August 2019

Original Article Lima et al The VICTIM register- Intra-hospital counseling Arq Bras Cardiol. 2019; 113(2):260-269 Table 4 – Relationship between self-reported in-hospital nutritional counseling and the nutritional knowledge in patients with STEMI receiving care at hospitals in Sergipe, based on the type of service (Public vs. Private) Level of nutritional knowledge Patients counseled (102) p value Patients not counseled (68) p value Public Private Public Private Low, n (%) 21 (26.3) 1 (4.5) 0.001* 14 (23.7) 0 (0) 0.240* Moderate, n (%) 38 (47.5) 6 (27.3) 23 (39.0) 4 (44.4) High, n (%) 21 (26.3) 15 (68.2) 22 (37.3) 5 (55.6) (*)Chi-square test. due to the greater practicality of such conduct, and the fact that it was performed, most often, by the physician. It is known that the promotion of the integration and/or replacement of food into the diet requires more in-depth knowledge about the characteristics of the nutrients; this competence is part of the nutritionist's knowledge. 35,36 This attitude, due to an incomplete nutritional orientation or even the absence of such orientation, does not educate the patient to make healthy food exchanges, which can compromise their nutritional status, by restricting their dietary options. Furthermore, during the data collection, most of the interviewees did not know what the guidelines meant, they only knew, in general, what they should restrict, without having a specific list with the food. Similar results were found by Gomes et al., 36 who verified that the guidelines distributed by the family health professionals to the patients with hypertension and/or diabetes mellitus were simplistic or insufficient. The patients did not have detailed information, with a higher prevalence of prohibitive recommendations, and without taking into account the daily habits of the individuals, and without the benefit of a participatory dialogue with them. The nutritional knowledge among the patients was higher in private health service. These findings lead to the reflection of the possible positive influence of their level of education in the assimilation of the information provided. We cannot forget, however, that nutritional knowledge is also constructed through information throughout the lifespan, and most patients in the private service already had some kind of nutritional orientation prior to hospitalization. This is a factor that could have influenced these findings. 37,38 The presence of nutritional counseling facilitates the improvement of nutritional knowledge, and according to the knowledge-attitude-behavior model, there is not a single condition for adherence to healthy eating practices, and may not cause significant positive changes in eating behavior. However, having nutritional knowledge facilitates the beginning of contemplation phases of the individual's behavior change. 38,39 This worrying scenario of underutilization of in-hospital nutritional orientation can be modified with the adherence of simple behaviors in the work routine of the multi-professional team. Improving the communication of the multi-professional team of care, dedicating more time and attention to the information given to the patient, and jointly dispensing individualized, well-written information to complement the orientation provided is a simple, low-cost alternative that can lead to a positive clinical outcome. 36,40 In addition, due to the fact that the time of hospital discharge represents a moment of anxiety for the patient and family, this can compromise the assimilation of information. Thus, nutritional counseling does not have to be restricted to this moment but can be performed during the entire in‑hospital period, which will also prevent the patient from being discharged before being instructed. It is also important to note the need for better linkage between the different care levels, to guarantee the integral care of the cardiac patient. The adequate preparation of health professionals to perform the counter-referral, as well as the best quality of specialized care services to meet demand, are fundamental for a successful referral. Limitations Some inherent limitations deserve to be highlighted: (1) much information was self-reported, and was dependent on the interviewee's memory, which may have been influenced by some independent factors, such as level of education and clinical condition at the time of the interview. In addition, many patients were elderly, which could lead to a larger memory bias; (2) As part of the research was performed by telephone, the contact with some patients was compromised, due to difficulty in understanding, or to health problems such as hearing or mental deficiencies. In order to reduce the limitations of the study, a pilot study was conducted prior to data collection, aiming to identify the ideal time interval for the telephone follow-up, in order to reduce memory loss, and also to standardize the interview questions, so that all patients, regardless of socioeconomic status, understood the points raised. Conclusion The results of this research demonstrate the lack of documentation of in-hospital nutritional counseling, as well as the low quality of this orientation given to patients with STEMI in both health services of Sergipe especially in the public service. These data cannot only represent the reality of the state of Sergipe, but also a national situation that needs to be better investigated in order to achieve improvements in the quality of the health service as a whole in the country, mainly the quality of in-hospital nutritional status counseling. This is a low-cost action that currently is not well performed; if achieved in an equitable manner, it can be very favorable for increasing the nutritional knowledge and clinical prognosis of patients with STEMI. 266