Avaliação da qualidade da assistência às pessoas com diabetes mellitus no ambito da atenção primária em Maringá, PR

• Autor(a) principal: Santos, Aliny de Lima
• Data de Publicação: 2014
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da Universidade Estadual de Maringá (RI-UEM)
• Texto Completo: http://repositorio.uem.br:8080/jspui/handle/1/2275
• topic: Diabetes mellitus; Atenção primária à saúde; Saúde da família - Maringá (PR); Programas e projetos de saúde - Maringá (PR); Ciências da Saúde; Enfermagem

This is an evaluative, quantitative, cross-sectional study accomplished in Maringá-Pr with the objective of evaluating the quality of the attendance given to individuals with diabetes mellitus type 2 in the scope of primary health care in the municipal district of Maringá-PR. Twenty-nine Basic Health Units, 63 nurses from Family Health Strategy Program and 408 patients with diabetes mellitus type 2 were assessed, from November 2013 to July 2014. Data was collected through interviews. For data analysis it was used the components structure, process and result, the SWOT matrix, the diagram of relationships and the descriptive and inferential statistics (variance analysis, chi-square and multiple logistics regression), considering significant the value of p <0.05. Results showed insufficiency or absence of components of the physical structure, inputs, materials and necessary equipment for the assistance. The work process pointed inadequacy related to the actions in health education, captivation, follow-up and supervision of new cases, management of the information, offer of permanent education, and planning of actions of the teams. The adhesion of the users to the offered services, connection with the team, the professionals' involvement and offer of educational activities, were mentioned as potentialities by the nurses; while the noncompliance to the treatment, gaps in the team work process and reduced availability of resources, as limitations in the assistance. In relation to the attributes of the primary health care, according to the nurses and users, it was evidenced that there was no difference among the pointed averages in the attribute access to the services; differing from the longitudinality of care, coordination and the kind of services provided that presented significant difference in the general averages. With relationship to the quality of the care that are offered, it was observed that 24.0% of users with diabetes were in compliance with the appropriate diet, 29.4% with the practice of physical activity and 84.1% with the medical treatment. Also, 27.9% of them referred complications of the disease and 27.5% mentioned hospitalizations due to diabetes. It was verified that the adhesion to the medical treatment was related to the participation in activities of health education (OR = 2.83) and assistance by the same nurse (OR=2.28). Checking capillary glycaemia every 3 months, and the orientation on the practice of physical activity (OR = 0.45 and 1.93, respectively), were shown to be related to a proper_diet. The practice of frequent physical activity was already more frequently mentioned by those that were satisfied with the received assistance (OR = 2.99), that waited for a long time to be assisted (OR = 2.51), informed about their health condition (OR = 1.94), assisted by the same nurse (OR = 1.72), that took part on the activities of health education (OR = 0.57) and that were assisted in the same day that sought assistance at the BHU (OR = 0.49). Having no orientation about a proper diet (OR = 1.60), having blood pressure checked during the visit to a doctor (OR = 2.85) and to be satisfied with the received assistance (OR = 0.46), were associated with absence of microvascular complications. The absence of hospitalization for problems related to diabetes presented association with the periodicity of the capillary glycaemia checking (OR = 5.15), absence of exams of the feet (OR = 2.97), a doctor visit in the same day (OR = 2.53) and delivery of oral anti-diabetic medicine and/or insulin (OR =2.90). Rates of 81.9% of satisfaction with the assistance were found, being greater among the men (OR = 2.96), who do physical exercises (OR = 2.54), are assisted in the same day they go to the Basic Health Unit (OR = 2.60), that receive orientation about a proper diet (OR = 2.72), and that are able to show the results of exams to the doctor with promptness (OR = 3.09).To receive oral anti-diabetic medicine and/or insulin (OR = 0.12) was considered a factor of protection. It was concluded that there is a need of reorganizing the assistance provided to the individuals with diabetes in Maringá, in a way to reach the excellence of the quality of the care that is offered, considering that the results point to an assistance to the users with diabetes directed to the biomedical model and to the curative actions in detriment of the ones of health promotion and prevention of injuries.