Indicadores de qualidade no cuidado ao paciente com diabetes melito tipo 2 : uma análise por nível de complexidade de atendimento

O diabetes melito tipo 2 (DM2) é uma doença crônica, progressiva, causada pela deficiência relativa de insulina, que ocorre pela disfunção de células β pancreáticas e resistência à insulina em órgãos alvo. Com o envelhecimento da população, aliado ao aumento global da obesidade e ao estilo de vida sedentário, quadruplicou a incidência e a prevalência de DM2 entre os anos de 1980 e 2004. Indicadores de qualidade são estratégias utilizadas para garantir adequado fornecimento do processo de cuidado do diabetes, a fim de melhorar o controle glicêmico dos pacientes e prevenir complicações relacionadas à doença. Devido à grande variedade de indicadores, sem consenso comum de quais os mais indicados e visto que alguns autores sugerem uma adaptação às peculiaridades socioculturais de cada população, o presente estudo vem mostrar alguns indicadores de qualidade ao cuidado com os pacientes com DM2 atendidos nos centros de atenção primária (baixa complexidade) e atenção terciária (alta complexidade), traçando uma comparação entre estes dois sistemas de atendimento. Trata-se de uma coorte retrospectiva com 488 pacientes com diabetes melito tipo 2, com seguimento de um ano, a qual analisou os seguintes indicadores de qualidade de atendimento: presença de duas ou mais avaliações de hemoglobina glicada, avaliação de nefropatia, neuropatia e retinopatia diabéticas, perfil lipídico anual, avaliação nutricional anual e abordagem sobre tabagismo. Nossos resultados evidenciaram níveis muito baixos de atingimento das metas de avaliação do cuidado oferecido ao paciente com DM2 tanto em centros primários, quanto terciário de atendimento. Esperamos poder contribuir para o diálogo entre os gestores em saúde visando a melhoria dos protocolos e linhas de cuidado ao paciente com DM2

The impact of patient navigation on glycemic control, adherence to self-care and knowledge about diabetes : an intervention study

Background Patient navigation helps with better adherence to treatment, as well as better knowledge about diabetes and greater interest in performing, monitoring, and seeking health care. Therefore, this study aims to evaluate the efect of patient navigation on glycemic control, disease knowledge, adherence to self-care in people with type 1 diabetes mellitus. Methods This is an intervention study using a single group pre-test post-test design, carried out in a tertiary public teaching hospital in Southern Brazil. Participants over 18 years of age and diagnosed with type 1 diabetes were included. In total, three teleconsultations and one face-to-face consultation were carried out, with three-month intervals, until completing one year of follow-up. The nurse navigator conducted diabetes education based on the guidelines of the Brazilian Diabetes Society and the Nursing Interventions Classifcation. The diferences between glycated hemoglobin, adherence to self-care, and knowledge about initial and fnal diabetes were estimated to verify the efect of patient navigation by nurses, according to the tool applied in the frst and last consultations. Interaction analyses between variables were also performed. Student’s t-test, Generalized Estimating Equations, Wilcoxon test, and McNemar test were used. Results The fnal sample consisted of 152 participants, of which 85 (55.9%) were women, with a mean age of 45±12 years, and diabetes duration of 23.6±11.1 years. Nurse navigators conducted 812 teleconsultations and 158 face-to-face consultations. After the intervention, glycemic control improved in 37 (24.3%) participants (p<0.001), and knowledge about diabetes also improved in 37 (24.3%) participants (p<0.001). Adherence to self-care increased in 82 (53.9%) patients (p<0.001). The analysis of the interaction between glycemic control and the results from the questionnaire of knowledge about diabetes showed an interaction efect (p=0.005). However, we observed no interaction efect between glycemic control and the results from the questionnaire on adherence to self-care (p=0.706). Conclusions Our results showed improvement in glycemic control, adherence to self-care, and knowledge of diabetes in the study participants. In addition, they suggest that patient navigation performed by nurses is promising and feasible in improving care for patients with type 1 diabetes

Knowledge about diabetes and its association with adherence to self-care and glycemic control in patients with type 1 diabetes in Southern Brazil

Objective: To evaluate the association between knowledge about the disease, adherence to self-care, and glycemic control in people diagnosed with type 1 diabetes mellitus. Subjects and methods: A cross-sectional study of patients aged over 18 years diagnosed with type 1 diabetes mellitus, treated at an outpatient clinic of a Brazilian university hospital. Participants with other types of diabetes, cognitive impairment, pregnancy, and outpatient discharge were excluded. Data were collected from January to March 2021 (by telephone call), with questions about the participants' profile, diabetes knowledge questionnaire (DKN-A), and self-care inventory revised (SCI-R) translated into and adapted for Brazilian Portuguese. Data analysis involved chi-square associations, Mann-Whitney U tests, and Poisson regression. Results: Among 198 adult participants, the mean age was 42 ± 12 years, 53.5% were women, the mean glycated hemoglobin was 8.6 ± 1.6%, 140 (70.8%) had satisfactory knowledge about diabetes, 65 (32.8%) had adherence to self-care, and 46 (23.2%) had adequate glycemic control. We found an association between knowledge and adherence to self-care (p < 0.001). Knowledge was not associated with glycemic control (p = 0.705). Conclusion: Knowledge about diabetes was associated with greater adherence to self-care in people with type 1 diabetes mellitus, but it did not reflect in better glycemic control

Quality indicators in type 2 diabetes patient care: analysis per care-complexity level

Background: This study was developed to evaluate quality indicators in type 2 diabetes patient care at the Unified Public Health System’s primary and tertiary health care centers within a local population. Methods: This was a retrospective cohort of 488 patients with type 2 diabetes (148 in each primary health care unit, ESF and UBS, and 192 at the tertiary health care unit) with a 1-year follow-up to evaluate the following care quality indicators: nephropathy, neuropathy and retinopathy tests, yearly lipid profile and nutritional assessments, and an inquiry about tobacco use. The presence of > 50% of the quality of care assessment measures was considered acceptable. Indicators were also evaluated in relation to patients without proper diabetes control (HbA1c > 8.5%). Results: In the results, a high percentage of patients were excluded specifically for not presenting the two HbA1c tests within a year (n = 208, 58.1% at ESF; n = 225, 58.4% at UBS; and n = 39, 16.9% at the tertiary health care unit). From the included patients, only 7 (4.7%) at ESF, 7 (4.7%) at UBS, and 52 (27.0%) at the tertiary health care unit showed > 50% of the quality criteria covered. When only patients without proper diabetes control were evaluated, none of them at any of the health care units showed all the quality criteria covered. Conclusions: Our results show a low percentage of care assessment measures at each evaluated health care unit, pointing out the need to improve the protocols and care lines of diabetic patients