Gerenciamento de cuidados crônicos na Atenção Primária de Pacientes com Diabetes Mellitus tipo 2 no Amazonas

Abstract

The proper management of chronic conditions, including Type 2 Diabetes Mellitus (T2DM), within the context of Primary Health Care (PHC), is becoming increasingly necessary due to the progressive increases in the incidence of this disease and the negative implications it causes, such as strain on critical sectors like health and the economy. It's important for healthcare systems to be mindful of their capacity to provide care to users diagnosed with chronic conditions. Evaluating the institutions that provide these services helps to highlight weaknesses and potential areas for improvement in service delivery and, consequently, care provision. The Assessment of Chronic Illness Care (ACIC) and Patient Assessment of Chronic Illness Care (PACIC) instruments are tools that can be used in these assessments. They take into account the perspective of professionals working in the institutions and the users of the service, respectively. Among the advantages of using these tools is the ability to obtain objective data about the quality of the service offered, facilitating decision-making and directing the implementation of improvements. The study had two objectives: 1) evaluate the institutional capacity of PHC in the interior of Amazonas to care for users diagnosed with DM2, from the perspective of health professionals and service users; 2) verify the association between socio-educational, work, geographic location, sociodemographic, clinical, behavioral and functional performance variables with this institutional capacity. This is a cross-sectional quantitative study conducted between October 2020 and December 2022. The research resulted in two articles. The first article pertains to the evaluation using the ACIC. It was conducted in 36 Primary Health Units (PHUs) in seven cities in the interior of Amazonas and included 230 participants. Microsoft Office Excel 2019 and R version 4.2.1 were used for data tabulation and analysis. Multiple logistic regression analysis was used to verify the association between selected independent variables and institutional capacity. It was found that PHUs in the interior of Amazonas have basic capacity to care for users with T2DM. Regression analysis demonstrated that some variables were associated with institutional capacity, with geographic location being a notable factor. The second article concerns the application of the PACIC. It was conducted in ten municipalities in Amazonas and included 965 participants. R version 4.2.1 was used to generate a generalized linear model to determine the influence of selected independent variables on institutional capacity. It was observed that the capacity of PHUs in these locations to support users diagnosed with T2DM is weakened. Sociodemographic, clinical, and behavioral variables were associated with institutional capacity.