Schneiders Josiane, Telo Gabriela H, Bottino Leonardo Grabinski, Pasinato Bruna, Neyeloff Jeruza Lavanholi, Schaan Beatriz D
1Programa de Pós-Graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 21, 6º andar, Porto Alegre, RS 90035-003 Brazil.
2Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Diabetol Metab Syndr. 2019 May 2;11:34. doi: 10.1186/s13098-019-0428-8. eCollection 2019.
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.
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%).
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.
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.
本研究旨在评估当地人群中统一公共卫生系统的初级和三级医疗保健中心对2型糖尿病患者的护理质量指标。
这是一项对488例2型糖尿病患者的回顾性队列研究（每个初级卫生保健单位，即基本卫生单位和综合卫生单位各148例，三级卫生保健单位192例），进行为期1年的随访，以评估以下护理质量指标：肾病、神经病变和视网膜病变检查、年度血脂谱和营养评估，以及吸烟情况询问。护理质量评估措施中有超过50%存在则被认为是可接受的。还针对糖尿病控制不佳（糖化血红蛋白>8.5%）的患者评估了各项指标。
结果显示，有很高比例的患者因一年内未进行两次糖化血红蛋白检测而被专门排除（基本卫生单位有208例，占58.1%；综合卫生单位有225例，占58.4%；三级卫生保健单位有39例，占16.9%）。在纳入的患者中，基本卫生单位只有7例（4.7%）、综合卫生单位只有7例（4.7%）、三级卫生保健单位有52例（27.0%）达到了超过50%的质量标准。当仅对糖尿病控制不佳的患者进行评估时，任何一个医疗保健单位的患者均未达到所有涵盖的质量标准。
我们的结果表明，每个评估的医疗保健单位的护理评估措施比例都很低，指出需要改进糖尿病患者的诊疗方案和护理流程。
