Revista de Saúde Pública
On-line version ISSN 1518-8787
ASSUNCAO, Maria Cecília F; SANTOS, Iná da Silva dos and GIGANTE, Denise P. Diabetes mellitus at the primary health care level in Southern Brazil: structure, course of action and outcome. Rev. Saúde Pública [online]. 2001, vol.35, n.1, pp. 88-95. ISSN 1518-8787. http://dx.doi.org/10.1590/S0034-89102001000100013.
OBJECTIVE: To describe and evaluate the structure, course of action, and the outcome of diabetic patient care delivered at primary health care level in Pelotas, Southern Brazil. METHODS: Through a cross-sectional study all of 32 health centers in the region were assessed, along with the 61 doctors who were managing diabetic patients. A sample of 378 diabetic patients who attended these health centers was also included. Patients were interviewed at home and their glucose capillary blood level, blood pressure and body mass index were assessed and compared with standard parameters. Course of action and structure components were compared against the basic recommendations for the care of diabetic patients. RESULTS: Most centers didn't meet the basic recommendations. Blood pressure measurement was the most reported action in the physical examination in the first visit. As part of the management plan set in the first visit, almost 85% of the doctors reported to prescribe a special diet and 72% referred recommending physical exercise. For laboratory monitoring, all doctors reported asking for fasting blood glucose and 60% of them reported checking their patients' glycated hemoglobin. The rate of disease control ranged from 6 to 11%, according to the Latin American Diabetes Association and the Ministry of Health parameters, respectively. CONCLUSIONS: Although currently undersupplied, the primary health sector is potentially able to improve in its three components (structure, course of actions and outcome) by training medical doctors and their compliance with established guidelines.
Keywords : Diabetes mellitus [prevention and control]; Primary health care; Outcome and process assessment (health care); Health services research; Quality of health care; Health services administration; Medical care; Diabetes mellitus [therapy]; Evaluation, health services.