Diabetes Care in Brazil

Tomasi, Elaine; Cesar, Maria Aurora Dropa Chrestani; Neves, Rosália Garcia; Schmidt, Paulo Ricardo Correa; Thumé, Elaine; Silveira, Denise Silva da; Siqueira, Fernando Vinholes; Nunes, Bruno Pereira; Fassa, Anaclaudia Gastal; Saes, Mirelle de Oliveira; Duro, Suele Manjourany Silva; Völz, Pâmela Moraes; Facchini, Luiz Augusto

doi:10.1097/jac.0000000000000184

Cited by 29 publications

(12 citation statements)

References 31 publications

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“…In our study, diabetic neuropathy evaluation had very low rates, particularly in primary care. This was similar to another Brazilian study in which less than one-third of patients had undergone feet assessments [22], but this was higher than the data found in an Italian study that evaluated 20,744 patients via the records of 270 physicians. In this study, only 0.9% of the patients were evaluated for neuropathy [23].…”

Section: Discussionsupporting

confidence: 86%

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

Schneiders

Teló

Bottino

et al. 2019

Diabetol Metab Syndr

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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.

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Section: Discussionsupporting

confidence: 86%

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

Schneiders

Teló

Bottino

et al. 2019

Diabetol Metab Syndr

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“…Low frequency of ophthalmoscopy and of screening for loss of protective plantar sensation was described by the physicians in this study. These rates are lower than those reported previously in Brazil [25]. Actually, the frequency of both examinations varies worldwide [22, 23, 26].…”

Section: Discussionmentioning

confidence: 58%

Quality of Care of Patients with Diabetes in Primary Health Services in Southeast Brazil

Simão

Costa

Colugnati

et al. 2017

Journal of Environmental and Public Health

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Background Diabetes management involves multiple aspects that go beyond drug therapy as a way of providing high quality care. The objective of this study was to describe quality of care indicators for individuals with diabetes in southeast Brazil and to explore associations among these indicators. Methods In this cross-sectional, observational study, health care providers filled out a questionnaire addressing health care structure and processes at 14 primary health care units (PHCUs). Clinical and laboratory data of diabetic patients attending the PHCUs and from patients referred to a secondary health care (SHC) center were collected. Results There was a shortage of professionals in 53.8% of the PHCUs besides a high proportion of problems regarding referrals to SHC. At the PHCU, glycated hemoglobin results were available only in half of the medical records. A low rate of adequate glycemic control was also observed. An association between structure and process indicators and the outcomes analyzed was not found. Conclusion Major deficiencies were found in the structure and processes of the PHCUs, in addition to unsatisfactory diabetes care outcomes. However, no association between structure, process, and outcomes was found.

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“…Despite 9 years of implementation, PMAQ is still underevaluated in terms of its effects on endpoint outcomes. Studies relied mainly on descriptive analyses, 10 based on a subset of data on structure, access, service organisation and management indicators, generally for a specific health condition such as diabetes, 11 antenatal care, 12 cervical cancer screening, 13 user's satisfaction 14 and work processes. 15 Hospitalisation rate for ambulatory care sensitive conditions (ACSCs) have been used as an indirect indicator of the effectiveness and quality of PHC.…”

Section: Key Questionsmentioning

confidence: 99%

Pay for performance in primary care: the contribution of the Programme for Improving Access and Quality of Primary Care (PMAQ) on avoidable hospitalisations in Brazil, 2009–2018

et al. 2021

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BackgroundEvidence on the effect of pay-for-performance (P4P) schemes on provider performance is mixed in low-income and middle-income countries. Brazil introduced its first national-level P4P scheme in 2011 (PMAQ-Brazilian National Programme for Improving Primary Care Access and Quality). PMAQ is likely one of the largest P4P schemes in the world. We estimate the association between PMAQ and hospitalisations for ambulatory care sensitive conditions (ACSCs) based on a panel of 5564 municipalities.MethodsWe conducted a fixed effect panel data analysis over the period of 2009–2018, controlling for coverage of primary healthcare, hospital beds per 10 000 population, education, real gross domestic product per capita and population density. The outcome is the hospitalisation rate for ACSCs among people aged 64 years and under per 10 000 population. Our exposure variable is defined as the percentage of family health teams participating in PMAQ, which captures the roll-out of PMAQ over time. We also provided several sensitivity analyses, by using alternative measures of the exposure and outcome variables, and a placebo test using transport accident hospitalisations instead of ACSCs.ResultsThe results show a negative and statistically significant association between the rollout of PMAQ and ACSC rates for all age groups. An increase in PMAQ participating of one percentage point decreased the hospitalisation rate for ACSC by 0.0356 (SE 0.0123, p=0.004) per 10 000 population (aged 0–64 years). This corresponds to a reduction of approximately 60 829 hospitalisations in 2018. The impact is stronger for children under 5 years (−0.0940, SE 0.0375, p=0.012), representing a reduction of around 11 936 hospitalisations. Our placebo test shows that the association of PMAQ on the hospitalisation rate for transport accidents is not statistically significant, as expected.ConclusionWe find that PMAQ was associated with a modest reduction in hospitalisation for ACSCs.

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Diabetes Care in Brazil

Cited by 29 publications

References 31 publications

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

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

Quality of Care of Patients with Diabetes in Primary Health Services in Southeast Brazil

Pay for performance in primary care: the contribution of the Programme for Improving Access and Quality of Primary Care (PMAQ) on avoidable hospitalisations in Brazil, 2009–2018

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