Social inequalities in care for the elderly with diabetes in Brazil

Abstract

Objective. To measure the prevalence of various care services offered to the elderly with diabetes mellitus in Brazil, and to assess the social inequalities in these services. Methods. This cross-sectional, population-based study was carried out in 2013. The care services offered were evaluated in terms of the following eight indicators: recommendations to lower carbohydrates, to measure blood glucose, and to examine the feet; requests made for blood tests, for glycated hemoglobin tests, and for glycemic curve tests; and whether service users had had their eyes or feet examined in the previous year. We used the slope index of inequality and the concentration index to assess the inequalities among wealth quintiles. Results. A total of 1 685 elderly persons with diabetes were evaluated. Overall, 41.7% of them had had their eyes examined in the preceding year, 35.4% had had their feet examined in the preceding year, and 10.9% had been offered all eight of the care services. The largest absolute differences (in percentage points) between the first (poorest) and fifth (richest) wealth quintiles in terms of the care services that were offered to the users were for: a recommendation to measure blood glucose (25.8), a glycated hemoglobin test request (27.4), a glycemic curve test request (31.9), having the eyes examined in the preceding year (29.3), and having the feet examined in the preceding year (27.0). Conclusion. There were notable inequalities in the prevalences of the care services. In the future, measurement of blood glucose and examination of the feet should be emphasized, especially for elderly persons in a lower socioeconomic level.

Examining inequality in utilisation of health management services for the elderly in rural Henan China

“…The pro-rich finding of HMS utilisation for the elderly in rural areas of Henan is consistent with some studies but different from others [ 15 – 17 ]. The utilisation of HMS varies in different regions or countries possibly due to differences in the health management system and financial investment [ 25 ].…”

“…However, few studies have examined inequality in HMS utilisation for the elderly; seniors in rural areas are more likely to be ignored. Although some scholars have reported that there is inequality for the elderly to utilise HMS in other countries, we cannot be sure that the findings are consistent with those in China [16,17].…”

Cuidados dos profissionais de saúde aos idosos com diabetes: um estudo de base populacional no sul do Brasil

“…Em um estudo realizado com indivíduos de todas as cinco regiões do Brasil, evidenciou que os exames mais solicitados para a população com diagnóstico de DM eram análise de sangue (glicemia em jejum) (93,1%), seguido de exame de hemoglobina glicada (72,9%) (Neves et al 2018). Outro estudo realizado com diabéticos tipo 2 observou que 62,6% apresentavam pelo menos uma avaliação de hemoglobina glicada registrada no prontuário e entre estes, 32,0% apresentavam pelo menos duas avaliações no período de um ano, conforme o recomendado pelo MS (Fernandez et al, 2016).…”

“…Cabe destacar que o exame de visão e do pé diabético foram responsáveis por reduzir a prevalência de cuidado adequado. Um estudo com dados do PNS aponta que, dos 1.685 entrevistados que possuíam diagnóstico prévio de DM, apenas 10,9% recebeu assistência de todos os oito indicadores avaliados, sendo eles: recomendação para diminuir carboidrato; recomendação para medição de glicose no sangue; recomendação para examinar os pés; pedido de análise de sangue; solicitação de hemoglobina glicada; solicitação de curva glicêmica; olhos examinados no último ano; pés examinados no último ano (Neves et al, 2018), demonstrando uma fragilidade na atenção integral ao indivíduo com DM.…”

“…No Brasil há poucos estudos de base populacional direcionados para a avaliação do processo de cuidado oferecido pelos serviços de atenção primária à saúde às pessoas com diabetes (Tomasi et al, 2017;Neves et al, 2018). Portanto este estudo tem como objetivo avaliar o cuidado dos profissionais de saúde aos idosos com DM nos serviços de atenção primária no município de Bagé, Rio Grande do Sul.…”