Autocuidado entre personas con Diabetes Mellitus y la calidad de la atención en Atención Primaria de Salud

Suplici, Samara Eliane Rabelo; Meirelles, Betina Hörner Schlindwein; Lacerda, Josimari Telino de; Silva, Denise Maria Guerreiro Vieira da

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 74 (2) • 2021 • https://doi.org/10.1590/0034-7167-2020-0351 copiar

Autocuidado entre personas con Diabetes Mellitus y la calidad de la atención en Atención Primaria de Salud

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

verificar la adherencia a las actividades de autocuidado en personas con diabetes mellitus y su asociación con la calidad de la atención recibida en Atención Primaria.

Métodos:

estudio transversal con 329 personas con diabetes atendidas en Atención Primaria. Se recogieron datos sociodemográficos y de autocuidado. Para evaluar la calidad de la atención en Atención Primaria se utilizaron datos secundarios del Programa de Mejora de Acceso y Calidad. Para las comparaciones entre la adherencia a las actividades de autocuidado y la calidad de la atención recibida en Atención Primaria se utilizó la prueba de Kruskal-Wallis.

Resultados:

se observó mejor adherencia a la dieta, seguimiento glucémico y uso de medicamentos en personas con diabetes atendidas en Atención Primaria con mejor coordinación de la atención, organización de la agenda y equipamiento. El examen de los pies, a pesar de la relación inversa con la calidad de la atención, resultó ser deseable.

Conclusiones:

la adherencia al autocuidado en personas con diabetes se asoció con la calidad de la atención recibida en Atención Primaria.

Descriptores:
Autocuidado; Diabetes Mellitus; Atención Primaria de Salud; Evaluación en Salud; Atención de Enfermería

	Frequencies N = 329	n (%)
Age group
Up to 59 years old	110	33.4
60-69 years old	127	38.6
70 years or over	92	28
Total	329	100
Sex
Male	93	28.3
Female	236	71.7
Total	329	100
Marital status
Married	166	50.5
Single	24	7.3
Separated/divorced	57	17.3
Widowed	82	24.9
Total	329	100
Years of education^a a 2 missing;
Never attended school	27	8.3
1 to 5 years	159	48.6
6 to 9 years	56	17.1
10 to 12 years	54	16.5
13 or more years	31	9.5
Total^a a 2 missing;	327	100
Occupational Status
Active	87	26.4
Under sick leave	17	5.2
Retired	193	58.7
Unemployed	32	9.7
Total	329	100
Income^* * Current minimum wage=R$ 937.00 (about 187 US$), Brazil, 2017; ^b b 4 missing;
Less than one wage	9	2.8
1 to 3 wages	238	73.2
3 to 6 wages	75	23.1
More than 6 wages	3	0.9
Total^b	325	100

QAD Items	Overall team performance			p value
QAD Items	Median or below average Mean (SD)	Above average Mean (SD)	Well above average Mean (SD)	p value
Followed a healthy diet	2.95 (2.91)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average);	3.20 (3.00)	4.09 (2.75)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average);	0.012^* * p<0.05; Kruskal-Wallis test;
Followed the food guidance given by a health professional	2.95 (2.91)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average);	3.20 (3.00)	4.08 (2.66)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average);	0.013^* * p<0.05; Kruskal-Wallis test;
Ate five or more fruits and/or vegetables	4.43 (2.50)	4.84 (2.67)	4.92 (2.58)	0.350
Ate high-fat foods	2.15 (2.73)	2.29 (2.75)	1.86 (2.43)	0.585
Ate sweets	2.08 (2.52)	2.28 (2.58)	1.69 (2.06)	0.456
Performed physical activity for at least 30 min	1.85 (2.63)	1.38 (2.32)	1.51 (2.30)	0.491
Performed specific physical exercise	1.36 (2.34)	1.07 (2.16)	1.53 (2.35)	0.225
Rated blood sugar	1.77 (2.60)	2.15 (2.97)	2.49 (2.95)	0.180
Rated blood sugar as recommended by a professional	1.28 (2.22)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average);	1.66 (2.75)	2.48 (3.08)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average);	0.018^* * p<0.05; Kruskal-Wallis test;
Examined the feet	5.85 (2.47)	5.98 (2.48)^# # Dunn's post hoc (differences between above average and well above average).	4.98 (3.01)^# # Dunn's post hoc (differences between above average and well above average).	0.002^* * p<0.05; Kruskal-Wallis test;
Examined the shoes before wearing them	5.13 (3.12)	5.18 (3.06)	4.91 (3.12)	0.707
Dried the space between the toes after cleaning them	6.13 (2.28)	6.06 (2.40)	5.91 (2.49)	0.760
Took the medications as recommended	4.85 (3.16)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average);	5.34 (2.82)^# # Dunn's post hoc (differences between above average and well above average).	6.51 (1.64)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average); .^# # Dunn's post hoc (differences between above average and well above average).	*<0.001^ * p<0.05; Kruskal-Wallis test;**

QAD Items	Team performance in the coordination of care, care network and problem solving subdimension			p value
QAD Items	Median or below average Mean (SD)	Above average Mean (SD)	Well above average Mean (SD)	p value
Followed a healthy diet	2.78 (2.88)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average); .^€ € Dunn's post hoc (differences between median or below average and above average);	3.95 (3.00)^€ € Dunn's post hoc (differences between median or below average and above average);	4.05 (2.66)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average);	0.003^* * p<0.05; Kruskal-Wallis test;
Followed the food guidance given by a health professional	2.78 (2.88)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average); .^€ € Dunn's post hoc (differences between median or below average and above average);	3.96 (2.86)^€ € Dunn's post hoc (differences between median or below average and above average);	4.02 (2.64)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average);	0.003^* * p<0.05; Kruskal-Wallis test;
Ate five or more fruits and/or vegetables	4.52 (2.68)	4.70 (2.53)	5.09 (2.56)	0.183
Ate high-fat foods	2.32 (2.75)	2.19 (2.68)	1.67 (2.32)	0.270
Ate sweets	2.20 (2.63)	2.08 (2.37)	1.58 (1.93)	0.463
Performed physical activity for at least 30 min	1.69 (2.54)	1.34 (2.08)	1.59 (2.46)	0.745
Performed specific physical exercise	1.20 (2.26)	1.24 (2.02)	1.63 (2.53)	0.445
Rated blood sugar	1.77 (2.67)	2.34 (3.02)	2.57 (2.92)	0.080
Rated blood sugar as recommended by a professional	1.37 (2.39)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average);	1.97 (2.96)^# # Dunn's post hoc (differences between above average and well above average).	2.61 (3.07)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average); .^# # Dunn's post hoc (differences between above average and well above average).	0.004^* * p<0.05; Kruskal-Wallis test;
Examined the feet	5.95 (2.42)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average);	5.12 (2.99)	5.11 (2.93)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average);	0.049^* * p<0.05; Kruskal-Wallis test;
Examined the shoes before wearing them	5.08 (3.14)	4.90 (3.09)	5.06 (3.09)	0.854
Dried the space between the toes after cleaning them	6.05 (2.37)	5.96 (2.43)	5.97 (2.47)	0.946
Took the medications as recommended	5.13 (3.01)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average);	5.83 (2.46)	6.53 (1.61)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average);	<0.001 ^* * p<0.05; Kruskal-Wallis test;

QAD Items	Team performance in the agenda organization subdimension			p value
QAD Items	Median or below average Mean (SD)	Above average Mean (SD)	Well above average Mean (SD)	p value
Followed a healthy diet	3.20 (3.00)	2.67 (2.94)^# # Dunn's post hoc (differences between above average and well above average). .^€ € Dunn's post hoc (differences between median or below average and above average);	4.05 (2.66)^# # Dunn's post hoc (differences between above average and well above average).	0.002^* * p<0.05; Kruskal-Wallis test;
Followed the food guidance given by a health professional	3.20 (3.00)	2.67 (2.94)^# # Dunn's post hoc (differences between above average and well above average). .^€ € Dunn's post hoc (differences between median or below average and above average);	4.02 (2.64)^# # Dunn's post hoc (differences between above average and well above average).	*0.001^ * p<0.05; Kruskal-Wallis test;**
Ate five or more fruits and/or vegetables	4.66 (2.53)	4.56 (2.68)	5.09 (2.56)	0.188
Ate high-fat foods	1.95 (2.57)	2.60 (2.84)	1.67 (2.32)	0.060
Ate sweets	2.12 (2.43)	2.15 (2.57)	1.58 (1.93)	0.451
Performed physical activity for at least 30 min	1.43 (2.13)	1.59 (2.51)	1.59 (2.46)	0.995
Performed specific physical exercise	1.30 (2.03)	1.12 (2.25)	1.63 (2.53)	0.280
Rated blood sugar	2.34 (2.91)	1.77 (2.81)^# # Dunn's post hoc (differences between above average and well above average).	2.57 (2.92)^# # Dunn's post hoc (differences between above average and well above average).	0.026^* * p<0.05; Kruskal-Wallis test;
Rated blood sugar as recommended by a professional	2.04 (2.88)	1.29 (2.47)^# # Dunn's post hoc (differences between above average and well above average).	2.61 (3.07)^# # Dunn's post hoc (differences between above average and well above average).	0.001 ^* * p<0.05; Kruskal-Wallis test;
Examined the feet	5.03 (3.01)^€ € Dunn's post hoc (differences between median or below average and above average);	6.07 (2.33)^# # Dunn's post hoc (differences between above average and well above average). .^€ € Dunn's post hoc (differences between median or below average and above average);	5.11 (2.93)^# # Dunn's post hoc (differences between above average and well above average).	0.008^* * p<0.05; Kruskal-Wallis test;
Examined the shoes before wearing them	4.63 (3.21)	5.41 (2.95)	5.06 (3.09)	0.175
Dried the space between the toes after cleaning them	5.97 (2.42)	6.04 (2.38)	5.97 (2.47)	0.963
Took the medications as recommended	5.69 (2.60)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average);	5.29 (2.89)^# # Dunn's post hoc (differences between above average and well above average).	6.53 (1.61)^# # Dunn's post hoc (differences between above average and well above average). .^¥ ¥ Dunn's post hoc (differences between median or below average and well above average);	0.001^* * p<0.05; Kruskal-Wallis test;

QAD Items	Team performance in the equipment, materials and supplies subdimension			p value
QAD Items	Median or below average Mean (SD)	Above average Mean (SD)	Well above average Mean (SD)	p value
Followed a healthy diet	2.24 (2.80)^€ € Dunn's post hoc (differences between median or below average and above average); .^¥ ¥ Dunn's post hoc (differences between median or below average and well above average);	3.86 (2.79)^€ € Dunn's post hoc (differences between median or below average and above average);	4.29 (2.81)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average);	*<0.001^ * p<0.05; Kruskal-Wallis test**
Followed the food guidance given by a health professional	2.24 (2.80)^€ € Dunn's post hoc (differences between median or below average and above average); .^¥ ¥ Dunn's post hoc (differences between median or below average and well above average);	3.86 (2.77)^€ € Dunn's post hoc (differences between median or below average and above average);	4.26 (2.64)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average);	*<0.001^ * p<0.05; Kruskal-Wallis test**
Ate five or more fruits and/or vegetables	4.36 (2.76)	5.05 (2.53)	4.63 (2.55)	0.139
Ate high-fat foods	2.68 (2.82)^€ € Dunn's post hoc (differences between median or below average and above average);	2.25 (2.55)	1.66 (2.43)^€ € Dunn's post hoc (differences between median or below average and above average);	0.007^* * p<0.05; Kruskal-Wallis test
Ate sweets	2.41 (2.81)	1.72 (2.14)	1.93 (2.15)	0.438
Performed physical activity for at least 30 min	1.87 (2.70)	1.36 (2.30)	1.66 (2.24)	0.147
Performed specific physical exercise	1.27 (2.45)	1.30 (2.29)	1.64 (2.23)	0.119
Rated blood sugar	1.78 (2.79)	2.34 (2.90)	2.50 (2.95)	0.160
Rated blood sugar as recommended by a professional	1.31 (2.47)	2.18 (2.90)	2.36 (3.10)	0.051
Examined the feet	5.89 (2.50)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average);	5.64 (2.64)^# # Dunn's post hoc (differences between above average and well above average).	4.98 (3.21)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average); .^# # Dunn's post hoc (differences between above average and well above average).	<0.001 ^* * p<0.05; Kruskal-Wallis test
Examined the shoes before wearing them	5.00 (3.18)	5.12 (3.07)	4.82 (3.10)	0.670
Dried the space between the toes after cleaning them	5.75 (2.66)	6.03 (2.40)	6.08 (2.29)	0.665
Took the medications as recommended	4.97 (3.05)^€ € Dunn's post hoc (differences between median or below average and above average); .^¥ ¥ Dunn's post hoc (differences between median or below average and well above average);	5.97 (2.38)^€ € Dunn's post hoc (differences between median or below average and above average);	6.49 (1.61)^¥ ¥ Dunn's post hoc (differences between median or below average and well above average);	0.003^* * p<0.05; Kruskal-Wallis test

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[1] Corresponding author: Samara Eliane Rabelo Suplici E-mail: samara.suplici@gmail.com