Atenção primária à criança com diabetes mellitus tipo 1: perspectiva de cuidadores

Abstract

Objective: To evaluate and compare the quality of primary care provided for children with type 1 diabetes mellitus, among the types of public health care services, based on the experience of their main caregivers. Methods: Cross-sectional study, grounded in health assessment, using interviews with 55 caregivers of children with type 1 diabetes mellitus, based on the Primary Care Assessment Tool-Child Version. Results: Most of the attributes of primary health care presented unsatisfactory scores, including the general and essential scores. A greater link with the specialized service (pediatric endocrinology clinics) was found. Although the general and essential scores did not attain satisfactory values, the specialized services achieved better results than the primary health care services, showing, from the perception of the consumers, relevant differences between services. Specialized services were perceived as regular sources of care, and better providers of primary health care practices. This point may be related to the greater contact of the participants with the professionals from the specialized services, and the readiness of these services to care for children with type 1 diabetes mellitus, suggesting fragilities in the primary health care services. Conclusion: The health care of children with type 1 diabetes mellitus, in the studied municipality, shows little presence and extension of primary care attributes, with fragmented and disconnected actions, leading to losses in the integration and expansion of the care network. ResumoObjetivo: Avaliar e comparar a qualidade da atenção primária ofertada às crianças com diabetes mellitus tipo 1 entre os tipos de serviços públicos de atenção à saúde na experiência dos seus principais cuidadores. Métodos: Estudo transversal, fundamentado em avaliação em saúde, a partir de entrevistas com 55 cuidadores de crianças com diabetes mellitus tipo 1, com base no instrumento de avaliação Primary Care Assessment Tool-versão criança. Resultados: Grande parte dos atributos da atenção primária à saúde apresentou escores considerados insatisfatórios, inclusive os escores Geral e Essencial. Foi encontrado maior vínculo com o serviço especializado (ambulatórios de endocrinologia pediátrica). Apesar dos escores Geral e Essencial não terem alcançado valores satisfatórios, os serviços especializados apresentaram melhores resultados que os serviços de atenção primária à saúde, mostrando, na percepção dos usuários, diferenças relevantes entre os serviços. Os serviços especializados foram percebidos como fontes regulares de atenção e melhores fornecedores de práticas de atenção primária à saúde. Tal apontamento pode estar relacionado ao maior contato dos participantes com os profissionais dos serviços especializados e prontidão desses serviços na atenção às crianças com diabetes mellitus tipo 1, sugerindo fragilidades nos serviços de atenção primária à saúde. Conclusão: A atenção à saúde das crianças com diabetes mellitus tipo 1 no município estudado apresenta pouca presença e ex...

Avaliação da Atenção Primária à Saúde sob a ótica de cuidadores de crianças: revisão integrativa

“…Of the four studies (23,28,(32)(33) which assessed the degree of affiliation, three (23,28,32) (75%) had a high score, showing that the primary care service is recognized as a reference for health care by users of the health system, considering that the degree of affiliation is configured as recognition of that health service/professional as the main source to promote the user's healthcare (33) . It is noteworthy that some problems related to the lack of resoluteness of the service and the difficulty of accessibility may influence the degree of affiliation (33) .…”

“…The longitudinality attribute was well evaluated in 60% of the articles (14,17,21,23,27,32) that measured it. This attribute is considered as being central to PHC (27) , as it represents the continuity of user care over time and permanently (28) .…”

“…In addition, a compromise in comprehensiveness may result from overvaluation and searching for services with higher technological densities in the Brazilian health system. In this sense, it is considered essential that professionals and managers identify the health needs of the population and coordinate care in order to provide equitable actions and services (32) .…”

“…The derived attribute of family orientation considers the family as a care subject, recognizing and meeting their needs (17,29) . It is recognized that knowing the context in which the individual/family live provides the professional new care possibilities and more resolute care committed to meeting health needs (31)(32) . Thus, comprehensiveness can be compromised if family orientation is ineffective (32) .…”

“…For community orientation, the results show a lack of participation and social control by the population studied in the articles (17) , which portrays the importance of knowing the health needs of the community through knowing the context in which families are inserted, and that health actions should take into account the epidemiological profile of the community (16) . A weakness of this attribute may compromise planning and evaluation (32) , as the developed actions may not be recognized as a priority need by the community.…”