Diabetes Mellitus macro-regional inequalities in PHC: comparing the three PMAQ-AB cycles

Abstract

This study aimed to identify macro-regional structure and work process inequalities for Diabetes Mellitus (DM) treatment in Primary Health Care (PHC) throughout the three cycles of the National Program for Access and Quality Improvement of Primary Care (PMAQ-AB) in Brazil. This ecological, longitudinal, nationwide study employed secondary data from the three PMAQ-AB cycles. The data were compared between the Brazilian macro-regions using the t-test with Bonferroni correction. The North and Northeast had the lowest percentages of adequacy in the structure items: unit premises (<74%), wheelchair user accessibility (<63%), special opening hours (<16%), expanded teams (<12%), and supplies (<89%) in all PMAQ-AB cycles when compared to other regions. The items related to the work process barely varied between regions, and those with mean adequacy percentages ≤ 75% were specialized agenda (41%, 33%, 41%), matrix support (58%, 72%, 70 %), offer and resolution of actions (62%, 64%, 75%) and continuing education (35%, 42%, 58%). Investments are still required in the structure and improvement in the teams’ work process, especially in the North and Northeast macro-regions.

Apoio matricial na atenção especializada respaldado no modelo de atenção às condições crônicas: pesquisa avaliativa

“…A maioria dos estudos avaliativos está focada especificamente na linha de cuidados da saúde mental (8)(9)(10)(11)(12) . Outros estudos avaliativos foram conduzidos na perspectiva da APS erevelaram suas responsabilidades como coordenadora e ordenadora do cuidado, integração com os demais pontos das RAS e o envolvimento das equipes apoiadora e de referência (10,(13)(14)(15) .…”

Matrix support in specialized care backed by the care model for chronic conditions: evaluative research

“…Most evaluative studies are specifically focused on the mental health care line (8)(9)(10)(11)(12) . Other evaluative studies from the APS perspective were conducted and revealed responsibilities in the coordination and ordering of care, integration with other points of health care networks (RAS) and the involvement of support and reference team (10,(13)(14)(15) .…”