Disponibilidade de medicamentos, estrutura de materiais e cuidado ofertado a pacientes com hipertensão e diabetes a Atenção Primária à Saúde: um estudo a partir do Programa Nacional de Melhoria do Acesso e Qualidade

Abstract

Noncommunicable chronic diseases (NCDs) are a serious worldwide public health problem and include several diseases, including systemic arterial hypertension (SAH) and diabetes mellitus (DM). Primary Health Care (PHC) is the coordinator of health care and aims to solve the most prevalent problems at this level of care. Pharmaceutical Services are part of the actions and services within the Unified Health System (SUS) and seeks to ensure the population's access to medicines considered essential, which treat most of the health problems present in primary care services. In Brazil, the National Program for Access and Quality Improvement of Primary Care (PMAQ-AB) is a strategy that aims to improve the quality of PHC. This program allows to evaluate the quality of the structure and the assistance in the services provided in the basic health units. This research is aimed to evaluate, at national level, the association between the availability of antihypertensive and antidiabetic drugs with the care offered to hypertensive and diabetic patients and the material structure for these diseases in PHC. A cross-sectional study was conducted from the data obtained from the external evaluation of the 2nd cycle of PMAQ-AB, collected between 2013 and 2014. The family health teams (eSF) that constituted the universe of this research were those who adhered to the program and answered to the external evaluation questionnaire. For the analysis were selected 22905 teams (75%) who reported decentralized drug dispensing. The statistical analysis considered as explanatory variables: geographic macroregion, Human Development Index (HDI), Family Health Strategy (FHS) coverage, adequacy of care and material structure. Descriptive analyzes were performed using the Statistical Package for Social Sciences (SPSS) version 20.0 and the inferences on R version 3.6.1. In the inferential analyzes, a significance level of 5% and a confidence interval of 95% were considered. More than 70% of the teams were considered satisfactory regarding the availability of medicines for hypertension and diabetes. Regarding the materials, it was observed that only 6.8% of the teams were classified as “adequate”, throughout the national territory. When assessing the care for hypertension and DM, it was evidenced that 57.9% of the teams were classified as “excellent or satisfactory”. In the univariate analysis, all explanatory variables studied were statistically significant (p <0.20) and were therefore selected for multivariate analysis. The results of the multivariate inferential analysis showed a significant positive association between drug availability and the South (OR = 2.06; p <0.01) and Southeast (OR = 1.65; p <0.01) macroregions; 100% ESF coverage (OR = 1.14; p = 0.015); highest municipal HDI (OR = 2.71; p <0.01); satisfactory structure of materials (OR = 3.69; p <0.01) and the excellent care offered in SAH and DM (OR = 2.55; p <0.01). The Hosmer-Lemeshow test (p = 0.649) showed that the data fit is adequate. The findings of this study enable important reflections on coping with NCDs in public health services in Brazil It also contributes to directing public policies for the provision of high quality care and equity in the country's health services.