Acompanhamento de pessoas com Diabetes Mellitus na Atenção Primária à Saúde em Belo Horizonte: estudo ecológico de série temporal entre 2017 e 2023

Abstract

Introduction: Diabetes Mellitus (DM) is a chronic disease that can be asymptomatic and cause systemic complications. Primary Health Care (PHC) is the gateway to the Unified Health System (SUS), responsible for prevention, treatment and health surveillance actions. However, political and economic factors and the COVID-19 pandemic have affected the provision of these services. The study aimed to identify the characteristics of monitoring people with DM in Primary Health Care, in the city of Belo Horizonte, between 2017 and 2023. Method: This is an ecological time series study. Variables were analyzed regarding records of medical and nursing care for adults diagnosed with DM in PHC services in Belo Horizonte. Data were extracted from the Health Information System for Primary Care (SISAB) via Health/Production. The care rates were calculated for every 1,000 people with DM and SUS dependents, according to the Brazilian Institute of Geography and Statistics (2010 census and annual estimates), annual prevalence rates from VIGITEL (2017 to 2023) and data from the National Health Agency, via DataSUS. Time series regression was performed using Jointpoint. Result: Considering the Joinpoint time series regression from 2017 to 2023, an increasing trend was observed for most of the follow-ups analyzed. However, more than 50% of general appointments corresponded to spontaneous demand, and there was a low proportion of users who underwent glycated hemoglobin testing and scheduled consultations during the period. Throughout the entire analysis period, there was an increase in nursing appointments related to spontaneous demand, scheduled consultations for continued care, and diabetic foot exams. An increase in general and spontaneous demand appointments conducted by nurses was observed approximately in the first six months after the onset of the COVID-19 pandemic. Additionally, there was an increase in spontaneous demand care and referrals to specialized services performed by physicians during this period. Diabetic foot exams performed by physicians showed a declining trend from September 2017 to December 2023.Conclusion: Nurses and physicians working in Primary Health Care (PHC) services were found to be more involved in spontaneous demand care than in continued care for the population with diabetes mellitus. Efficient use of the SISAB system is essential to understanding the territory and the needs of the population.