Utilização dos serviços de saúde segundo determinantes sociais, comportamentos em saúde e qualidade de vida entre portadores de diabetes

Abstract

INTRODUCTION: Diabetes mellitus (DM) is a global public health problem, this is aggravated by systemic complications that may appear due to metabolic uncontrolled, interfering on Use of Health Services (UHS) and increasing the potential for morbidity and mortality of these people. OBJECTIVES: Investigate the use of health services by patients with diabetes enrolled in the Family Health Strategy (FHS), the impact of the disease on the quality of life of these individuals, and other associated factors, comparing those using public services, with or without regularity, and those who use private service or health insurance. MATERIALS AND METHOD: This work was a cross-sectional study population-based, accomplished in Cajazeiras-PB, involving a representative sample of 416 patients with diabetes from 8 (eight) FHS teams. Data has been collected by interviews structured containing socioeconomic and demographic information, issues related to UHS and health care was applied, furthermore, the quality of life was also evaluated through the application of the Diabetes-39 formulary. A descriptive and inferential statistical analysis was performed, the latter using Cluster Analysis (K-means), Pearson's Chi-square test and Fisher's exact test, and Decision Tree Analysis using CHAID (Chi-squared Automatic Interaction Detector) algorithm. RESULTS: The general profile of the sample was characterized by a majority of females (65,6%), predominantly from 60 to 74 years old (46,2%), with low schooling (52,6%) and monthly family income up to R$ 1776 (79,8%), the majority did not practice physical activity (69,7%), and did not perform the adequate amount of fasting (85,8%) and sight/ eye (61,8%), in addition, 53,8% never had their feet examined. A significant use of public health services by the population studied (80,7%). The use of the public health service on a regular basis was characterized by individuals with low or medium schooling (p < 0,001), employed or retired and/or pensioners (p = 0,019), with a low impact of diabetes on quality of life (p = 0,032), and who performed the amount recommended by the Ministry of Health for fasting blood glucose tests per year (p < 0,001). On the other hand, use of this service without regularity was shown to be associated with DM people non-schooling, and who did not perform the appropriate amount of fasting glucose tests per year (p < 0,001), despite reporting that complementary exams were requested (p = 0,024). CONCLUSIONS: The results show that the socioeconomic characteristics interfere directly with the UHS by DM patients, and the low schooling level is one of the main barriers to the use of regular public health services. Therefore, it is reiterated that favorable outcomes in glycemic control come from the interaction of factors such as motivation and patient adherence to treatment, treatment advised and received, and organization and access to health services.