Characterization of primary health care for patients with diabetes based on the PMAQ-AB

Muzy, Jéssica; Campos, Mônica; Emmerick, Isabel; Avelar, Fernando Genovez de

doi:10.1590/1413-81232022279.17542021EN

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FREE THEMES • Ciênc. saúde coletiva 27 (09) • Sept 2022 • https://doi.org/10.1590/1413-81232022279.17542021EN copy

Characterization of primary health care for patients with diabetes based on the PMAQ-AB

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This article aims to present a proposal for making the instruments used in the three cycles of the PMAQ-AB compatible and to analyze the information on access, coverage, structure, organization and provision of services in PHC related to care for DM in Brazil, according to regions, from the perspective of family health professionals and users. We performed an analysis of the degree of compatibility of the PMAQ-AB questions (2012, 2014 and 2017). To analyze the temporal evolution of the components, we performed a proportion difference test. We calculated the percentage difference between the perspective of professionals and users, per year analyzed, for Brazil. In general, there was an improvement in the quality of care and examinations, except for the diabetic foot. Worse results were found for the North region in relation to the other regions. Despite the structural improvement and the quality of care reported by professionals, there are significant gaps in the quality of care for patients with DM in the SUS. In the scenario of scarce investment added to the growing prevalence of DM, obstacles become progressively more challenging. Therefore, monitoring and evaluating the quality of services provided are essential tasks of the Brazilian Health System.

Key words:
Type 2 Diabetes Mellitus; Diabetes Complications; Primary Health Care; Medical Examination; Quality of Health Care

Id.	2012		2014		2017		Comparability between years
Id.	Variable	Category	Variable	Category	Variable	Category
TQE01	II.13.7	Yes	II.10.5	Yes	II.6.3	Yes	Total
TQE02	II.14.5	Yes	II.11.3	Yes	II.12.3.1.4	Electronic medical record - Yes	High
TQE03	II.15.4	Yes	II.12.1	Yes	II.10.1	Yes	High
TQE04	II.15.8	Yes	II.12.8.9	No	II.10.5.1	Urgent care	High
TQE05	II.18.2.2	Test scheduling	Unavailable		II.12.8.2	Test scheduling	Total
TQE06	II.15.14	Yes	II.12.6	Yes	Unavailable		High
TQE07	II.16.6	Yes	II.13.1.4	Continuing care consultations	II.9.2	(01) The next appointment is scheduled at the end of the previous appointment; (02) The appointment is scheduled by the team and then communicated to the user	Medium
TQE08	II.16.7.8	Users with DM - Yes	II.14.3.3	DM - Yes	II.18.8	Yes	High
TQE09	II.16.8	Yes	II.13.3	Yes	II.10.5.2	Renewal of drug prescriptions (General) - Yes	Medium
TQE10	II.17.3	Yes	II.14.4.13	Uses no protocol - No	II.12.9.6	All categories except “No route defined”	Medium
TQE11	II.17.4.6	DM - Yes	Unavailable		II.10.6	Yes	Medium
TQE12	II.26.3	Yes	II.14.2.6	Of people with diabetes - Yes	II.18.5	Yes	High
TQE13	II.26.4	Yes	II.14.4.6	DM - Yes	II.18.4	Yes	High
TQE14	II.26.5	Yes	II.14.5.3	DM - Yes	II.18.3	Yes	Medium
TQE15	II.26.6	Yes	II.14.6.2	Diabetes - Yes	II.18.6	Yes	High
TQE16	II.31.1.8	DM prevention and treatment - Yes	Unavailable		Unavailable		-
TQE17	II.31.1.9	Conducts groups to support self-care for chronic diseases - Yes	II.26.1.9	Activities in groups aimed at supporting self-care for chronic diseases	Unavailable		High
TQE18	II.32.4	Yes	II.28.3	Yes	II.25.4	Yes	High
TQE19	II.32.5.4	Diabetics at fault - Yes	II.14.7.11	DM - Yes	Unavailable		High
TQE20	II.26.1	Scheduling any day of the week, any time	II.12.12	Any day of the week, any time	Unavailable		Medium
TQE21	II.17.5.1	Creatinine - Yes	II.15.1.1	Creatinine - Yes	II.12.2.4	Creatinine - Yes	High
TQE22	II.17.5.2	Lipid profile - Yes	II.15.1.2	Lipid profile - Yes	II.12.2.9	Lipid profile - Yes	High
TQE23	II.17.5.3	Electrocardiogram - Yes	II.15.1.3	Electrocardiogram - Yes	II.12.2.6	Electrocardiogram - Yes	High
TQE24	II.17.6.1	Glycosylated hemoglobin - Yes	II.15.1.5	Glycosylated hemoglobin - Yes	II.12.2.7	Glycosylated hemoglobin - Yes	High
TQE25	II.17.10.1	Fasting blood glucose - Yes	II.15.2.1	Fasting blood glucose - Yes	II.12.2.3	Fasting blood glucose - Yes	High
TQE26	II.17.10.5	Urine culture or urine summary (type I urine) - Yes	II.15.2.10	Urine culture or urine summary (type I urine) - Yes	II.12.1.11 + II.12.1.12	Urine summary (type I urine) - Yes + Urine culture - Yes	High
TQE27	II.26.7	Yes	Unavailable		II.18.9	Yes	Total
TQE28	II.26.8	Yes	Unavailable		II.18.10	Yes	Total

Note: TQ01: II.13.7, II.10.5, II.6.3 (Is there a population discovered by primary care in the surroundings of the territory covered by the team?); TQ02: II.14.5, II.11.3, (Is there electronic medical records implemented in the team?), II.12.3.1.4 (What is the institutional flow of communication? Electronic medical records?); TQ03: II.15.4 (Do all users who arrive at the health unit spontaneously seeking care have their needs heard and evaluated?), II.12.1, II.10.1 (Does the team host spontaneous demand in this unit?); TQ04: II.15.8 (Does the team perform urgent and emergency care at this health unit?), II.12.8.9 (Does not perform urgently and emergency care), II.10.5.1 (In meeting spontaneous demand, the team performs: Urgent care ); TQ05: II.18.2.2; II.12.8.2 (Which scheduling centers are available? - Exam scheduling); TQ06: II.15.14 (If the user has a problem that it is not recommended to schedule it for another day, is there a reservation for service on the same day?), II.12.6 (Is there reservation of vacancies for consultations of spontaneous demand?); TQ07: II.16.6 (Does the team schedule consultations and actions for users who are part of priority programs or groups and need continued care?), II.13.1.4 (The professionals’ agenda is organized to carry out which actions? - Consultations for continued care), II.9.2 (About the demand for continued care, how is the appointment made? - 01. The next appointment is scheduled at the end of the previous appointment and 02. The appointment is scheduled by the team and then communicated to the user); TQ08: II.16.7.8 (For which groups and situations does the team schedule offers? - Users with DM), II.14.3.3 (The team schedules consultations offer for which situations? - DM), II.18.8 (The team schedules consultations and examinations of people with DM due to the stratification of cases and elements considered by her in the management of care?); TQ09: II.16.8, II.13.3 (Does the team renew prescriptions for users of continued care/programs such as hypertension and diabetes, without the need to schedule medical appointments?), II.10.5.2 (In meeting spontaneous demand, the team performs: - Renewal of medication prescriptions); TQ10: II.17.3 (Are there protocols in the health unit that guide the prioritization of cases that need a referral?), II.14.4.1.3 (Does the team use protocols for risk stratification for which situations? - Does not use protocols - No); II.12.9.6 (When a user is treated at the health unit and needs to be referred for specialized consultation, what are the possible ways?); TQTQ11: II.17.4.6 (Does the team have protocols with the definition of therapeutic guidelines for DM), II.10.6 (Does the team use protocols/criteria to guide the conduct of cases treated at the reception?); SQ12: II.16.3, II.18.5 (Does the team use any registration or follow-up form for people with DM?), II.14.2.6 (Does the team have a record of its territory: People with DM); TQ13: II.26.4 (Does the primary care team have a record of people with DM at greater risk/severity?), II.14.5.3 (Does the team use risk stratification protocols for which situations? - DM), II.18.4 (Does the team have a record of users with diabetes with higher risk/severity?); TQ14: II.26.5 (The team schedules consultations and examinations of people with DM according to the stratification of cases and elements considered by it in the management of care?), II.14.5.3 (Does the team’s agenda schedule comply with the classified risk, for which situations? - DM), II.18.3 (Does the team use protocols for risk stratification of users with diabetes?); TQ15: II.26.6, II.18.6 (Does the team coordinate the waiting list and follow-up of users with DM who need consultations and exams at other points of care?), II.14.6.2 (Does the team keep a record of high-risk users referred to other points of care? - Diabetes); TQ16: II.31.1.8 (The team offers educational and health promotion actions aimed at DM prevention and treatment); TQ17: II.31.1.9 (The team offers educational and health promotion actions to conduct groups to support self-care for chronic diseases), II.26.1.9 (The team offers educational and health promotion actions health aimed at Activities in groups aimed at supporting self-care for chronic diseases); TQ18: II.32.4, II.28.3 (Do community health agents have visits scheduled according to the priorities of the entire team?), II.25.4 (Are families in the area covered by the team visited at different intervals according to risk and vulnerability assessments?); TQ19: II.32.5.4 (In the home visits of ACS, an active search is carried out in the territory of: Diabetic absentees), II.14.7.1.1 (The team carries out an active search in the following situations: DM); EQ20: II.26.1, II.12.12 (How are appointments for people with DM scheduled??); TQ21: II.17.5.1 (Which tests are requested by the primary care team: For systemic arterial hypertension? - Creatinine), II.15.1.1 (Which of these tests are requested by your team and are performed by the health services network? - Creatinine), II. 12.2.4 (General - Which of these tests are requested by your team to be performed in the health services network? - Creatinine); SQ22: II.17.5.2 (Which tests are requested by the primary care team: For systemic arterial hypertension? - Lipid Profile), II.15.1.2 (Which of these tests are requested by your team and performed by the health services network? - Lipid Profile), II.12.2.9 (General - Which of these tests are requested by your team to be performed in the health services network? - Lipid Profile); TQ23: II.17.5.3 (Which tests are requested by the primary care team: For systemic arterial hypertension? - Electrocardiogram), II.15.1.3 (Which of these tests are requested by your team and are performed by the health services network? - Electrocardiogram); II.12.2.6 (General - Which of these tests are requested by your team to be performed in the health services network? - Electrocardiogram); SQ24: II.17.6.1 (Which tests are requested by the primary care team: For DM? - Glycosylated hemoglobin), II.15.1.5 (Which of these tests are requested by your team and performed by the health services network? - Glycosylated Hemoglobin), II.12.2.7 (General - Which of these tests are requested by your team to be performed in the health services network? - Glycosylated Hemoglobin); TQ25: II.17.10.1 (What tests are requested by the primary care team: For prenatal care? - Fasting blood glucose), II.15.2.1 (Which of these tests are requested by your team and performed by the health services network for prenatal care? - Fasting blood glucose), II.12.2.3 (General - Which of these tests are requested by your team to be performed in the health services network? - Fasting blood glucose); SQ26: II.17.10.5, II.15.2.10, II.12.2.11, and .12 (Which tests are requested by the primary care team: For prenatal care? - Urine culture or urine summary (type I urine)); SQ27: II.26.7, II.18.9 (Does the team perform a diabetic foot exam periodically?); SQ28: II.26.8, II.18.10 (Does the team perform an eye fundus examination periodically?).
Source: National Program for Improving Access and Quality of Primary Care (PMAQ-AB), 2012, 2014, and 2017.

Id.	Question	2012		2014		2017		Comparability between years
Id.	Question	Variable	Category	Variable	Category	Variable	Category
UQU01	Sex: (1) Male / (2) Female	III.4.6	Male/ Female	III.3.1	Male/ Female	III.3.1	Male/ Female	Total
UQU02	Elderly people (60 years old or older)	III.4.7	60 years old or older	III.3.2	60 years old or older	III.3.2	60 years old or older	Total
UQU03	Is literate	III.4.11	Yes	III.3.4	Illiterate (cannot read nor write)	III.3.5	Illiterate (cannot read nor write)	High
UQU04	Has a paid job currently	III.4.14	Yes	III.3.5.0	Sim	Unavailable		High
UQU05	The family is part of the Bolsa Família Program	III.4.16	Yes	III.4.1	Sim	III.5.4	Is part of the program	High
UQU06	Lives near the health unit	III.5.2	(1) Close + (2) Fair	III.5.1	Up to 20 minutes (Categories 1 and 2)	III.4.1	Up to 20 minutes	High
UQU07	Is normally able to schedule an appointment for the same day	III.6.3	Yes	III.6.3	Yes	III.6.4	Yes	Total
UQU08	Is attended most of the time when goes to the health unit without making an appointment	III.7.1	Yes	Unavailable		III.6.9	Yes	High
UQU09	The guidance that professionals give at the unit always meets the needs	III.7.5	Yes, always	Unavailable		III.8.16	Yes, always	Total
UQU10	Thinks that the team seeks to solve their needs in the unit itself	III.8.1	(1) Yes, always + (2) Yes, sometimes	III.8.1	(1) Always + (2) Most of the time	Unavailable		Total
UQU11	Sought care the last time a health problem that was considered urgent appeared	III.7.7	Yes	Unavailable		III.7.1	Yes	High
UQU12	The office for the service is a reserved place with privacy	III.8.2	Yes	III.8.2	Yes	Unavailable		Total
UQU13	In consultations, team professionals perform the physical examination by touching the body to examine	III.8.3	(1) Always + (2) Most of the time	III.8.3	(1) Always + (2) Most of the time	III.8.2.1	Yes	High
UQU14	Is always guided by the professionals of this team on the care that must be taken to recover, such as: the need for rest, adequate food, and others	III.8.4	Always	III.8.4	Always	Unavailable		High
UQU15	Is always guided by the professionals of the team on the signs that indicate improvement or worsening	III.8.5	Always	III.8.5	Always	Unavailable		High
UQU16	The professional takes notes in the medical record or form during consultations	III.8.6	Yes	Unavailable		Unavailable		-
UQU17	Professionals remember what happened on the last appointments	III.9.13	Yes	Unavailable		Unavailable		-
UQU18	Always needs to ask questions after consultations and has ease to talk to the professionals who attended him/her	III.9.14	Always	III.9.7	Always	III.8.15	Always	Total
UQU19	When treatment is interrupted by the patient for some reason, or he/she does not come to the consultation at this health unit, the professionals seek him/her out to find out what happened and continue care.	III.9.16	Yes	III.9.9	Always	III.8.8	Always	Total
UQU20	A doctor has told you that you have diabetes	III.16.1	Yes	III.21.1	Yes	III.17.1	Yes	Total
UQU21	Got a consultation with a doctor because of diabetes in the last six months	III.16.2	Yes	III.21.2	Yes	III.17.2	Yes	High
UQU22	Had a fasting blood test to measure blood sugar in the last six months	III.16.4	Yes	III.21.3	Yes	III.17.4	Yes	Total
UQU23	A healthcare professional has done the foot exam in the last six months	III.16.5	Yes	III.21.4	Yes	III.17.5	Yes	Total
UQU24	In the last six months, a member of the health team advised on foot care	III.16.6	Yes	Unavailable		III.17.6	Sim	High
UQU25	Has already left the appointment with the next appointment scheduled	III.16.7	Yes	III.21.5	Yes	III.17.7	Yes	Total
UQU26	Takes medicine for diabetes	III.16.8	Yes	III.21.6	Yes	Unavailable		Total

Note: UQ01: III.4.6, III.3.1 (Gender); UQ02: III.4.7, III.3.2 (How old are you?); UQ03: III.4.11 (Do you know how to read and write?), III.3.4 (How long have you studied?), III.3.5 (Up to which grade have you) did you study?); UQ04: III.4.14 (Do you currently have paid work?), III.3.5.0 (Do you work?); UQ05: III.1.16 (Is your family registered in the Bolsa Família program?), III.4.1 (Are you a Bolsa Família beneficiary?), III.5.4 (Regarding the Bolsa Família Program, does your family: Participates in the program); UQ06: III.5.2 (What do you think about the distance from your house to this health unit?), III.5.1 (How long do you take from your house to this one? health unit?), III.4.1 (How long does it take you from your home to this basic health unit/health post?); UQ07: III.6.3, III.6.4 (When you manage to make an appointment, is it generally for the same day?); UQ08: III.7.1 (Most of the time you come to the US without an appointment, can you be heard?) UQ09: III.7.5, III.8.16 (Do the guidelines provided by professionals at the unit meet your needs?) UQ10: III.8.1 (When you are treated at this health unit, do you think that the team seeks to solve your needs/problems in the health unit itself?); UQ11: III.7.7 III.7.1 (Did you seek care the last time you had an urgent health problem? ), III.7.2 (Did you seek care from this Basic Health Unit/Health Center the last time you had an urgent health problem? ), III.8.2 (Is the consultation room a reserved space (does it have privacy)?); UQ13: III.8.3a (Does the team perform a physical examination on you and touch your body to examine?), III.8.3b (Do team professionals perform a physical examination, examine your body, throat, and belly?), III.8.2.1 (In consultations in this unit, do the team professionals examine your body (e.g., legs, belly, throat, etc.)?) UQ14: III.8.4a (How often do the professionals on this team guide you in consultations on the care you should take to recover, such as the need for rest, adequate food, and others?) III.8.4b (Do the professionals advise you on the need for rest, adequate food, and how to take the medication?) UQ15: III.8.5a (In consultations, are you guided by the professionals of this team about the signs that indicate that you are improving or getting worse?), III.8.5b (Do health professionals advise you on what to do when your symptoms are getting worse?); UQ16: III.8.6 (During consultations, does the professional make notes in the patient’s chart or file?); UQ17: III.9.13 (Do the professionals remember what happened in your last consultations?); UQ18: III.9.4, III.9.7, III.8.15 (Do you find it easy to communicate with the professionals who attended you after consultations?); UQ19: III.9.16, III.9.9, III.8.8 (When you discontinue treatment for any reason or fail to appear for a consultation at this health unit, the professionals look for you to find out what happened and resume care); UQ20: III.16.1, III.21.1, III.17.1 (Has a doctor told you that you have diabetes (high blood sugar)?); UQ21: III.16.2, III.17.2 (Have you seen a doctor because of diabetes (high blood sugar) in the last six months?), III.21.2 (Have you) consulted with a doctor or nurse because of diabetes (high blood sugar) in the last six months?) UQ22: III.16.4, III.21.3, III.17.4 (Have you had a fasting blood sugar test in the last six months?); UQ23: III.16.5, III.21.4, III.17.5 (Has any professional from the health team examined your feet in the last six months? UQ24: III.16.6 (Did any professional advise you on foot care in the last six months?), III.17.6 (Did any health team professional advise you on foot care in the last six months?); UQ25: III.16.7, III.21.5, II.17.7 (You already leave the appointment with the next appointment scheduled); UQ26: III.16.8, III.21.6 (Do you take medication for diabetes?).
Source: National Program for Improving Access and Quality of Primary Care (PMAQ-AB), 2012, 2014, and 2017.

	Question	Year	N	NE	SE	S	MW	BR*
Unit cover and structure	TQ01. There is a population discovered by Primary Care in the surroundings of the territory covered by the team	2012	46,3	34,1	28,9	29,9	56,2	33,6
		2014	54,6	37,7	29,8	30,1	56,0	36,1
		2017	52,0	34,9	26,7	30,3	55,0	34,3
	TQ02. There is an electronic medical record implanted in the team	2012	3,5	1,3	18,0	30,3	20,9	14,0
		2014	2,9	1,3	20,1	32,9	18,4	13,9
		2017	12,0	8,5	21,0	52,9	33,7	21,5
	TQ03. All users who arrive at the health unit spontaneously seeking care have their needs heard and evaluated.	2012	91,5	96,5	98,6	98,1	94,4	97,2
		2014	93,1	95,4	98,8	98,5	96,5	96,9
		2017	98,2	98,7	99,6	99,3	99,5	99,1
	TQ04. The team performs urgent and emergency care at the health unit	2012	60,1	68,2	75,7	81,6	67,1	72,8
		2014	86,1	92,6	96,6	95,8	92,5	94,0
		2017	85,7	96,4	94,8	97,0	94,7	95,0
	TQ05. There is an exam scheduling center available at the health unit	2012	92,1	97,1	96,3	92,7	92,0	95,4
		2014	-	-	-	-	-	-
		2017	95,6	98,2	98,1	96,6	97,3	97,7
	TQ06. There are reservations for same-day service in case any user needs it	2012	89,5	92,9	93,1	90,5	90,4	92,2
		2014	81,8	86,3	90,6	88,9	84,5	87,7
		2017	-	-	-	-	-	-
	TQ07. There is a schedule of consultations and actions for users of programs or priority groups who need continued care	2012	90,6	92,5	91,4	89,2	86,4	91,0
		2014	83,5	92,2	90,3	85,8	84,1	89,3
		2017	93,1	95,2	95,1	91,6	89,1	94,0
Organization of care for patients with diabetes	TQ08. There are schedule queries and actions for users with DM	2012	88,0	90,1	87,1	84,9	83,9	87,6
		2014	96,1	98,0	92,3	81,9	92,4	93,1
		2017	89,7	95,2	91,6	88,7	91,4	92,4
	TQ09. Renewal of prescriptions is carried out for users of continued care/programs such as hypertension and diabetes, without the need to schedule medical appointments	2012	84,2	82,9	84,3	75,8	70,4	81,5
		2014	87,1	88,0	85,5	79,8	83,9	85,5
		2017	96,7	97,7	90,8	92,2	95,1	94,3
	TQ10. There are protocols in the health unit that guide the prioritization of cases that need a referral	2012	33,4	32,5	56,2	39,2	32,2	42,7
		2014	60,5	79,4	87,6	78,0	63,9	79,4
		2017	99,6	99,8	99,9	99,8	99,8	99,8
	TQ11. There are protocols in the health unit that guide the prioritization of cases that need a referral for DM	2012	66,6	60,5	80,3	67,0	60,4	69,5
		2014	-	-	-	-	-	-
		2017	75,0	89,9	91,6	88,8	86,5	88,9
	TQ12. The team uses some form of registration or monitoring of people with DM	2012	97,0	95,3	92,3	88,0	91,7	92,8
		2014	87,1	89,7	90,5	88,3	85,8	89,3
		2017	91,1	94,0	91,0	90,1	91,3	92,0
	TQ13. The team has a record of people with DM with higher risk/severity	2012	51,4	46,6	59,8	49,0	41,7	52,0
		2014	46,9	57,3	77,1	64,5	52,6	64,0
		2017	69,4	83,1	80,3	79,9	80,2	80,4
	TQ14. The team schedules consultations and examinations for people with DM according to the stratification of cases and elements considered by it in the management of care	2012	73,6	80,9	78,9	66,7	67,6	76,5
		2014	69,4	84,9	79,1	70,9	69,1	78,5
		2017	82,4	91,3	89,1	87,7	87,6	89,1
	TQ15. The team coordinates the waiting list and monitoring of users with DM who need consultations and exams at other points of care	2012	44,5	47,9	50,5	47,1	51,9	48,8
		2014	46,3	53,2	59,4	53,0	49,4	54,5
		2017	73,9	85,5	83,6	71,6	72,0	80,9
	TQ16. The team offers educational and health promotion actions aimed at the prevention and treatment of DM	2012	92,1	90,1	88,2	89,6	92,0	89,5
		2014	-	-	-	-	-	-
		2017	-	-	-	-	-	-
	TQ17. Conducts groups with the aim of supporting self-care for chronic diseases	2012	47,8	47,7	56,7	61,7	51,1	53,7
		2014	60,0	69,1	76,0	74,1	69,4	71,5
		2017	-	-	-	-	-	-
	TQ18. The CHAs have the schedule of visits made according to the priorities of the entire team	2012	88,7	93,6	90,7	89,5	87,8	91,1
		2014	89,4	96,1	93,7	92,4	91,6	93,9
		2017	96,9	99,2	98,1	97,8	97,8	98,4
	TQ19. The CHAs have a schedule of visits for absent diabetics	2012	92,2	89,5	90,2	80,0	87,5	88,2
		2014	80,7	73,5	72,8	66,7	77,6	73,1
		2017	-	-	-	-	-	-
	TQ20. Are appointments scheduled for people with diabetes mellitus performed on any day of the week, at any time?	2012	45,3	37,5	61,4	53,7	51,3	50,7
		2014	49,0	51,4	69,3	65,0	59,7	60,0
		2017	-	-	-	-	-	-
Exams carried out in the unit	Which of these tests are requested by your team and performed by the health services network?
	TQ21. Creatinine	2012	95,7	96,5	98,4	97,5	95,8	97,3
		2014	93,8	97,1	98,7	98,7	95,4	97,5
		2017	96,9	98,8	98,0	99,5	98,7	98,5
	TQ22. Lipid profile	2012	85,2	89,3	95,0	94,7	94,4	92,5
		2014	82,0	88,8	96,7	96,1	91,5	92,3
		2017	89,3	95,2	97,2	98,6	96,8	96,0
	TQ23. Electrocardiogram	2012	87,0	91,7	96,6	94,3	92,1	93,7
		2014	86,7	94,0	98,6	97,6	95,7	95,7
		2017	93,5	97,5	98,1	99,2	98,2	97,7
	TQ24. Glycosylated hemoglobin	2012	81,9	89,4	97,4	95,0	86,8	92,8
		2014	80,2	90,2	96,6	95,7	84,9	92,1
		2017	85,5	94,2	96,4	99,0	93,2	94,9
	TQ25. Fasting blood glucose	2012	99,6	99,4	97,5	97,5	98,6	98,3
		2014	98,7	99,2	98,4	97,9	98,4	98,6
		2017	98,7	99,3	98,2	99,6	99,1	98,9
	TQ26. Urine culture or urine summary (type I urine)	2012	93,0	98,6	96,2	96,8	95,1	96,8
		2014	88,2	97,3	96,6	96,6	88,8	95,7
		2017	97,9	99,5	97,1	98,2	98,5	98,3
	TQ27. Does the team perform a diabetic foot exam periodically?	2012	54,7	58,1	59,5	55,3	56,2	57,8
		2014	-	-	-	-	-	-
		2017	74,9	83,6	80,3	74,5	78,3	80,1
	TQ28. Does the team perform an eye fundus examination periodically?	2012	24,6	33,7	52,1	34,0	34,6	40,3
		2014	-	-	-	-	-	-
		2017	29,0	38,6	31,3	25,4	30,1	32,9

	Question	Year	N	NE	SE	S	MW	BR*
Demographic and socioeconomic aspects	UQ01. Male	2012	20,9	16,1	23,3	33,1	23,1	22,3
		2014	20,7	15,6	22,0	26,5	23,2	20,4
		2017	21,8	18,3	22,6	26,5	23,4	21,6
	UQ01. Female	2012	79,1	83,9	76,7	66,9	76,9	77,7
		2014	79,3	84,4	78,0	73,5	76,8	79,6
		2017	78,2	81,7	77,4	73,5	76,6	78,4
	UQ02. Elderly people (60 years old or older)	2012	15,6	16,6	30,7	22,6	32,3	24,0
		2014	15,1	16,4	29,8	25,7	28,9	23,3
		2017	15,9	15,5	29,1	27,5	20,9	22,2
	UQ03. Is literate	2012	84,5	79,1	87,3	91,6	82,2	84,8
		2014	94,0	89,3	93,6	96,3	92,1	92,4
		2017	94,9	92,5	95,4	97,5	95,6	94,6
	UQ04. Has a paid job currently	2012	28,6	24,4	32,8	44,2	30,2	31,4
		2014	34,7	28,8	31,7	44,1	35,5	33,1
		2017	-	-	-	-	-	-
	UQ05. The family is part of the Bolsa Família Program	2012	53,6	62,2	26,5	21,0	27,5	39,0
		2014	40,8	50,4	20,2	14,3	22,2	31,6
		2017	44,2	49,4	19,8	13,7	21,1	31,9
Access	UQ06. Lives near the health unit	2012	82,2	86,0	87,9	87,4	85,8	86,7
		2014	78,3	80,9	84,7	83,7	80,6	82,4
		2017	78,6	82,0	85,4	85,2	83,1	83,4
	UQ07. Is normally able to schedule an appointment for the same day	2012	51,6	57,6	35,9	57,8	55,6	48,7
		2014	48,4	54,5	31,3	47,2	51,3	44,7
		2017	41,2	52,4	28,4	42,6	48,7	41,7
	UQ08. Is attended most of the time when goes to the health unit without making an appointment	2012	57,4	64,0	68,2	73,8	58,2	66,5
		2014	-	-	-	-	-	-
		2017	66,8	72,1	76,1	79,5	75,1	74,3
	UQ09. The guidance that professionals give at the unit always meets the needs	2012	42,5	50,2	55,4	58,5	45,9	52,8
		2014	-	-	-	-	-	-
		2017	75,3	81,7	81,5	82,2	81,5	81,2
	UQ10. Thinks that the team seeks to solve their needs in the unit itself	2012	90,7	93,6	93,3	96,0	92,3	93,6
		2014	87,4	88,7	88,2	90,7	88,4	88,7
		2017	-	-	-	-	-	-
	UQ11. Sought care the last time a health problem that was considered urgent appeared	2012	64,7	58,7	63,5	71,1	61,0	63,0
		2014	-	-	-	-	-	-
		2017	56,1	65,7	60,2	70,0	58,2	63,0
Structure and adequacy of attention	UQ12. The office for the service is a reserved place with privacy	2012	91,5	93,3	95,6	96,0	94,6	94,6
		2014	93,0	93,5	94,9	96,6	95,6	94,6
		2017	-	-	-	-	-	-
	UQ13. In consultations, team professionals perform the physical examination by touching the body to examine	2012	59,7	70,7	78,9	76,4	67,7	74,0
		2014	59,4	66,6	70,4	73,8	65,5	68,4
		2017	60,9	70,1	69,9	70,0	68,3	69,2
	UQ14. Is always guided by the professionals of this team on the care that must be taken to recover, such as: the need for rest, adequate food, and others	2012	61,2	66,4	71,2	68,7	63,0	68,1
		2014	68,5	72,0	73,0	79,8	69,8	73,1
		2017	-	-	-	-	-	-
	UQ15. Is always guided by the professionals of the team on the signs that indicate improvement or worsening	2012	53,7	60,4	66,3	66,1	60,4	63,2
		2014	62,2	65,5	68,7	75,0	64,3	67,7
		2017	-	-	-	-	-	-
	UQ16. The professional takes notes in the medical record or form during consultations	2012	95,4	95,2	95,8	95,3	92,4	95,3
		2014	-	-	-	-	-	-
		2017	-	-	-	-	-	-
	UQ17. Professionals remember what happened on the last appointments	2012	44,2	47,5	54,3	50,2	46,4	50,3
		2014	-	-	-	-	-	-
		2017	-	-	-	-	-	-
	UQ18. Always needs to ask questions after consultations and has ease to talk to the professionals who attended him/her	2012	38,0	46,4	48,0	46,5	38,9	46,1
		2014	38,4	42,4	44,1	49,2	44,7	43,9
		2017	48,8	56,0	52,5	56,3	56,6	54,3
	UQ19. When treatment is interrupted by the patient for some reason, or he/she does not come to the consultation at this health unit, the professionals seek him/her out to find out what happened and continue care	2012	25,8	24,5	27,7	22,1	20,0	25,1
		2014	21,6	18,7	22,8	19,8	18,2	20,4
		2017	57,5	51,0	52,7	47,7	50,7	51,6
Special care for patients with diabetes	UQ20. A doctor has told you that you have diabetes	2012	8,9	8,1	16,5	11,4	15,4	12,4
		2014	9,4	9,7	17,9	13,8	17,3	13,7
		2017	9,4	9,4	16,5	14,0	11,9	12,6
	Assessment for patients with diabetes only
	UQ21. Got a consultation with a doctor because of diabetes in the last six months	2012	87,3	87,8	90,6	86,1	87,9	89,0
		2014	87,0	84,6	82,9	80,4	81,5	83,0
		2017	86,9	88,0	85,4	85,6	87,9	86,4
	UQ22. Had a fasting blood test to measure blood sugar in the last six months	2012	91,8	89,4	89,8	90,3	90,4	89,9
		2014	91,1	88,5	87,5	88,3	89,9	88,3
		2017	89,7	89,0	86,8	89,4	89,6	88,2
	UQ23. A healthcare professional has done the foot exam in the last six months	2012	21,2	24,4	34,7	27,1	30,5	30,5
		2014	21,5	25,2	35,2	28,9	28,3	30,4
		2017	25,3	36,5	36,5	31,3	32,1	34,7
	UQ24. In the last six months, a member of the health team advised on foot care	2012	37,6	41,9	49,8	40,5	46,0	45,9
		2014	-	-	-	-	-	-
		2017	43,0	51,3	47,1	40,9	44,0	46,8
	UQ25. Has already left the appointment with the next appointment scheduled	2012	39,4	37,3	35,1	28,0	33,7	34,6
		2014	32,9	30,7	28,4	24,6	25,4	28,3
		2017	39,6	46,7	37,3	31,2	36,0	39,0
	UQ26. Takes medicine for diabetes	2012	86,1	87,4	92,1	85,6	88,6	89,6
		2014	84,8	88,6	92,9	86,7	89,9	90,2
		2017	-	-	-	-	-	-

Team Question (QE) / User Question (UQ)	Year	Team (TQ)						User (UQ)						Dif. %
Team Question (QE) / User Question (UQ)	Year	N	NE	SE	S	MW	BR	N	NE	SE	S	MW	BR	BR
TQ03. All users who arrive at the health unit spontaneously seeking care have their needs heard and evaluated X UQ09. The guidelines that professionals give at the unit always meet your needs	2012	91,5	96,5	98,6	98,1	94,4	97,2	42,5	50,2	55,4	58,5	45,9	52,8	-45,6
	2014	93,1	95,4	98,8	98,5	96,5	96,9	-	-	-	-	-	-	-
	2017	98,2	98,7	99,6	99,3	99,5	99,1	75,3	81,7	81,5	82,2	81,5	81,2	-18,0
TQ04. Team performs urgent and emergency care at the health unit X UQ11. You sought care the last time you had a health problem that you considered urgent	2012	60,1	68,2	75,7	81,6	67,1	72,8	64,7	58,7	63,5	71,1	61,0	63,0	-13,4
	2014	86,1	92,6	96,6	95,8	92,5	94,0	-	-	-	-	-	-	-
	2017	85,7	96,4	94,8	97,0	94,7	95,0	56,1	65,7	60,2	70,0	58,2	63,0	-33,7
TQ08. There are schedule queries and actions for users with DM X UQ25. Already leave the appointment with the next appointment scheduled	2012	88,0	90,1	87,1	84,9	83,9	87,6	39,4	37,3	35,1	28,0	33,7	34,6	-60,5
	2014	96,1	98,0	92,3	81,9	92,4	93,1	32,9	30,7	28,4	24,6	25,4	28,3	-69,6
	2017	89,7	95,2	91,6	91,6	91,6	92,4	39,6	46,7	37,3	31,2	36,0	39,0	-57,8
TQ19. The CHAs have a schedule of visits for absent diabetics X UQ19. When he interrupts the treatment for some reason or does not come to the consultation at this health unit, the professionals seek him out to find out what happened and resume care	2012	92,2	89,5	90,2	80,0	87,5	88,2	25,8	24,5	27,7	22,1	20,0	25,1	-71,5
	2014	80,7	73,5	72,8	66,7	77,6	73,1	21,6	18,7	22,8	19,8	18,2	20,4	-72,0
	2017	-	-	-	-	-	-	57,5	51,0	52,7	47,7	50,7	51,6	-
TQ25. Which of these tests are requested by your team and performed by the health services network: Jeju blood glucose X UQ22. Had a fasting blood test to measure blood sugar in the last six months	2012	99,6	99,4	97,5	97,5	98,6	98,3	91,8	89,4	89,8	90,3	90,4	89,9	-8,6
	2014	98,7	99,2	98,4	97,9	98,4	98,6	91,1	88,5	87,5	88,3	89,9	88,3	-10,5
	2017	98,7	99,3	98,2	99,6	99,1	98,9	89,7	89,0	86,8	89,4	89,6	88,2	-10,9
TQ27. Does the team perform a diabetic foot exam periodically? X UQ23. Has any health care professional had their feet checked in the last six months	2012	54,7	58,1	59,5	55,3	56,2	57,8	21,2	24,4	34,7	27,1	30,5	30,5	-47,3
	2014	-	-	-	-	-	-	21,5	25,2	35,2	28,9	28,3	30,4	-
	2017	74,9	83,6	80,3	74,5	78,3	80,1	25,3	36,5	36,5	31,3	32,1	34,7	-56,6

ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

J Muzy was responsible for the conception, study design, data analysis and interpretation, and the review and approval of the final version of the manuscript. M Campos was responsible for the conception, study design, analysis and data interpretation. I Emmerick was responsible for the analysis, data interpretation, review and approval of the final version of the manuscript. FG Avelar was responsible for the analysis, data interpretation and general review of the manuscript.