Risk strata and quality of care for the elderly in Primary Health Care

Silva, Líliam Barbosa; Silva, Patrícia Aparecida Barbosa; Santos, Joseph Fabiano Guimarães; Silqueira, Salete Maria de Fátima; Borges, Eline Lima; Soares, Sônia Maria

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Brasil

Revista Latino-Americana de Enfermagem

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Brasil

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Sumário

Original Article • Rev Lat Am Enfermagem 27 • 2019 • https://doi.org/10.1590/1518-8345.2968.3166 copy

Risk strata and quality of care for the elderly in Primary Health Care ^* * Paper extracted from doctoral dissertation “Quality of care for the elderly with diabetes and / or hypertension attending in Primary Health Care”, presented to Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG, Brazil. Supported by Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG), grant #APQ 00108-11, APQ 02212-14 and APQ 03556-13.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective

to identify patterns of associations between the degree of compliance to laboratory test requests by risk strata and the parameters of quality of care outcomes in primary health care (PHC).

Method

a cross-sectional study involving 108 elderly patients with hypertension and/or diabetes treated in PHC. A semi-structured questionnaire and electronic medical record data were used. To evaluate the quality of care, the Patient Assessment of Chronic Illness Care (PACIC) questionnaire was used. Descriptive analysis, multiple correspondence analysis and k-means grouping were performed.

Results

it was observed low compliance of the care practice, standing out as the worst parameter the evaluation of the diabetic foot (2.2%). Three clusters were identified, with cluster 1 having the highest number of individuals (37.0%), with better indicators of quality of care, evidenced by above 50% of compliance with laboratory tests (75.0%), high PACIC score (47.2%), control of blood pressure (70.0%) and metabolic levels (95.0%), and satisfaction with health (92.5%) and health access (90.0%). In contrast, cluster 3 (29.6%) was made up of individuals with worse outcomes of care.

Conclusion

low compliance of care practice and asymmetries among health actions and users’ needs were observed, indicating failures in the care process in PHC.

Electronic Health Records; Quality of Health Care; Health of the Elderly; Primary Health Care; Chronic Disease; Cross-Sectional Studies

Variables	n	%
Care parameters complied
Medical consultation	56	51.9
Nursing consultation	27	25.0
Electrocardiogram	31	28.7
Fundoscopy	10	9.3
Chest x-ray	10	9.3
Diabetic foot evaluation*	1	2.2
Cardiovascular risk
Low	14	13.0
Medium	10	9.2
High	84	77.8
Control of blood pressure^†
Controlled	61	56.5
Uncontrolled	47	43.5
Metabolic control^‡
Controlled	83	76.9
Uncontrolled	25	23.1
Satisfaction with health^§
Very satisfied/satisfied	62	59.0
Neither satisfied nor dissatisfied	28	26.7
Very dissatisfied/dissatisfied	15	14.3
Satisfaction with access to health services^§
Very satisfied/satisfied	65	61.9
Neither satisfied nor dissatisfied	17	16.2
Very dissatisfied/dissatisfied	23	21.9
% tests complied
0%	35	32.4
1-50%	24	22.2
51-100%	49	45.4
PACIC scores^\|\|¶
Low (≤ 1.30)	29	28.7
Medium (1.31-2.22)	47	46.5
High (≥ 2.23)	25	24.8

Variables	Dimension 1		Dimension 2

	Discrimination measures	% contribution	Discrimination measures	% contribution
Metabolic control*	0.623	37.8	0.019	1.3
Blood pressure control^†	0.429	26.0	0.129	9.0
Satisfaction with access to health	0.222	13.5	0.115	8.0
Satisfaction with health	0.187	11.3	0.210	14.7
Total PACIC^‡	0.144	8.6	0.605	42.4
% tests complied	0.046	2.8	0.351	24.6
No. of cluster^§	0.711		0.627
Total active	1.650		1.428
Inertia	0.275		0.238
% explained variance	19.94		17.26
Alpha Cronbach’s	0.473		0.360

Variables		Typology

		Cluster 1		Cluster 2		Cluster 3

		n	%	n	%	n	%
% tests completed	T1^†(0%)	7	17.5	15	41.7	13	40.6
	T2^‡(1-50%)	3	7.5	14	38.9	7	21.9
	T3^§(51-100%)	30	75.0	7	19.4	12	37.5
	Total	40	100.0	36	100.0	32	100.0
Total PACIC*	P-l^\|\|	3	8.3	23	69.7	3	9.4
	P-m^¶	16	44.4	9	27.3	22	68.8
	P-h**	17	47.2	1	3.0	7	21.9
	Total	36	100.0	33	100.0	32	100.0
Control of blood pressure	BP-c^††	28	70.0	30	83.3	3	9.4
	BP-h^‡‡	12	30.0	6	16.7	29	90.6
	Total	40	100.0	36	100.0	32	100.0
Metabolic control	MC-c^§§	38	95.0	35	97.2	10	31.3
	MC-a^\|\|\|\|	2	5.0	1	2.8	22	68.8
	Total	40	100.0	36	100.0	32	100.0
Satisfaction with health	SH-s^¶¶	37	92.5	14	41.2	11	35.5
	SH-d***	3	7.5	20	58.8	20	64.5
	Total	40	100.0	34	100.0	31	100.0
Satisfaction with access to health	SA-s^†††	36	90.0	15	44.1	14	45.2
	SA-d^‡‡‡	4	10.0	19	55.9	17	54.8
	Total	40	100.0	34	100.0	31	100.0

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding author: Líliam Barbosa Silva E-mail: ligemeasbh@yahoo.com.br https://orcid.org/0000-0002-5576-9744