# Care and primary health care access indicators among Brazilian adults with diabetes mellitus, National Health Survey 2019

## TL;DR

This study examines how access to primary health care in Brazil affects the care of adults with diabetes, finding disparities in service use and health outcomes.

## Contribution

The study provides new insights into the relationship between primary health care registration and diabetes care quality in Brazil.

## Key findings

- Registered individuals were more likely to consult primary health care units and see specialists after referral.
- They were less likely to see the same doctor repeatedly or undergo recent eye exams.
- Disparities in care and access exist among Brazilian adults with diabetes.

## Abstract

To analyze indicators of access to health services and care among adults with Diabetes mellitus in Brazil, according to Primary Health Care coverage.

A cross-sectional study using data from the 2019 National Health Survey (PNS). Only individuals who self-reported a diagnosis of Diabetes mellitus were selected. Explanatory variables represented indicators of care and access among adults with a Diabetes mellitus diagnosis. Prevalence and 95% confidence intervals (95%CI) were calculated for the indicators. The association with registration in a Family Health Unit was verified by bivariate analysis. Indicators with p≤0.05 were included in a logistic regression model and, subsequently, in a model adjusted for sex and age.

Among the Brazilian adult population, 8.2% (95%CI 7.9-8.6) self-reported a diagnosis of Diabetes mellitus. After adjustment, individuals with diabetes living in households registered in a Family Health Unit were more likely to have had their last consultation in a Primary Health Care Unit (OR=2.13; 95%CI 1.71-2.64), to have been seen by a specialist physician after referral (OR=1.97; 95%CI 1.49-2.60), and to report severe limitations in usual activities due to the condition (OR=1.65; 95%CI 1.05-2.62). On the other hand, they were less likely to have been seen by the same doctor as in previous consultations (OR=0.65; 95%CI 0.53-0.81) and to have undergone an eye exam in the past year (OR=0.73; 95%CI 0.58-0.90).

Disparities exist in care and access to Primary Health Care services among Brazilian adults with diabetes.

Analisar os indicadores de acesso aos serviços de saúde e cuidado entre adultos com diabetes mellitus no Brasil, segundo a cobertura da atenção básica.

Estudo transversal, com dados da Pesquisa Nacional de Saúde (PNS) 2019. Foram selecionados apenas os indivíduos que autorreferiram diagnóstico de diabetes mellitus. As variáveis explicativas representaram indicadores de cuidado e acesso entre adultos com diagnóstico de diabetes mellitus. Foram calculados as prevalências e o Intervalo de Confiança de 95% (IC95%) dos indicadores. A associação com o cadastro em Unidade de Saúde da Família (USF) foi verificada por análise bivariada. Indicadores com p≤0,05 foram incluídos em modelo de regressão logística e, posteriormente, em modelo ajustado por sexo e idade.

Entre a população adulta brasileira, 8,2% (IC95% 7,9-8,6) autorrelataram diagnóstico de diabetes mellitus. Após ajuste, os indivíduos com diabetes e domicílio cadastrado em USF apresentaram maior chance de terem realizado a última consulta em uma Unidade Básica de Saúde (UBS) (OR=2,13; IC95% 1,71-2,64), de terem sido atendidos por médico especialista após encaminhamento (OR=1,97; IC95% 1,49-2,60) e de referir limitação intensa nas atividades habituais devido à condição (OR=1,65; IC95% 1,05-2,62). Por outro lado, observou-se menores chances de terem sido atendidos pelo mesmo médico das consultas anteriores (OR=0,65; IC95% 0,53-0,81) e de realizarem exame de vista no último ano (OR=0,73; IC95% 0,58-0,90).

Existem disparidades no cuidado e no acesso aos serviços de atenção básica entre adultos brasileiros com diabetes.