Users' Perceptions of Access to and Quality of Unified Health System Services in Brazil: A Cross-Sectional Study and Implications to Healthcare Management Challenges.

Evaluating the access to and quality of healthcare services from the users' perspective is an important assessment process to identify priorities. This study assessed the profile of health service usage and the views of the Unified Health System (SUS) users about the access to and quality of SUS public health services. A cross-sectional study was conducted with participants from the Coastal Lowlands Region of the Rio de Janeiro State/Brazil, between August and November 2023. The association between categorical variables was analyzed using the Pearson Chi-Square test, using R software 4.3. A total of 200 individuals were interviewed using a 66-question survey instrument. Participants who reported using SUS services more frequently rated this system as essential (p-value = 0.031). However, overall, 64% of participants rated the quality of care to be very bad/bad and 34.9% rated access as very bad/bad. Access was considered poor by respondents who used public services rarely or sometimes (p-value = 0.002). In terms of accessing SUS services consultations provided by specialists (e.g., neurologists), these were available only in another municipality (p-value = 0.001). Many participants were SUS dependent for health services, and gaps and weaknesses were observed regarding users' perspectives of the access to and quality of SUS health care. Policymakers should prioritize evaluations and dialogue with the community to make SUS services responsive and to optimize value-for-money in health service planning.

The individual contribution and relative importance of self-management and quality of care on glycaemic control in type 2 diabetes.

OBJECTIVE: To evaluate the relative importance of selfmanagement (SM) and quality of care (QoC) inpredicting glycaemic control in patients with type 2 diabetes. MATERIALS AND METHODS: A longitudinal cohort study was conducted in 204 adults diagnosed with type 2 diabetes. Self-management and quality of care were measured at baseline. HbA1c was measured at baseline and at six-month follow-up. RESULTS: None of the measures of self-management were significantly associated with HbA1c.Treatment intensification (TI) (a proxy for quality of care) resulted in lower HbA1c at follow-up. Other variables were associated with HbA1c at follow-up: HbA1c at baseline, age, diabetes duration, and combination of oral glucose-lowering medications. An exploratory analysis showed that patients who did not receive treatment intensification but performed more self-management behaviours had lower HbA1c levels at follow-up. CONCLUSION: Treatment intensification might be more important for glycaemic control than self-management but the interaction between treatment intensification and self-management needs further research.

The individual contribution and relative importance of self-management and quality of care on glycaemic control in type 2 diabetes / Contribución individual e importancia relativa del auto-cuidado y la calidad de la atención en el control glucémico de la diabetes tipo 2

Abstract: Objective: To evaluate the relative importance of selfmanagement (SM) and quality of care (QoC) inpredicting glycaemic control in patients with type 2 diabetes. Materials and methods: A longitudinal cohort study was conducted in 204 adults diagnosed with type 2 diabetes. Self-management and quality of care were measured at baseline. HbA1c was measured at baseline and at six-month follow-up. Results: None of the measures of self-management were significantly associated with HbA1c.Treatment intensification (TI) (a proxy for quality of care) resulted in lower HbA1c at follow-up. Other variables were associated with HbA1c at follow-up: HbA1c at baseline, age, diabetes duration, and combination of oral glucose-lowering medications. An exploratory analysis showed that patients who did not receive treatment intensification but performed more self-management behaviours had lower HbA1c levels at follow-up. Conclusion: Treatment intensification might be more important for glycaemic control than self-management but the interaction between treatment intensification and self-management needs further research.

Resumen: Objetivo: Evaluar la importancia relativa del autocuidado (AU) y calidad de la atención (CA) para predecir control glucémico en diabetes mellitus tipo 2 (DM2). Material y métodos: Estudio longitudinal en 204 adultos con DM2. AU y CA evaluados en la medición basal. HbA1c evaluada en la medición basal y a los seis meses. Resultados: A los seis meses, ninguna de las mediciones de AU se asoció significativamente con HbA1c. La intensificación en el tratamiento (IT) (proxy de CA) se asoció con disminución de HbA1c. Otras variables asociadas con HbA1c: HbA1c en medición basal, edad, duración de diabetes, y combinación de anti-hiperglucemiantes. En un análisis exploratorio, los participantes que no recibieron IT pero desempeñaron más conductas de AU tuvieron niveles más bajos de HbA1c. Conclusión: IT parece ser más importante para el control glucémico que AU, pero la interacción entre IT y conductas de AU se deben estudiar con más profundidad.

The relationship between quality of care and self-management in patients with type 2 diabetes: a cross-sectional survey in primary care in Mexico.

BACKGROUND: Achieving glycaemic control in diabetes reduces complications and improves outcomes. Glycaemic control requires both good quality clinical care and effective self-management support. However, the relationship between these factors in routine clinical practice is unclear. AIMS: To evaluate baseline levels of self-management and clinical quality of care in patients with type 2 diabetes in primary care in Mexico and to explore relationships between measures of self-management and clinical quality of care. METHODS: The sample consisted of adults (N=205) diagnosed with type 2 diabetes for over a year and registered at one of five practices in the Mexican Institute of Social Security in Aguascalientes. Self-management and quality of care were measured using medical record review and interviews, including validated measures of diabetes knowledge, self-care behaviours, self-efficacy, treatment intensification, continuity of care, doctor-patient communication, and patient satisfaction with diabetes care. HbA1c and cholesterol tests were taken. RESULTS: There were few associations between measures of self-management, and between measures of the quality of clinical care. 'Strong' knowledge about medical prescription was associated with higher diabetes knowledge (OR = 1.2, 95% CI 1.08 to 1.32). Diabetes self-efficacy was associated with self-care behaviours (OR = 1.51, 95% CI 1.26 to 1.81). Patient-doctor communication was associated with continuity of care (Chi-squared = 11.03, P <0.05), with patient satisfaction (ß = 6.17, 95% CI 4.47 to 7.93) and with diabetes self-efficacy (ß = 0.70, 95% CI 0.19 to 1.20, P <0.01). Patient satisfaction was associated with continuity of care (F = 7.82, P <0.001). CONCLUSION: The associations between measures of self-management and quality of care were modest. Patients who were achieving high levels of one aspect of care were not necessarily receiving high levels of the other. This indicates that different factors are likely to be driving each aspect of care and highlights the importance of measuring their relative importance.