Internações de idosos por diabetes mellitus: a influência da Estratégia Saúde da Família na saúde da pessoa idosa no Estado do Rio de Janeiro

Abstract

The aim of the study was to describe the influence of Brazil s Family Health Strategy (FHS) on hospitalization due to diabetes mellitus (DM) among the elderly population. It examines which indicators correlate with the reduction of hospital admissions in the state of Rio de Janeiro, having as theoretical background the Brazilian National Policy for the Elderly (PNSPI). The study follows an ecological design based on secondary data from DATASUS for the period of 2011 to 2015. Hospitalization rates among elderly with diabetes was the outcome variable. In the set of explanatory variables, indicators that could describe the local context of municipalities were selected, considering the performance of the FHS, resources available, socioeconomic conditions, as well as health status of the elderly population. To quantify the changes occurred over time, the relative percentage changes of hospitalization rates and FHS performance over the period were calculated. To identify the variables correlated with hospitalization rates among elderly with diabetes, it was used Pearson's correlation test. Multiple linear regression was used to identify statistically significant associations between hospitalization and explanatory variables. The results showed trends toward a reduction in hospitalization rates among elderly with diabetes and an increasing trend toward FHS coverage. Although the findings suggest a favorable influence on the FHS performance, there was a decrease in the FHS interventions at the same period. Simple linear regressions indicate that hospitalization rates among elderly with diabetes mellitus are reduced when: there is a higher proportion of diabetics included in the FHS, who were provided medical or nurse care, and higher rates of educational groups; and also when there are lower elderly population coverage and lower rates of community agents. Although the correlations found were significant they were not considered high. When processing the multiple linear regression, only variables indicative of PNSPI measurements remained in the final model. Although the increase in coverage and the decrease in FHS productivity occurred simultaneously with the reduction of the investigated hospitalization, the methodology applied does not allow inferences as to any causality relation between them. In addition, the FHS performance is strongly dependent on local context and it is necessary to consider other factors associated with the explanation of those events. The absence of factors directly related to FHS performance in the final regression model leads to further investigation of primary care gaps and weaknesses. Appreciation of social issues and other factors affecting health care are important measures and need to be faced. For the time being, the PNSPI definitions represent an ideal situation and the FHS actions toward the elderly population should reach for the established guidelines to be effective, such as: continuing education of FHS professionals in Geriatrics and Gerontology and Management for Elderly Care; implementation of validated and multidimensional protocols for monitoring and forestalling elderly health problems; to foster educational health group activities in order to prevent functional limitations, promote health and quality of life.