Article

Evaluación de la calidad de la asistencia al paciente diabético en América Latina

Revista Panamericana de Salud Pública 01/2001;
Source: DOAJ

ABSTRACT Objetivos. Hacer un diagnóstico preliminar de la calidad de la atención que reciben las personas con diabetes (DM) en centros tributarios de la red QUALIDIAB y analizar el potencial de esta información y la importancia de la expansión de la red en América Latina y el Caribe. Métodos. Se analizaron 13 513 registros provenientes de centros de atención del subsector público y privado de salud y de la Seguridad Social de Argentina, Brasil, Chile, Colombia, Paraguay y Uruguay (red QUALIDIAB). Se utilizaron indicadores de la calidad de la atención basados en valores de referencia internacionales, una planilla de registro de parámetros clínicos, bioquímicos y terapéuticos y de la tasa de uso de elementos diagnósticos y terapéuticos, un programa para cargar los datos y otro para su análisis estadístico. Resultados. La diabetes tenía una duración < 5 años en alrededor de la mitad de las personas con DM de tipo 1 (DM1) y de tipo 2 (DM2) registradas. El 24% de las personas con DM1 y el 15 % con DM2 tenían glucemias < 4,4 mmol/L, mientras que el 41% con DM1 y el 57% con DM2 tenían glucemias > 7,7 mmol/L. La frecuencia de la asociación de la DM2 con otros factores de riesgo cardiovascular (FRCV) fue la siguiente: sobrepeso/obesidad, 59%; hipertensión, 60%; colesterol total > 5,5 mmol/L, 53%; colesterol de las lipoproteínas de alta densidad < 1 mmol/L, 32%; triglicéridos > 1,7 mmol/L, 45%; tabaquismo 13%. El 20% de las personas con DM1 tenían un índice de masa corporal < 19 kg/m² que probablemente refleje un deficiente control metabólico e hipoinsulinización. La verificación sistemática de indicadores del control metabólico y la detección de FRCV y de complicaciones crónicas de la DM fueron deficientes en el 3 al 75% de los casos. Según los indicadores de educación terapéutica, solo la mitad o la cuarta parte de los participantes podrían desempeñar un papel activo y eficaz en el control y tratamiento de su DM. El 50% de las personas con DM1 son tratadas con combinación de insulinas (NPH + corriente), administrada en dos inyecciones diarias en el 43% de los casos. El 5 y el 9% de los pacientes reciben, respectivamente, 1 y > 3 inyecciones diarias de insulina. El 13% de las personas con DM2 tratan su enfermedad solo con dieta y el 14% solo con insulina. Entre los pacientes tratados con fármacos, los hipoglucemiantes orales más utilizados como monoterapia fueron las sulfonilureas (33%), seguidas por las biguanidas (9%) y su administración combinada (14%). Menos de la mitad de las personas con diabetes reciben farmacoterapia para tratar los FRCV asociados. La frecuencia de las complicaciones microangiopáticas y macroangiopáticas aumentó con la antigüedad de la enfermedad, verificándose los incrementos máximos en la insuficiencia renal y en las amputaciones (alrededor de 7 veces) y los menores en la neuropatía periférica (2 veces) y los accidentes cerebrovasculares (1,6 veces). Conclusiones. Estos resultados demuestran la necesidad de mejorar la calidad de la atención a los pacientes diabéticos y que QUALIDIAB puede ser el instrumento idóneo para ello en América Latina y el Caribe. La ampliación de la Red QUALIDIAB contribuirá a establecer un diagnóstico más preciso de la calidad de dicha atención en la Región y facilitará la implementación de intervenciones destinadas a optimizarla, mejorando así la calidad de vida de quienes la padecen y disminuyendo simultáneamente el costo socioeconómico de la enfermedad.

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