Relationships between quality of care characteristics directed to hypertensive and diabetic patients of the Family Health Strategy and the control of prognostic factors for complications

Abstract Background Although the Family Health Strategy (FHS) is designed to meet the requirements of care for patients with chronic diseases, it appears that in practice, the control of arterial hypertension and diabetes mellitus remains unsatisfactory. Objective The objective was to assess if quality of care influenced the control of prognostic factors of complications in subjects with hypertension or diabetes enrolled in the FHS in Pernambuco. Method This is a cross-sectional study on a random sample of 1607 hypertensive and diabetic subjects enrolled with the FHS in 35 municipalities in the state of Pernambuco. Quality of care was evaluated by “accessibility”, “services available”, “services provided” and “satisfaction”. The relationships with control of prognostic factors were sought using the chi-square test. Results The practice of physical activity was the outcome that was most closely linked to quality of care; on the other hand, quality of care was not found associated with smoking cessation. The relationship between quality of care and control of weight, blood pressure or diabetes were nonexistent or paradoxical. Conclusion Good quality of care may have a positive impact on the practice of physical activity by hypertensive or diabetic subjects.

摘要
研究背景：尽管家庭健康策略（Family Health Strategy，FHS）旨在满足慢性病患者的照护需求，但临床实践中，动脉高血压（arterial hypertension）与糖尿病（diabetes mellitus）的病情控制效果仍不尽如人意。
研究目的：本研究旨在评估巴西伯南布哥州纳入FHS管理的高血压或糖尿病患者，其照护质量是否会影响并发症预后相关危险因素的控制情况。
研究方法：本研究为横断面研究，研究对象为抽取自伯南布哥州35个市、纳入FHS管理的1607名高血压及糖尿病患者的随机样本。照护质量通过「可及性」「可获得的服务」「已提供的服务」及「患者满意度」四个维度进行评估。采用卡方检验（chi-square test）分析照护质量与并发症预后危险因素控制情况之间的关联。
研究结果：体力活动行为是与照护质量关联最为紧密的结局指标；另一方面，未发现照护质量与戒烟行为存在显著关联。照护质量与体重、血压或糖尿病病情控制之间的关联要么不存在，要么呈现悖论性结果。
研究结论：优质照护或可对高血压或糖尿病患者的体力活动行为产生积极影响。