Gastos do tratamento de pacientes atendidos na Atenção Primária do município de Bauru–SP, segundo diagnóstico de Diabetes Mellitus e nível de atividade física: acompanhamento de 8 anos
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Data
2020-05-15
Autores
Kikuti-Koyama, Kelly Akemi
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Universidade Estadual Paulista (Unesp)
Resumo
O diabetes mellitus (DM) é considerado problema de saúde pública, vem crescendo e gerando altos gastos para a saúde. A atividade física (AF) é alternativa de tratamento que traz benefícios à saúde e atua na redução dos gastos. Dessa forma, o objetivo deste trabalho foi analisar os gastos do tratamento de pacientes atendidos na atenção primária do município de Bauru-SP, segundo diagnóstico de Diabetes Mellitus e nível de atividade física: acompanhamento de 8 anos. Para amostra foram avaliados participantes com idade igual ou superior a 50 anos, cadastrados em cinco Unidades Básicas de Saúde do Município de Bauru/SP, acompanhados por um período de oito anos. O diagnóstico de DM foi avaliado a partir dos registros dos prontuários clínicos, onde também foram levantados os gastos com saúde. Foram averiguados os indicadores de saúde: tabagismo e uso de álcool por meio de questionário, obesidade, através do índice de massa corporal (IMC), e o nível de atividade física habitual, realizado por meio do questionário de Baecke (1982). Informações sobre as variáveis de confusão foram coletadas por meio do questionário da Associação Brasileira de Pesquisa (ABEP) e entrevista. Essa dissertação está estruturada em 3 capítulos; Capítulo 1: Introdução, objetivos e metodologia geral; Capítulo 2: Estudo longitudinal com objetivo de verificar os fatores associados incidência de DM e analisar como nível de atividade física habitual impacta na ocorrência da doença e consequentemente nos gastos com saúde no período de oito anos. Os resultados mostraram a prevalência do DM em 2018 de 42,7% enquanto a incidência acumulada foi de 14,5% no último biênio, ao longo dos 8 anos. Os gastos com saúde, aumentaram para medicamentos e total (p= 0,001), como também os gastos específicos com DM, onde insulina, medicamentos orais e DM total foram significante superiores (p= 0,001); Capítulo 3: Com objetivo de investigar os determinantes dos gastos com saúde entre pacientes com DM, bem como, avaliar o impacto das mudanças na prática de atividades físicas sobre as mudanças nos gastos com saúde ao longo de 8 anos de acompanhamento. Quanto maior tempo de diagnóstico com o DM, maiores foram os gastos com medicamentos, quanto maior o índice de massa corporal (IMC) maiores foram os gastos com consultas, exames e total. Em relação a AF na linha de base, participantes mais ativos apresentaram a economia de 115,61 reais em gastos com saúde. Por fim, observou-se o aumento da prevalência do DM na população ao longo dos oito anos, como também o aumento dos gastos em relação à saúde, devida a baixa prática de AF. Em contrapartida o aumento do escore de AF na linha de base mostrou-se importante para diminuição dos custos no mesmo período.
Diabetes mellitus (DM) is considered a public health problem, it has been growing and generating high health costs. Physical activity (PA) is an alternative treatment that brings health benefits and reduces costs. Thus, the objective was to analyze the costs of treating primary care patients of Bauru-SP city, according to the diagnosis of Diabetes Mellitus and level of physical activity: 8-year follow-up. For the sample, participants aged 50 years or older, registered in five Basic Health Units in the city of Bauru/SP, were monitored for a period of eight years. The diagnosis of DM was evaluated based on the records of the medical records, where health expenses were also raised. The following health indicators were investigated: smoking and alcohol use, by questionnaire; obesity, through the body mass index (BMI); habitual physical activity, performed through the questionnaire by Baecke (1982). Information on the confounding variables was taken from the Brazilian Research Association (ABEP) questionnaire and interview. This dissertation is structured in 3 chapters; Chapter 1: introduction, objectives and general methodology; Chapter 2: longitudinal study with the objective of verifying the factors associated with the incidence of DM and analyzing how the level of habitual physical activity impacts on the occurrence of the disease and, consequently, health expenditures in the eight-year period. The results showed the prevalence of DM in 2018 of 42.7% while the cumulative incidence was 14.5% in the last biennium, over the 8 years. Spending on health increased for medication and total (p = 0.001), as well as, specific DM spending (insulin, oral medications and total DM) were significantly higher (p=0.001); Chapter 3: the objective of this study was to investigate the determinants of health expenditure among patients with DM, as well as to assess the impact of changes in physical activity on changes in health expenditure over 8 years of follow-up. The longer the time of diagnosis with DM, the greater the expenditure on medication, the higher the body mass index (BMI), the greater the expenditure on consultations, exams and total. In relation to PA at the baseline, participants that are more active showed savings of R$ 115.61 in health expenditures. Finally, we conclude the increase in the prevalence of DM in the population over the eight years, as well as the increase in spending in relation to health, due to the low practice of PA. On the other hand, the increase in the score of PA at the baseline proved to be important for decreasing costs in the same period.
Diabetes mellitus (DM) is considered a public health problem, it has been growing and generating high health costs. Physical activity (PA) is an alternative treatment that brings health benefits and reduces costs. Thus, the objective was to analyze the costs of treating primary care patients of Bauru-SP city, according to the diagnosis of Diabetes Mellitus and level of physical activity: 8-year follow-up. For the sample, participants aged 50 years or older, registered in five Basic Health Units in the city of Bauru/SP, were monitored for a period of eight years. The diagnosis of DM was evaluated based on the records of the medical records, where health expenses were also raised. The following health indicators were investigated: smoking and alcohol use, by questionnaire; obesity, through the body mass index (BMI); habitual physical activity, performed through the questionnaire by Baecke (1982). Information on the confounding variables was taken from the Brazilian Research Association (ABEP) questionnaire and interview. This dissertation is structured in 3 chapters; Chapter 1: introduction, objectives and general methodology; Chapter 2: longitudinal study with the objective of verifying the factors associated with the incidence of DM and analyzing how the level of habitual physical activity impacts on the occurrence of the disease and, consequently, health expenditures in the eight-year period. The results showed the prevalence of DM in 2018 of 42.7% while the cumulative incidence was 14.5% in the last biennium, over the 8 years. Spending on health increased for medication and total (p = 0.001), as well as, specific DM spending (insulin, oral medications and total DM) were significantly higher (p=0.001); Chapter 3: the objective of this study was to investigate the determinants of health expenditure among patients with DM, as well as to assess the impact of changes in physical activity on changes in health expenditure over 8 years of follow-up. The longer the time of diagnosis with DM, the greater the expenditure on medication, the higher the body mass index (BMI), the greater the expenditure on consultations, exams and total. In relation to PA at the baseline, participants that are more active showed savings of R$ 115.61 in health expenditures. Finally, we conclude the increase in the prevalence of DM in the population over the eight years, as well as the increase in spending in relation to health, due to the low practice of PA. On the other hand, the increase in the score of PA at the baseline proved to be important for decreasing costs in the same period.
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Palavras-chave
Diabetes Mellitus, Despesa pública, Política governamental, Exercício