Chronic care management in primary care for patients with type 2 diabetes mellitus in Amazonas

Conducting health systems assessments helps highlight weaknesses and strengths to be explored to improve care delivery. The Assessment of Chronic Illness Care (ACIC) considers the perspective of professionals who work in the care-providing institution. Its structure comprises seven dimensions that provide specific data about the care offered. Objectives: (1) evaluate the institutional capacity for Type 2 Diabetes Mellitus (T2DM) management in the interior of the State of Amazonas from the perspective of health professionals; (2) verify the association between socio-educational, work and geographic location variables with the dimensions of the ACIC.

A cross-sectional study carried out between October 2020 and December 2022 in 36 Primary Health Units (PHUs) of the seven cities of the Amazonas, totaling 230 participants. Excel 2019 and R (4.2.1) were used for data analysis. The association between independent variables and ACIC dimensions was analyzed using multiple logistic regression analysis.

The PHUs in the rural Amazonas have the basic capacity to care for patients with T2DM. Analysis of each dimension of the ACIC demonstrated that geographic location was the most relevant factor, showing an association with all instrument dimensions.

Socioeducational variables showed an association with the dimensions of Decision Support, Design of the Service Delivery System, Clinical Information System, and Integration of components of the Care Model for Chronic Conditions. Work-related variables, on the other hand, were associated with the dimensions of Organization of Health Care, Community Resources, Support for Self-Management and Integration of the components of the Chronic Conditions Care Model.