Cuidado farmacêutico ao paciente com Diabetes mellitus na atenção primária à saúde do município de Fortaleza-CE: descrição e avaliação

Abstract

Pharmaceutical care has been consolidated as an essential element in Primary Health Care (PHC), especially in the management of chronic diseases such as Diabetes Mellitus. This condition represents a public health challenge, requiring continuous monitoring, therapeutic adherence and multidisciplinary support, in which the pharmacist assumes a strategic role. This study aimed to evaluate the pharmaceutical care offered to patients with diabetes in the PHC of Fortaleza/CE, through the description and analysis of the clinical services provided by pharmacists. This is a research with quantitative and qualitative approaches, carried out in the pharmacies of the Primary Health Care Units of the city of Fortaleza/CE, distributed in six health regions. The integrative review, aimed at monitoring the quality of the services and practices analyzed, was conducted in five scientific databases (PubMed, SCOPUS, Web of Science, CINAHL and LILACS), resulting in the identification of 11 studies, from which 23 quality indicators were extracted. After a consensus workshop with experts, a final matrix was developed with 16 indicators validated for their applicability and relevance. The situational diagnosis revealed that, although the structure had availability of inputs and human resources, weaknesses were identified in the physical environment, furniture and information systems. Insufficiency in pharmacovigilance, proper disposal of medicines and educational actions was observed during the process. User satisfaction was associated with factors such as care in regions V (p=0.009) and VI (p=0.002), type of care (p=0.010) and waiting time (p<0.001). Furthermore, it was observed that the greatest satisfaction was related to consultations carried out at an institution in region V (OR[95%CI]=0.21(0.06-0.74)), clinical care (OR[95%CI]=0.32(0.21-0.63)), and waiting time of up to 20 minutes (OR[95%CI]=0.20(0.50- 0.89)). The qualitative stage, with interviews analyzed via IRaMuTeQ, highlighted the appreciation of pharmaceutical care by users and professionals, but also pointed out challenges such as work overload and low integration among PHC professionals. It is concluded that pharmaceutical care in PHC is essential to optimize pharmacotherapy, promote adherence to treatment, and improve clinical outcomes in diabetes. The use of quality indicators, combined with professional training and strengthening of infrastructure, is essential to consolidate a more resolute care model that is integrated into the health system.