Diabetes: SUS computerization can contribute to disease screening and management – 06/26/2023 – Saúde em Público

Noncommunicable Chronic Diseases (CNCD) are responsible for the death of 3 out of 4 Brazilians annually. With accelerated population aging and the impacts resulting from the Covid-19 pandemic on the health system and the population’s routine, the incidence of these diseases tends to increase, making tackling them an urgent necessity. To confront this scenario, it is essential to strengthen Primary Health Care (PHC), with a special focus on improving the surveillance system for CNCDs and their risk factors. In this context, the expansion of PHC digitization and the integration of user information at all levels of health care emerge as important allies.

In Brazil, Diabetes Mellitus (DM) is one of the CNCDs with the highest incidence. It is a metabolic syndrome resulting from the body’s difficulty in producing insulin, a hormone that regulates glucose in the body. It is no coincidence that the 26th of June is dedicated to raising awareness of diabetes in the country, since Brazil ranks 5th in the incidence of the disease, according to the most recent edition of the IDF Diabetes Atlas. It is estimated that there are 16.8 million adult Brazilians living with diabetes (20 to 79 years old), with one third of them still undiagnosed. In the capitals, in 2021, approximately 8.7% of the population had diabetes and projections indicate that the number of Brazilians with the disease should increase by more than 25% between 2020 and 2025. Risk Factors for Chronic Non-Transmissible Diseases in Times of Pandemic), the incidence of diabetes among Brazilians had a slight worsening after the Covid-19 pandemic.

Inequality in people’s ability to prevent and live with CNCDs is very present, especially in low-income countries. The high cost of medication, the need to adopt specific diets and the difficulty in remaining physically active are problems faced by the population of these countries. Technical Note No. 25, prepared by the Institute for Health Policy Studies (IEPS), pointed out that in Brazil, despite the prevalence of diabetes remaining stable between 2010 and 2020, the incidence of obesity, a risk factor for its development, in capitals increased from 11.8% in 2006 to 21.5% in 2020. Considering the performance of the Unified Health System (SUS), the way to reduce the prevalence of diabetes is to implement the lines of care for CNCDs in Primary Care to Health, that is, assistance flows that guarantee the fulfillment of the real needs of users, moving away from a model that cures diseases, to a model that is capable of predicting risks, outcomes and preventing acute complications. This means offering comprehensive and continuous care, with health promotion measures, disease prevention and management of cases already diagnosed.

According to Panorama IEPS on the subject, in 72% of the cases of diagnosed NCDs, patients only discovered that they were suffering from a chronic condition after the appearance of the first symptoms. Most NCD carriers are not monitored, and, in this scenario, only 10% of diabetics receive requests for glycated hemoglobin tests.

Computerization of Primary Care can ensure more effective surveillance and control of chronic diseases

In order to organize the work according to a care plan, guaranteeing the minimum number of consultations and the performance of preventive exams, it is necessary that the information about these patients is properly registered and shared between the different levels of care. There is little point in caring for people with complications related to diabetes at the specialized hospital and outpatient level, if there is no counter-referral and the sharing of clinical information about these patients with Primary Care, which has the role of continuous monitoring of these patients.

The book “Challenges of the Digital Health Strategy for Brazil 2020-2028”, an IEPS production that will be launched next Wednesday (28/06), shows that in the last three years, there has been an advance in computerization and connectivity in basic health units, as a result of the efforts of the Informatiza APS Program, even in the face of a scenario of territorial inequalities. In 2022, 71.56% of Brazilian municipalities had an Electronic Citizen’s Record (PEC) or their own system implemented, and 49.21% had the PEC fully implemented.

Despite the advances observed, there are still weak points in the computerization expansion process that directly affect the lines of care for CNCDs and other services in the health network. Management changes that lead to the discontinuity of processes and the difficulty of complete integration between the different sources and health information systems are problems that undermine the provision of comprehensive care. Mainly for the effective monitoring of chronic diseases, which depend on information about the patient’s health status being integrated at all levels of the network.

Finally, even if the PHC computerization and the integration between the systems occur, it will not be possible to carry out an active search for patients in the territory or adequately plan the primary care service if there is no production of evidence by the Ministry of Health. Health. This evidence is essential for the coordination of a strategy, at the national level, to control CNCDs. Among the existing strategies for producing evidence, we have Vigitel, a survey that monitors the frequency and distribution of risk and protective factors for chronic noncommunicable diseases and has been running for 16 years. However, in 2020 and 2021, data for this survey were collected with a delay. According to information presented by the Ministry of Health via the Access to Information Law, Vigitel 2022 also suffered delays and adaptations in the collection methodology, compared to previous years, and so far has not been released. So far, the Ministry has yet to hammer out the new research methodology, which was based on the use of landlines.

Therefore, the effective integration of SUS information systems and the continuous surveillance of CNCDs and their risk factors are essential for the effective monitoring and control of diabetes in Brazil.

Julia Pereira is an Institutional Relations Analyst at IEPS. Maria Letícia Machado is the TechSUS Program Manager at IEPS; and Sara Tavares is an IEPS Public Policy Analyst.

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