Validação de conteúdo e pré-teste de indicadores de qualidade do cuidado em população idosa com diabetes mellitus tipo 2

Abstract

Introduction: Chronic Noncommunicable Conditions (CCNTs) represent one of the main challenges in public health today. Among them, diabetes mellitus (DM) stands out due to its high prevalence, significant socioeconomic impact, and association with multiple complications. Although national and international guidelines provide recommendations for DM management, significant variability in the quality of care provided is observed, especially in primary care. Furthermore, there is a lack of indicators and instruments that allow for a comprehensive assessment of the quality of care provided. Objective: To perform content validation and pre-testing of quality of care indicators in an elderly population with diabetes treated in primary care. Methods: The study was conducted in two stages. In the first, content validation of quality of care indicators was performed through a methodological study based on the Delphi Consensus Technique, using the recommendations available in the American Diabetes Association (ADA) Standards of Care in Diabetes. The second stage consisted of a cross-sectional study to pre-test the validated indicators. This phase took place between September 2024 and January 2025, and included 114 participants aged 60 or older, with a medical diagnosis of type 2 diabetes mellitus (T2DM), who were being followed in public pharmacies in a Brazilian municipality. Results: Eight endocrinologists from three regions of Brazil agreed to participate in the expert panel. Of the 48 recommendations evaluated, 35 reached consensus in the first round, with an agreement rate greater than 85%. The remaining items were reassessed in the second round, resulting in the exclusion of four indicators and the final validation of 44. Of the validated indicators, 27 were assessed through private room interviews, while the remaining 17 were analyzed through the participants' electronic medical records. Important gaps were identified in the management of hypoglycemia, vaccination status, and social aspects. Indicators related to behavioral factors were most frequently explored during consultations. Conclusion: The validated indicators demonstrated viability for assessing the quality of care for elderly people with DM and can be applied in excellent care contexts, allowing the identification of aspects that require improvements in assistance to the population.