Avaliação da qualidade de um serviço de assistência oftalmológica da atenção secundária do Sistema Único de Saúde na percepção dos usuários e/ou de seus pais ou responsáveis em uma cidade do Sudoeste da Bahia

Abstract

Vision, as well as the other senses, is fundamental for the maintenance of people’s quality of life. Visual functionality can be ensured by affordable, high-quality eye care services. The objective was to evaluate and characterize the quality of eye care offered in an outpatient service unit of SUS secondary care. In addition, factors associated with low quality levels perceived by users and/or those responsible for the users were identified. A probabilistic sample was estimated for a finite population of 1058 users and/or those responsible for users assisted in an eye service unit in Northeast of Brazil. The following parameters were considered: universe or N=1058; confidence level or standardized score (Z) =1.96; rate ratio (p) = 0.5; and sampling error (e) = 0.05. Of 1058 people consulted from September 1, 2019 to March 31, 2020, 422 were randomly selected, of which only 389 were eligible. Participants were interviewed via telephone. The dependent variable was estimated by the simple additive method considering 12 questions of the Questionnaire of Responsiveness to Eye Care System. Quality scale ranged from 12 to 60, with 12 meaning the highest quality and 60, the lowest quality. Mean, Confidence Interval at 95% and Standard Deviation of this scale were calculated, which was dichotomized considering the upper limit of the confidence interval as the cut-off point. Descriptive analyzes (absolute value and percentage/mean, standard deviation, range, and 95% confidence interval) and bivariate analyzes using the chi-square test were performed. The multiple model considered variables with p-value ≤ 0.20 in the bivariate analysis. Of the 389 eligible people, 378 accepted to participate in the survey, which represents a acceptance rate of 97.17%. Of the 389, 132 were under 18 years of age, therefore, the interview was conducted with the minors accompanied by their parents or guardians. The mean age of the participants was 30.69 years (95% CI = 28.94- 32.44 / SD = 17.55), ranging from 1 to 72 years. The participants’ mean years of schooling was 12.32 years (95% CI = 11.78-12.86 / SD = 4.85), ranging from 1 to 25 years. The average per capita income was R$ 785.94 (95% CI = R$ 699.58–872.30 / SD = 616.18), ranging from 0 to 6,000 reais. The mean score referring to the quality of eye care was 18.37 (95% CI 18.25-18.50 / SD = 1.22), ranging from 14 to 24. Of the 12 questions from the questionnaire, only the question referring to “freedom to choose the eye care provider” was evaluated negatively. All participants evaluated positively the quality of eye care, when considering the mean distribution and SD of the score. However, when considering the cut-off point, 55% of the participants showed lower levels of satisfaction. The lowest levels of satisfaction were associated with males; the age group ≥ 60 years; schooling in years ≥ 12; the self-declared white race; per capita income ≥ one minimum wage; the marital status of married; and self-perception of health as excellent. All participants evaluated the quality of care positively; thus, among those who were satisfied, the factors associated with lower levels of satisfaction were identified. Therefore, these factors must be considered by the managers and providers of eye care services to seek constant improvement of eye health care.