Continuity of care for children and adolescents with Type 1 Diabetes Mellitus during the COVID-19 pandemic
Continuidad de la atención a niños y adolescentes con Diabetes Mellitus tipo 1 durante la pandemia de COVID-19
Continuidade do cuidado a crianças e adolescentes com Diabetes Mellitus Tipo 1 na pandemia de COVID-19
Alyne Lorys Amaral dos Santos; Larissa Karoline Dias da Silva Cassemiro; Letícia Pancieri; Carla Maria Ramos Germano; Regina Aparecida Garcia de Lima; Aline Cristiane Cavicchioli Okido
Abstract
Objective: to analyze continuity of care for children and adolescents with Type 1 Diabetes Mellitus during the COVID-19 pandemic from the perspective of family caregivers and healthcare professionals.
Method: a descriptive and exploratory study with a qualitative approach, guided by the concept of continuity of care from the World Health Organization. It was conducted at a pediatric endocrinology outpatient clinic in the countryside of São Paulo state, involving family caregivers and professionals (physician, nutritionist, and nurse). Data collection was carried out through the application of a sociodemographic characterization tool and a semi-structured interview. The interviews were fully transcribed and analyzed through the process of inductive thematic content analysis.
Results: twenty-one caregivers and three healthcare professionals participated. The interview results were organized around two topics: (1) Interpersonal and longitudinal (dis)continuity, resulting in feelings of insecurity and lack of glycemic control; and (2) Management dis(continuity), with an emphasis on the lack of supplies during the pandemic period.
Final considerations and implication for practice: during the pandemic, the bond between children/adolescents, families, and professionals was weakened, and care demands were not always met in a timely manner, negatively impacting continuity of care.
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Resumo
Objetivo: analisar a continuidade do cuidado a crianças e adolescentes com Diabetes Mellitus Tipo 1 durante a pandemia de COVID-19 na perspectiva de familiares cuidadores e profissionais de saúde.
Método: estudo qualitativo, descritivo e exploratório, que adotou como quadro teórico o conceito de continuidade do cuidado em saúde da Organização Mundial da Saúde. Foi realizado em um ambulatório de endocrinologia pediátrica do interior do estado de São Paulo junto a familiares cuidadores e profissionais (médico, nutricionista e enfermeiro). A coleta de dados se deu mediante aplicação de instrumento de caracterização sociodemográfica e entrevista semiestruturada. As entrevistas foram analisadas segundo o processo de análise de conteúdo do tipo temática indutiva.
Resultados: participaram 21 familiares cuidadores e três profissionais de saúde. Os resultados das entrevistas foram organizados ao redor de dois temas: (1) Des(continuidade) interpessoal e longitudinal, repercutindo no sentimento de insegurança e no descontrole glicêmico; e (2) Des(continuidade) gerencial, com ênfase na falta de insumos durante o período pandêmico.
Considerações finais e implicação para a prática: durante a pandemia, o vínculo entre crianças/adolescentes, familiares e profissionais foi fragilizado, e as demandas de cuidado nem sempre foram atendidas em tempo oportuno, impactando negativamente a continuidade do cuidado.
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Referências
1 International Diabetes Federation. Diabetes atlas. 8ª ed. Bruxelas: IDF; 2021 [citado 2024 fev 20]. Disponível em:
2 Hermes TSV, Viera CS, Rodrigues RM, Toso BRGO, Fonseca LMM. Criança diabética do tipo 1 e o convívio familiar: repercussões no manejo da doença. Saúde Debate. 2018;42(119):927-39.
3 Souza MHDN, Nóbrega VMD, Collet N. Social network of children with cronic disease: knowledge and practice of nursing. Rev Bras Enferm. 2020;73(2):e20180371.
4 Neves ET, Okido ACC, Buboltz FL, Santos RP, Lima RAG. Accessibility of children with special health needs to the health care network. Rev Bras Enferm. 2019;72(Suppl 3):65-71.
5 Elbarbary NS, Santos TJ, Beaufort C, Agwu JC, Calliari LE, Scaramuzza AE. COVID-19 outbreak and pediatric diabetes: perceptions of health care professionals worldwide. Pediatr Diabetes. 2020;21(7):1083-92.
6 Predieri B, Leo F, Candia F, Lucaccioni L, Madeo SF, Pugliese M et al. Glycemic control improvement in Italian children and adolescents with Type 1 Diabetes followed through telemedicine during lockdown due to the COVID-19 pandemic. Front Endocrinol. 2020;11:595735.
7 Negreiros FDD, Araújo ALD, Mattos SM, Moreira TR, Cestari VRF, Silva LMSD et al. Digital technologies in the care of people with diabetes during the COVID-19 pandemic: a scoping review. Rev Esc Enferm USP. 2021;55:e20210295.
8 World Health Organization. Continuity and coordination of care: a practice brief to support implementation of the WHO Framework on integrated people-centred health services. Geneva: World Health Organization; 2018 [citado 2024 fev 20]. Disponível em:
9 Santos MTD, Halberstadt BMK, Trindade CRP, Lima MADS, Aued GK. Continuidade e coordenação do cuidado: interface conceitual e contribuições dos enfermeiros. Rev Esc Enferm USP. 2022;56:e20220100.
10 Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349-57.
11 Silva-Rodrigues FM, Lucca M, Leite ACAB, Alvarenga WA, Nunes MDR, Nascimento LC. Management of chemotherapy-related symptoms in children and adolescents: family caregivers’ perspectives. Rev Esc Enferm USP. 2021;55:e20200484.
12 Minayo MCS. O desafio do conhecimento: pesquisa qualitativa em saúde. 14ª ed. São Paulo: HUCITEC; 2014.
13 Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health. 2019;11(4):589-97.
14 Geranios K, Kagabo R, Kim J. Impact of COVID-19 and socioeconomic status on delayed care and unemployment. Health Equity. 2022;6(1):91-7.
15 Phoswa WN, Khaliq OP. Is pregnancy a risk factor of COVID-19? Eur J Obstet Gynecol Reprod Biol. 2020;252:605-9.
16 Dayal D, Gupta S, Raithatha D, Jayashree M. Missing during COVID-19 lockdown: children with onset of type 1 diabetes. Acta Paediatr. 2020;109(10):2144-46.
17 Lazzerini M, Barbi E, Apicella A, Marchetti F, Cardinale F, Trobiae G. Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet Child Adolesc Health. 2020;4(5):e10-1.
18 Hartmann-Boyce J, Highton P, Rees K, Onakpoya I, Suklan J, Curtis F et al. The impact of the COVID-19 pandemic and associated disruptions in health-care provision on clinical outcomes in people with diabetes: a systematic review. Lancet Diabetes Endocrinol. 2024;12(2):132-48.
19 Duarte V, Mota B, Ferreira S, Costa C, Correia CC. Impact of COVID-19 lockdown on glycemic control in type 1 diabetes. Arch Pediatr. 2022;29(1):27-9.
20 Zucchini S, Scozzarella A, Maltoni G. Multiple influences of the COVID-19 pandemic on children with diabetes: changes in epidemiology, metabolic control and medical care. World J Diabetes. 2023;14(3):198-208.
21 Reed D, Wolfe I, Greenwood J, Lignou S. Accessing healthcare during the COVID-19 pandemic: a qualitative exploration of the experiences of parents and carers of children with chronic illness to inform future policies in times of crisis. BMC Health Serv Res. 2023;23(1):530.
22 Beran D, Perone SA, Perolini MC, Chappuis F, Chopard P, Haller DM et al. Beyond the virus: ensuring continuity of care for people with diabetes during COVID-19. Prim Care Diabetes. 2021;15(1):16-7.
Aceito em:
31/03/2025
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