Aline Ale Beraldo

Atraso na busca por serviço de saúde para o diagnóstico da tuberculose em Ribeirão Preto (SP)

The scope of this paper is to analyze delays in locating health services for the diagnosis of tuberculosis in Ribeirao Preto in 2009. An epidemiological and cross-sectional study was conducted with 94 TB patients undergoing treatment. A structured questionnaire, based on the Primary Care Assessment Tool adapted for TB care was used. A median (15 days or more) was established to characterize delay in health attendance. Using the Prevalence Ratio, the variables associated with longer delay were identified. The first healthcare services sought were the Emergency Services (ES) (57.5%). The longest period between seeking assistance occurred among males, aged between 50 and 59, who earned less than five minimum wages, had pulmonary TB, were new cases, were not co-infected with TB/HIV, did not consume alcohol, had satisfactory knowledge about TB before diagnosis (with a statistically significant association with delay) and who did not seek healthcare close to home before developing TB. There is a perceived need for training healthcare professionals about the signs and symptoms of the disease, reducing barriers of access to timely diagnosis of TB and widely disseminating it to the community in general.

Validity and reliability of a health care service evaluation instrument for tuberculosis

OBJECTIVE To evaluate the validity and reliability of an instrument that evaluates the structure of primary health care units for the treatment of tuberculosis. METHODS This cross-sectional study used simple random sampling and evaluated 1,037 health care professionals from five Brazilian municipalities (Natal, state of Rio Grande do Norte; Cabedelo, state of Paraíba; Foz do Iguaçu, state of Parana; Sao José do Rio Preto, state of Sao Paulo, and Uberaba, state of Minas Gerais) in 2011. Structural indicators were identified and validated, considering different methods of organization of the health care system in the municipalities of different population sizes. Each structure represented the organization of health care services and contained the resources available for the execution of health care services: physical resources (equipment, consumables, and facilities); human resources (number and qualification); and resources for maintenance of the existing infrastructure and technology (deemed as the organization of health care services). The statistical analyses used in the validation process included reliability analysis, exploratory factor analysis, and confirmatory factor analysis. RESULTS The validation process indicated the retention of five factors, with 85.9% of the total variance explained, internal consistency between 0.6460 and 0.7802, and quality of fit of the confirmatory factor analysis of 0.995 using the goodness-of-fit index. The retained factors comprised five structural indicators: professionals involved in the care of tuberculosis patients, training, access to recording instruments, availability of supplies, and coordination of health care services with other levels of care. Availability of supplies had the best performance and the lowest coefficient of variation among the services evaluated. The indicators of assessment of human resources and coordination with other levels of care had satisfactory performance, but the latter showed the highest coefficient of variation. The performance of the indicators “training” and “access to recording instruments” was inferior to that of other indicators. CONCLUSIONS The instrument showed feasibility of application and potential to assess the structure of primary health care units for the treatment of tuberculosis.

Early diagnosis of tuberculosis in the health services in different regions of Brazil

13 Objetivo: analisar o primeiro contato do doente com os servicos de saude para o diagnostico oportuno da tuberculose (TB), em diferentes regioes do Brasil. Metodo: trata-se de estudo de coorte transversal, em 6 municipios das Regioes Sudeste, Sul e Nordeste. Para a coleta utilizaram-se fontes secundarias e entrevista com os doentes. Os dados foram analisados por meio de tecnicas descritivas e analise fatorial de correspondencia multipla. Resultados: a Atencao Primaria a Saude apresentou maior tempo e menor proporcao de diagnosticos. Os servicos associados ao diagnostico, na primeira consulta, foram os servicos especializados e os Programas de Controle da TB, que oferecem consulta e exames no proprio local. Conclusao: faz-se necessaria a organizacao do trabalho de forma integrada, entre as equipes dos diferentes servicos, para as acoes de controle da TB. Na Atencao Primaria a Saude, e preciso ainda observar o grau de incorporacao e sustentabilidade na execucao dessas acoes a pratica diaria dos servicos.

Atraso no diagnóstico da tuberculose em sistema prisional: a experiência do doente apenado

This study analyzed the causes of delay in the diagnosis of tuberculosis in the prison system, according to the experience of incarcerated patients. The theoretical and methodological framework of the French school of discourse analysis was used, which seeks to comprehend the processes of meaning production, in the relationship of language with ideology and the development of subjects in their positions. Semi-directed interviews were conducted with seven incarcerated tuberculosis patients in a hospital of Joao Pessoa, Paraiba, Brazil, between August and October 2009. The delay in the diagnosis of tuberculosis was related to the naturalization of the lack of care for the prisoner, to the interpretation of the prison as a place of death and suffering and to the deprivation of the right to health for the detainees as a result of their position in the asymmetric power relationships and ideological effects.This study analyzed the causes of delay in the diagnosis of tuberculosis in the prison system, according to the experience of incarcerated patients. The theoretical and methodological framework of the French school of discourse analysis was used, which seeks to comprehend the processes of meaning production, in the relationship of language with ideology and the development of subjects in their positions. Semi-directed interviews were conducted with seven incarcerated tuberculosis patients in a hospital of Joao Pessoa, Paraiba, Brazil, between August and October 2009. The delay in the diagnosis of tuberculosis was related to the naturalization of the lack of care for the prisoner, to the interpretation of the prison as a place of death and suffering and to the deprivation of the right to health for the detainees as a result of their position in the asymmetric power relationships and ideological effects. DESCRIPTORS: Tuberculosis. Prisons. Diagnosis.

Diagnóstico da tuberculose: atenção básica ou pronto atendimento?

OBJECTIVE To assess primary health care and emergency medical services performance for tuberculosis diagnosis. METHODS Cross-sectional study were conducted with 90 health professionals from primary health care and 68 from emergency medical services, in Ribeirao Preto, SP, Southeastern Brazil, in 2009. A structured questionnaire based on an instrument of tuberculosis care assessment was used. The association between health service and the variables of structure and process for tuberculosis diagnosis was assessed by Chi-square test, Fishers exact test (both with 5% of statistical significance) and multiple correspondence analysis. RESULTS Primary health care was associated with the adequate provision of inputs and human resources, as well as with the sputum test request. Emergencial medical services were associated with the availability of X-ray equipment, work overload, human resources turnover, insufficient availability of health professionals, unavailability of sputum collection pots and do not request sputum test. In both services, tuberculosis diagnosis remained as a physicians responsibility. CONCLUSIONS Emergencial medical services presented weaknesses in its structure to identify tuberculosis suspects. Gaps on the process were identified in both primary health care and emergencial medical services. This situation highlights the need for qualification of health services that are the main gateway to health system to meet sector reforms that prioritize the timely diagnosis of tuberculosis and its control.OBJECTIVE : To assess primary health care and emergency medical services performance for tuberculosis diagnosis. METHODS : Cross-sectional study were conducted with 90 health professionals from primary health care and 68 from emergency medical services, in Ribeirao Preto, SP, Southeastern Brazil, in 2009. A structured questionnaire based on an instrument of tuberculosis care assessment was used. The association between health service and the variables of structure and process for tuberculosis diagnosis was assessed by Chi-square test, Fisher’s exact test (both with 5% of statistical significance) and multiple correspondence analysis. RESULTS : Primary health care was associated with the adequate provision of inputs and human resources, as well as with the sputum test request. Emergencial medical services were associated with the availability of X-ray equipment, work overload, human resources turnover, insufficient availability of health professionals, unavailability of sputum collection pots and do not request sputum test. In both services, tuberculosis diagnosis remained as a physician’s responsibility. CONCLUSIONS : Emergencial medical services presented weaknesses in its structure to identify tuberculosis suspects. Gaps on the process were identified in both primary health care and emergencial medical services. This situation highlights the need for qualification of health services that are the main gateway to health system to meet sector reforms that prioritize the timely diagnosis of tuberculosis and its control.

Tuberculosis diagnosis: primary health care or emergency medical services?

OBJECTIVE To assess primary health care and emergency medical services performance for tuberculosis diagnosis. METHODS Cross-sectional study were conducted with 90 health professionals from primary health care and 68 from emergency medical services, in Ribeirao Preto, SP, Southeastern Brazil, in 2009. A structured questionnaire based on an instrument of tuberculosis care assessment was used. The association between health service and the variables of structure and process for tuberculosis diagnosis was assessed by Chi-square test, Fishers exact test (both with 5% of statistical significance) and multiple correspondence analysis. RESULTS Primary health care was associated with the adequate provision of inputs and human resources, as well as with the sputum test request. Emergencial medical services were associated with the availability of X-ray equipment, work overload, human resources turnover, insufficient availability of health professionals, unavailability of sputum collection pots and do not request sputum test. In both services, tuberculosis diagnosis remained as a physicians responsibility. CONCLUSIONS Emergencial medical services presented weaknesses in its structure to identify tuberculosis suspects. Gaps on the process were identified in both primary health care and emergencial medical services. This situation highlights the need for qualification of health services that are the main gateway to health system to meet sector reforms that prioritize the timely diagnosis of tuberculosis and its control.OBJECTIVE : To assess primary health care and emergency medical services performance for tuberculosis diagnosis. METHODS : Cross-sectional study were conducted with 90 health professionals from primary health care and 68 from emergency medical services, in Ribeirao Preto, SP, Southeastern Brazil, in 2009. A structured questionnaire based on an instrument of tuberculosis care assessment was used. The association between health service and the variables of structure and process for tuberculosis diagnosis was assessed by Chi-square test, Fisher’s exact test (both with 5% of statistical significance) and multiple correspondence analysis. RESULTS : Primary health care was associated with the adequate provision of inputs and human resources, as well as with the sputum test request. Emergencial medical services were associated with the availability of X-ray equipment, work overload, human resources turnover, insufficient availability of health professionals, unavailability of sputum collection pots and do not request sputum test. In both services, tuberculosis diagnosis remained as a physician’s responsibility. CONCLUSIONS : Emergencial medical services presented weaknesses in its structure to identify tuberculosis suspects. Gaps on the process were identified in both primary health care and emergencial medical services. This situation highlights the need for qualification of health services that are the main gateway to health system to meet sector reforms that prioritize the timely diagnosis of tuberculosis and its control.

Effectiveness in the diagnosis of tuberculosis in Foz do Iguaçu, the triple-border area of Brazil, Paraguay and Argentina

This study sought to assess the effectiveness of health services in the diagnosis of tuberculosis in Foz do Iguaçu-PR, the triple border region of Brazil, Paraguay, and Argentina. In this epidemiologic, cross-sectional study, 101 persons with tuberculosis were interviewed in 2009 by using an instrument based on the Primary Care Assessment Tool . The analysis was based on proportions and respective 95% confidence intervals (95%) and means. Emergency units (37%) and primary health care units (26%) were the most sought units. Access to medical consultation on the same day reached 70%, but tuberculosis was suspected in less than 47% of patients; bacilloscopy was conducted in 50% of patients. We conclude that although these services provide rapid care, they do not determine the true diagnosis and lead the patient to seek specialized services. Specialty services are more effective in establishing the correct diagnosis. In the triple border region, seeking care at a primary health care unit led to extra time and more returns to the hospital for a tuberculosis diagnosis.Este estudio tuvo como objetivo evaluar la efectividad de los servicios de salud en el diagnostico de la tuberculosis en Foz de Iguazu - Parana. Se realizo una investigacion evaluativa con un diseno epidemiologico transversal. Fueron entrevistados 101 pacientes con tuberculosis en el 2009, utilizando un instrumento basado en la Herramienta de Evaluacion de la Atencion Primaria . El analisis se produjo a partir de proporciones y los respectivos intervalos de confianza (95%) y la mediana. La atencion de emergencia (37%) y la Atencion Primaria de Salud (ABS) (36%) fueron los locales mas buscados. El acceso a la consulta en el mismo dia llego a 70%, pero la sospecha de la enfermedad fue menor que 47%; baciloscopia fue realizada en el 50% de los pacientes. Se concluyo que, si bien estos servicios atienden rapidamente, eso no determino el alcance del diagnostico, llevando al paciente a buscar los Servicios Especializados mas efectivos en la deteccion de los casos. La busqueda de la ABS genero mayor tiempo y numero de retornos para el diagnostico de la tuberculosis en la triple frontera.

Efetividade no diagnóstico da tuberculose em Foz do Iguaçu, tríplice fronteira Brasil, Paraguai e Argentina

This study sought to assess the effectiveness of health services in the diagnosis of tuberculosis in Foz do Iguaçu-PR, the triple border region of Brazil, Paraguay, and Argentina. In this epidemiologic, cross-sectional study, 101 persons with tuberculosis were interviewed in 2009 by using an instrument based on the Primary Care Assessment Tool . The analysis was based on proportions and respective 95% confidence intervals (95%) and means. Emergency units (37%) and primary health care units (26%) were the most sought units. Access to medical consultation on the same day reached 70%, but tuberculosis was suspected in less than 47% of patients; bacilloscopy was conducted in 50% of patients. We conclude that although these services provide rapid care, they do not determine the true diagnosis and lead the patient to seek specialized services. Specialty services are more effective in establishing the correct diagnosis. In the triple border region, seeking care at a primary health care unit led to extra time and more returns to the hospital for a tuberculosis diagnosis.Este estudio tuvo como objetivo evaluar la efectividad de los servicios de salud en el diagnostico de la tuberculosis en Foz de Iguazu - Parana. Se realizo una investigacion evaluativa con un diseno epidemiologico transversal. Fueron entrevistados 101 pacientes con tuberculosis en el 2009, utilizando un instrumento basado en la Herramienta de Evaluacion de la Atencion Primaria . El analisis se produjo a partir de proporciones y los respectivos intervalos de confianza (95%) y la mediana. La atencion de emergencia (37%) y la Atencion Primaria de Salud (ABS) (36%) fueron los locales mas buscados. El acceso a la consulta en el mismo dia llego a 70%, pero la sospecha de la enfermedad fue menor que 47%; baciloscopia fue realizada en el 50% de los pacientes. Se concluyo que, si bien estos servicios atienden rapidamente, eso no determino el alcance del diagnostico, llevando al paciente a buscar los Servicios Especializados mas efectivos en la deteccion de los casos. La busqueda de la ABS genero mayor tiempo y numero de retornos para el diagnostico de la tuberculosis en la triple frontera.

DELAY IN THE DIAGNOSIS OF TUBERCULOSIS IN PRISONS: THE EXPERIENCE OF INCARCERATED PATIENTS

This study analyzed the causes of delay in the diagnosis of tuberculosis in the prison system, according to the experience of incarcerated patients. The theoretical and methodological framework of the French school of discourse analysis was used, which seeks to comprehend the processes of meaning production, in the relationship of language with ideology and the development of subjects in their positions. Semi-directed interviews were conducted with seven incarcerated tuberculosis patients in a hospital of Joao Pessoa, Paraiba, Brazil, between August and October 2009. The delay in the diagnosis of tuberculosis was related to the naturalization of the lack of care for the prisoner, to the interpretation of the prison as a place of death and suffering and to the deprivation of the right to health for the detainees as a result of their position in the asymmetric power relationships and ideological effects.This study analyzed the causes of delay in the diagnosis of tuberculosis in the prison system, according to the experience of incarcerated patients. The theoretical and methodological framework of the French school of discourse analysis was used, which seeks to comprehend the processes of meaning production, in the relationship of language with ideology and the development of subjects in their positions. Semi-directed interviews were conducted with seven incarcerated tuberculosis patients in a hospital of Joao Pessoa, Paraiba, Brazil, between August and October 2009. The delay in the diagnosis of tuberculosis was related to the naturalization of the lack of care for the prisoner, to the interpretation of the prison as a place of death and suffering and to the deprivation of the right to health for the detainees as a result of their position in the asymmetric power relationships and ideological effects. DESCRIPTORS: Tuberculosis. Prisons. Diagnosis.

Atenção Primária à Saúde e tuberculose: avaliação dos serviços

RESUMO: Introducao: Visando controlar a tuberculose, o Ministerio da Saude recomenda a descentralizacao das acoes de controle para a Atencao Primaria a Saude, sendo escassos os estudos acerca do desempenho do Programa de Controle da Tuberculose em contextos descentralizados. Objetivo: Avaliar o desempenho dos servicos da Atencao Primaria a Saude no tratamento da tuberculose. Metodos: Estudo avaliativo, realizado de maneira transversal em 2011. Foram entrevistados 239 profissionais de saude da Atencao Primaria a Saude utilizando um instrumento estruturado com base no referencial de avaliacao da qualidade dos servicos de saude (estrutura, processo e resultado). O desempenho de tais servicos foi analisado mediante tecnicas de estatistica descritiva, validacao e construcao de indicadores e calculo da variavel reduzida Z. Resultados: Os indicadores “participacao de profissionais no atendimento aos pacientes com tuberculose” (estrutura) e “referencia e contrarreferencia” (processo) foram os melhores avaliados, enquanto “capacitacao dos profissionais” (estrutura) e “acoes externas para o controle da tuberculose” (processo) tiveram os piores resultados. Conclusao: A descentralizacao das acoes de controle da tuberculose vem ocorrendo de maneira verticalizada na Atencao Primaria a Saude. O desafio de controlar a tuberculose perpassa pela superacao de fragilidades relacionadas ao envolvimento, a capacitacao e a rotatividade profissional, que e a articulacao entre os pontos de atencao e monitoramento das acoes de controle na Atencao Primaria a Saude.