Aline Aparecida Monroe

Envolvimento de equipes da atenção básica à saúde no controle da tuberculose

This study was aimed at analyzing the involvement of Health Primary Care teams in the tuberculosis control actions in the perception of the Tuberculosis Control Program coordinators of nine priority municipalities of the State of São Paulo. It is a qualitative research whose data were collected in June of 2005 through semistructured interviews with nine coordinators. The content thematic modality was used for the analysis of the data. The results pointed out to difficulties in the implementation of the tuberculosis control actions in primary care related to quantitative and qualitative deficiencies of human resources and to a centralized and fragmented view regarding the organization of these actions in the health system. The integration of tuberculosis control activities in primary care is possible provided the system is organized according to primary care principles and a policy of human resources that ensures continuous education and capacity-building of health teams is elaborated/implemented.Este estudo objetivou analisar o envolvimento de equipes da Atencao Basica a Saude nas acoes de controle da tuberculose, ante a percepcao dos coordenadores do Programa de Controle da Tuberculose de nove municipios prioritarios do Estado de Sao Paulo. Trata-se de uma pesquisa qualitativa, cujos dados foram coletados em junho/2005 por meio de entrevista semi-estruturada com nove coordenadores e analisados pela tecnica de analise de conteudo-modalidade tematica. Os resultados apontaram dificuldades para incorporacao das acoes de controle da tuberculose, na atencao basica, relacionadas a debilidade quantitativa e qualitativa de recursos humanos e a visao centralizada e fragmentada da organizacao dessas acoes no sistema de saude. A integracao das atividades de controle da tuberculose na atencao basica sera possivel mediante organizacao do sistema de saude, seguindo os principios da atencao primaria e elaboracao/implementacao de uma politica de recursos humanos que garanta formacao e capacitacao continua das equipes de saude.

A incorporação da busca ativa de sintomáticos respiratórios para o controle da tuberculose na prática do agente comunitário de saúde

Este estudo procurou analisar, sob a percepcao dos enfermeiros supervisores do Programa de Agentes Comunitarios de Saude (PACS), a incorporacao da busca ativa de sintomaticos respiratorios (SR) para o controle da tuberculose em um distrito de saude do municipio de Ribeirao Preto. A populacao estudada constituiu-se de oito enfermeiros/supervisores. Utilizou-se entrevista semi-estruturada como instrumento de coleta de dados. O tratamento dos dados fundamentou-se no metodo de analise de conteudo, elegendo-se duas Unidades Tematicas: 1) a insercao do PACS em Unidades de Saude e suas debilidades, e 2) a relacao entre o PACS e a Unidade de Saude nas acoes de controle da Tuberculose. As debilidades apontadas referem-se ao processo de conformacao e organizacao do PACS: ausencia de discussao sobre a insercao do agente na equipe de saude; ausencia de lideranca municipal do PACS; acumulo de funcoes do enfermeiro supervisor; capacitacao insuficiente dos agentes. Quanto a incorporacao das acoes de controle da tuberculose apontam que a descentralizacao poderia resultar em beneficios para o usuario. Entretanto, julga-se necessario repensar a forma de organizacao dos servicos de saude de modo que seja assumido um conjunto de acoes que avancem para uma nova logica de trabalho.

A atencao primaria a saude na coordenacao das redes de atencao: uma revisao integrativa

Health systems organized in health care networks and coordinated by Primary Health Care can contribute to an improvement in clinical quality with a positive impact on health outcomes and user satisfaction (by improving access and resolubility) and a reduction in the costs of local health systems. Thus, the scope of this paper is to analyze the scientific output about the evidence, potential, challenges and prospects of Primary Health Care in the coordination of Health Care Networks. To achieve this, the integrative review method was selected covering the period between 2000 and 2011. The databases selected were Medline (Medical Literature Analysis and Retrieval System online), Lilacs (Latin American Literature in Health Sciences) and SciELO (Scientific Electronic Library Online). Eighteen articles fulfilled the selection criteria. It was seen that the potential impacts of primary care services supersede the inherent weaknesses. However, the results revealed the need for research with a higher level of classification of the scientific evidence about the role of Primary Healh Care in the coordination of Health Care Networks.

Tratamento supervisionado no controle da tuberculose em uma unidade de saúde de Ribeirão Preto: a percepção do doente

The goal of this study was to analyze the perception of tuberculosis patients under direct observed treatment (DOT) in a District Health Unit in the City of Ribeirao Preto SP. A qualitative analysis was selected as the methodological approach. The study analized 6 tuberculosis patients participating in the Tuberculosis Control Program under the a regimen of supervised treatment. The patients’ medical records, the Epidemiological Form of Disease Notification and semi-structured interviews were used as instruments for data collection. The following were used as guiding questions: “the significance of tuberculosis” and “the supervised treatment in the patient’s life”. The Content Analysis technique Thematic Modality was used for data analysis. The main thematic unit “Supervised treatment in tuberculosis: the patient’s perception” was found from the following meaning units: the focus of ST as a therapeutic action (medication ingestion and the weaknesses and strengths of ST); and the Singularities of patients under supervised treatment (The perception of the disease, Living with the disease, The consequences of ST on the patient’s life). The following were perceived by patients as strengths in the disease and treatment process: the provision of free medication; the availability of other forms of incentive such funding basic alimentation and transportation vouchers; supervision through home visits. These factors were considered responsible for the link between health workers, the patients and their families. The perceived weaknesses of ST were perceived: the surveillance of medication ingestion and the dependence on the visiting hours for medication ingestion. The social actors involved in the treatment, such as the family and the health care team (in the visiting figure), were identified as factors responsible for adherence to the treatment.

Desempenho de serviços de saúde no Tratamento Diretamente Observado no domicílio para controle da tuberculose

Exploratory study of qualitative and quantitative nature that evaluates the performance of the health services in providing DOT in households of a big city in Brazil. For the quantitative analysis, indexes were created to evaluate the optimization of material/human resources and the observation of the medicine ingestion. It was observed that performance of services is influenced by the availability of human/material resources, the internal organization of services and the absence of the ill person in the household. For the qualitative analysis it was used the content analysis, thematic modality. The main factors influencing the performance of the health service were found to be its insufficiency of material and human resources and the ill persons social-cultural and economic context. Concluding, it is necessary permanent managerial, organizational and techno-assistance qualification of the health professionals in the TB control.Exploratory study of qualitative and quantitative nature that evaluates the performance of the health services in providing DOT in households of a big city in Brazil. For the quantitative analysis, indexes were created to evaluate the optimization of material/human resources and the observation of the medicine ingestion. It was observed that performance of services is influenced by the availability of human/material resources, the internal organization of services and the absence of the ill person in the household. For the qualitative analysis it was used the content analysis, thematic modality. The main factors influencing the performance of the health service were found to be its insufficiency ofmaterial and human resources and the ill persons social-cultural and economic context. Concluding, it is necessary permanent managerial, organizational and techno-assistance qualification of the health professionals in the TB control.

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.

Tuberculose no idoso: análise do conceito

O estudo teve como objetivo definir o conceito de tuberculose no idoso, expresso pela literatura existente na decada de 80 e 90. Utilizou-se a analise de conceito, destacando-se os atributos essenciais, eventos antecedentes e consequentes do conceito a ser definido. A tuberculose no idoso e expressa como o recrudescimento de infeccao longamente inativa. O idoso esta mais predisposto a reinfeccao, tanto endogena (mais frequente) como exogena. Dentre os eventos antecedentes, identificou-se a moradia nas instituicoes para idosos como importante fonte de contagio da doenca. Os eventos consequentes mostraram a necessidade de enfoque diferenciado no diagnostico e tratamento da doenca no idoso, devido as carateristicas clinicas especificas que o diferenciam dos adultos jovens. Conclui-se a necessidade de realizar novas indagacoes sobre a analise do conceito desenvolvido, a fim de contribuir na construcao de conhecimentos que subsidiem no diagnostico, tratamento e cuidado do doente idoso.

Tuberculosis patients submitted to supervised treatment. Ribeirão Preto - São Paulo - Brazil. 1998 and 1999

This study presents a survey conducted among 132 Tuberculosis patients submitted to Supervised Treatment between 01/1998 and 12/1999, with a view to describing epidemiological aspects, according to the gender, (final) treatment result and HIV immunology result variables. The number of patients covered by Supervised Treatment rose from 19% to 30%. For each of these years, 64% and 71% of the patients were male, while 89% and 77% evolved towards cure. The rate of abandonment increased from 7% to 10%, while 4% and 10% of the patients died of Tuberculosis. The Tb/HIV co-infection represented 22% and 42% of the cases. The obtained results disclosed a tendency towards the gradual amplification of Supervised Treatment and its implementation implied.This study presents a survey conducted among 132 Tuberculosis patients submitted to Supervised Treatment between 01/1998 and 12/1999, with a view to describing epidemiological aspects, according to the gender, (final) treatment result and HIV immunology result variables. The number of patients covered by Supervised Treatment rose from 19% to 30%. For each of these years, 64% and 71% of the patients were male, while 89% and 77% evolved towards cure. The rate of abandonment increased from 7% to 10%, while 4% and 10% of the patients died of Tuberculosis. The Tb/HIV co-infection represented 22% and 42% of the cases. The obtained results disclosed a tendency towards the gradual amplification of Supervised Treatment and its implementation implied.

Diagnóstico da tuberculose: desempenho do primeiro serviço de saúde procurado em São José do Rio Preto, São Paulo, Brasil

Estudo transversal com objetivo de analisar o desempenho do primeiro servico de saude procurado para o diagnostico da TB pulmonar em Sao Jose do Rio Preto, Sao Paulo, Brasil, em 2009. Foram entrevistados 81 doentes em tratamento. Adotou-se um questionario baseado no Primary Care Assessment Tool, adaptado para atencao a TB, e o referencial de avaliacao dos servicos de saude (estrutura e processo). Os dados foram analisados mediante tecnicas descritivas e analise de correspondencia multipla. O principal servico procurado foi o Pronto Atendimento (UPA) (49,4%) e o que mais diagnosticou os casos de TB foi o hospital (39,5%) e a atencao basica (30,9%). Os servicos especializados apresentaram associacao com o melhor desempenho no diagnostico e a UPA com o pior. A atencao basica associou-se com desempenho intermediario e fragilidades na estrutura. O alcance de uma deteccao eficaz dos casos de TB nas principais portas de entrada perpassa pela melhoria na suspeicao, reforcando a necessidade de investimentos da gestao na capacitacao dos recursos humanos para a identificacao dos sintomaticos respiratorios.

Performance indicators of DOT at home for tuberculosis control in a large city, SP, Brazil

The study had the objective to analyze the performance of the health services that implement the Directly Observed Therapy at home for tuberculosis control. This study analyzed four Tuberculosis Control Programs, referred to as A, B, C, and D, using the following indicators: Resource use; Performance quickness; Monitoring medication administration; Time spent per home visit. Data were collected during visits to 47 patients receiving DOT at home. Resource use was higher in program B (91.3%); program A showed quicker performance (5.8) and more visits during which medication administration was monitored (77.4%); program C had the longest time spent per home visit (14.7 minutes) and program A the shortest (10.4 minutes). The best or worst performance numerically expresses how resources are being used and whether the observation of medication intake is being achieved.The study had the objective to analyze the performance of the health services that implement the Directly Observed Therapy at home for tuberculosis control. This study analyzed four Tuberculosis Control Programs, referred to as A, B, C, and D, using the following indicators: Resource use; Performance quickness; Monitoring medication administration; Time spent per home visit. Data were collected during visits to 47 patients receiving DOT at home. Resource use was higher in program B (91.3%); program A showed quicker performance (5.8) and more visits during which medication administration was monitored (77.4%); program C had the longest time spent per home visit (14.7 minutes) and program A the shortest (10.4 minutes). The best or worst performance numerically expresses how resources are being used and whether the observation of medication intake is being achieved.