Beatriz Estuque Scatolin

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.

Accessibility to tuberculosis treatment: assessment of health service performance

El objetivo de este estudio fue analizar la accesibilidad de los pacientes al tratamiento de tuberculosis (TB) en Ribeirao Preto, ciudad del interior del estado de Sao Paulo. Se trata de un estudio de evaluacion de servicios de salud, con abordaje cuantitativo. Fueron entrevistados 100 pacientes que iniciaron el tratamiento de TB entre 2006-2007, utilizando un cuestionario estructurado basado en el Primary Care Assessment Tool (PCAT). Los datos fueron sometidos al analisis de varianza. Fueron observadas evaluaciones positivas en relacion a la accesibilidad organizacional, sin embargo, el desempeno de los servicios de salud fue poco satisfactorio en el ofrecimiento de ayuda de dislocamiento y en la necesidad de la utilizacion de transporte en el traslado hasta la unidad de salud, generando costos indirectos a los pacientes. Los servicios con mayor numero de enfermos atendidos fueron los que presentaban mayor irregularidad en la realizacion de visitas domiciliares, demostrando que la disponibilidad de recursos (humanos, materiales y tiempo) y la organizacion de la atencion pueden influir en la accesibilidad al tratamiento.Descriptores: Tuberculosis; Terapia por Observacion Directa; Evaluacion de Servicios de Salud; Accesibilidad a los Servicios de Salud.The aim of this study was to assess the accessibility of patients to the treatment of tuberculosis in Ribeirão Preto, countryside of São Paulo State. Evaluation study type, with a quantity approach. Interviews with 100 patients initiated on anti-tuberculosis chemotherapy between 2006-2007 were conducted, using a structured questionnaire based on the Primary Care Assessment Tool (PCAT). Data were analyzed through variance analysis. There was a positive feedback regarding to organizational accessibility, however, the performance of health services has been unsatisfactory in providing transportation vouchers and in addressing the need to use transport for displacement to the health unit, resulting in indirect costs to patients. The services with the highest number of patients treated were those with higher irregularity in the conduct of home visits, showing that the availability of resources (human, material and time) and the organization of care may influence the accessibility to treatment.

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.

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.

Tuberculosis diagnosis and performance assessment of the first health service used by patients in São José do Rio Preto, São Paulo State, Brazil

This cross-sectional study aimed to analyze the first health service to which patients turned for tuberculosis diagnosis in São José do Rio Preto, São Paulo, Brazil, 2009. Eighty-one patients in treatment were interviewed with a questionnaire based on the Primary Care Assessment Tool adapted to TB care and used as a reference for health services performance (structure and process). Data analysis used descriptive and multiple correspondence techniques. Nearly half of the patients initially came to emergency care departments (49.4%), and most TB diagnoses were made in hospitals (39.5%) and primary care services (30.9%). Specialized services were associated with the best diagnostic performance, as opposed to emergency departments, with the worst performance. Primary care services were associated with intermediate performance and weaknesses in infrastructure. The reach of effective detection of TB cases in the portals of entry into the health system involves enhanced diagnostic suspicion, thus emphasizing the need for investments in the management of human resources training for the identification of individuals with respiratory symptoms.

Delay in seeking initial care for tuberculosis diagnosis

Estudio descriptivo objetivando analizar el tiempo transcurrido entre la percepcion de los primeros sintomas de tuberculosis (TB) y la busqueda de una primera consulta en servicios de salud, segun caracteristicas de los enfermos de TB en Sao Jose de Rio Preto-SP. Fueron entrevistados 97 enfermos de TB, utilizandose instrumento estructurado. Se identifico atraso del enfermo por la mediana de tiempo entre percepcion de sintomas y busqueda de atencion (>15 dias). Se calculo la razon prevalente para identificar variables relacionadas al atraso. Existio atraso entre: enfermos masculinos, con 18 a 29 y 50 a 59 anos, baja escolarizacion, mayor renta familiar, casos pulmonares, no coinfectados con HIV, sintomas debiles, consumidores de alcohol y tabaco, sin control sanitario preventivo, buscando servicio de salud proximo al domicilio. El reconocimiento del perfil de pacientes buscando atencion es primordial para definir estrategias que favorezcan la utilizacion de los servicios en el momento oportuno.

Atraso na procura pelo primeiro atendimento para o diagnóstico da tuberculose

Estudio descriptivo objetivando analizar el tiempo transcurrido entre la percepcion de los primeros sintomas de tuberculosis (TB) y la busqueda de una primera consulta en servicios de salud, segun caracteristicas de los enfermos de TB en Sao Jose de Rio Preto-SP. Fueron entrevistados 97 enfermos de TB, utilizandose instrumento estructurado. Se identifico atraso del enfermo por la mediana de tiempo entre percepcion de sintomas y busqueda de atencion (>15 dias). Se calculo la razon prevalente para identificar variables relacionadas al atraso. Existio atraso entre: enfermos masculinos, con 18 a 29 y 50 a 59 anos, baja escolarizacion, mayor renta familiar, casos pulmonares, no coinfectados con HIV, sintomas debiles, consumidores de alcohol y tabaco, sin control sanitario preventivo, buscando servicio de salud proximo al domicilio. El reconocimiento del perfil de pacientes buscando atencion es primordial para definir estrategias que favorezcan la utilizacion de los servicios en el momento oportuno.

Acessibilidade ao tratamento de tuberculose: avaliação de desempenho de serviços de saúde

El objetivo de este estudio fue analizar la accesibilidad de los pacientes al tratamiento de tuberculosis (TB) en Ribeirao Preto, ciudad del interior del estado de Sao Paulo. Se trata de un estudio de evaluacion de servicios de salud, con abordaje cuantitativo. Fueron entrevistados 100 pacientes que iniciaron el tratamiento de TB entre 2006-2007, utilizando un cuestionario estructurado basado en el Primary Care Assessment Tool (PCAT). Los datos fueron sometidos al analisis de varianza. Fueron observadas evaluaciones positivas en relacion a la accesibilidad organizacional, sin embargo, el desempeno de los servicios de salud fue poco satisfactorio en el ofrecimiento de ayuda de dislocamiento y en la necesidad de la utilizacion de transporte en el traslado hasta la unidad de salud, generando costos indirectos a los pacientes. Los servicios con mayor numero de enfermos atendidos fueron los que presentaban mayor irregularidad en la realizacion de visitas domiciliares, demostrando que la disponibilidad de recursos (humanos, materiales y tiempo) y la organizacion de la atencion pueden influir en la accesibilidad al tratamiento.Descriptores: Tuberculosis; Terapia por Observacion Directa; Evaluacion de Servicios de Salud; Accesibilidad a los Servicios de Salud.The aim of this study was to assess the accessibility of patients to the treatment of tuberculosis in Ribeirão Preto, countryside of São Paulo State. Evaluation study type, with a quantity approach. Interviews with 100 patients initiated on anti-tuberculosis chemotherapy between 2006-2007 were conducted, using a structured questionnaire based on the Primary Care Assessment Tool (PCAT). Data were analyzed through variance analysis. There was a positive feedback regarding to organizational accessibility, however, the performance of health services has been unsatisfactory in providing transportation vouchers and in addressing the need to use transport for displacement to the health unit, resulting in indirect costs to patients. The services with the highest number of patients treated were those with higher irregularity in the conduct of home visits, showing that the availability of resources (human, material and time) and the organization of care may influence the accessibility to treatment.

Agente Comunitário de Saúde no controle da tuberculose na Atenção Primária à Saúde

RESUMO Objetivo: Avaliar o desempenho do Agente Comunitario de Saude (ACS) no controle da tuberculose (TB) em areas assistidas pela Estrategia Saude da Familia (ESF), sendo estabelecida uma analise comparativa com os ACSs inscritos nas Unidades Basicas de Saude (UBS) tradicionais. Metodos: Estudo transversal, realizado em um municipio prioritario para o controle da TB no Estado de Sao Paulo, com uma amostra minima de 108 ACSs das ESFs e das UBSs. Para a coleta de dados, utilizou-se um instrumento elaborado para a Atencao Primaria a Saude (APS), adaptado para atencao a TB. Resultados: No que concerne as acoes de controle da TB, observou-se que nao houve diferencas com significância estatistica entre o desempenho dos ACSs das unidades da ESF e os inscritos nas UBSs. Conclusao: O estudo evidenciou a fragilidade dos ACSs em incorporar na sua pratica as acoes de controle da TB nas distintas modalidades de APS, apesar do destaque dado a ESF. Descritores: Agentes comunitarios de saude; Tuberculose/prevencao & controle; Atencao primaria a saudeObjective: To evaluate the performance of the Community Health Agent (CHA) in the control of tuberculosis (TB) in areas served by the Family Health Strategy (FHS), which established a comparative analysis with the CHAs enrolled in the traditional Basic Health Units (BHU) . Methods: A cross-sectional study in a priority municipality for TB control in the state of Sao Paulo, with a minimum sample of 108 CHAs of FHSs and the BHUs. For the collection of data, we used an instrument developed for Primary Health Care (PHC), adapted for TB care. Results: With regard to the actions of TB control, it was observed that there were no statistically significant differences between the performance of CHAs, the units of the FHS, and those enrolled in the BHUs. Conclusion: The study highlighted the fragility of CHAs to incorporate into their practice actions to control TB in the distinct modalities of PHC, despite the prominence given to the FHS.

Tuberculosis Control: patient Perception Regarding Orientation for the Community and Community Participation

To evaluate, from the patients perspective, actions of orientation for the community and community participation carried out in tuberculosis control in health services in Ribeirão Preto-SP. This was an evaluative quantitative exploratory study which used part of the Primary Care Assessment Tool, adapted and validated for tuberculosis care, applied through interview, with 100 patients. Indicators of the instrument and analysis of variance were used. The realization of social partnerships for delivery of the sputum pot together with the community, the delivery of the sputum pot to the community by professionals, and the participation of the community to discuss the problem of tuberculosis were identified, 5%, 6% and 5%, respectively. The health services with fewer patients in treatment showed the best indicators. The actions of social partnerships, searching for respiratory symptomatics in the community and community participation in tuberculosis control are poorly incorporated by health services.O objetivo deste estudo foi avaliar, sob a percepcao dos doentes, acoes de orientacao para a comunidade e participacao comunitaria, realizadas no controle da tuberculose em servicos de saude de Ribeirao Preto, SP. E pesquisa avaliativa quantitativa exploratoria que utilizou parte do Primary Care Assessment Tool, adaptado e validado para atencao a tuberculose, aplicado por meio de entrevista a 100 doentes. Utilizaram-se indicadores do instrumento e analise de variância. Foram identificadas a realizacao de parcerias sociais para entrega do pote para coleta de escarro junto a comunidade, entrega do pote para coleta de escarro na comunidade pelos profissionais e a participacao da comunidade para discutir o problema da tuberculose, 5, 6 e 5% respectivamente. Os servicos de saude com menor numero de doentes em tratamento apresentaram os melhores indicadores. Conclui-se que as acoes de parcerias sociais, busca de sintomaticos respiratorios na comunidade e participacao da comunidade no controle da tuberculose sao pouco incorporadas pelos servicos de saude.