Lúcia Marina Scatena

Retardo no diagnóstico da tuberculose em município da tríplice fronteira Brasil, Paraguai e Argentina

OBJETIVO: Identificar os aspectos relacionados aos doentes e aos servicos de saude no retardo do diagnostico da tuberculose. METODOS: Estudo epidemiologico em Foz do Iguacu, Parana, Brasil, realizado em 2009. Utilizou-se o instrumento The Primary Care Assessment Tool adaptado para a avaliacao da atencao a tuberculose. Empregaram-se tambem tecnicas de estatistica descritiva, como analise de frequencia, medidas de posicao (mediana e intervalos interquartis) e odds. RESULTADOS: Houve retardo na busca por servicos de saude entre aqueles na faixa etaria > 60 anos, sexo feminino, baixa escolaridade e conhecimento precario sobre a doenca. As variaveis clinicas caso novo e infeccao por HIV e as variaveis comportamentais uso de cigarros e bebidas alcoolicas nao estiveram relacionadas ao retardo no diagnostico. O tempo para o diagnostico atribuido ao doente e ao servico de saude foi de 30 e 10 dias (mediana), respectivamente. O Pronto Atendimento 24 Horas e a Atencao Primaria a Saude nao foram efetivos para a suspeicao de tuberculose e solicitacao de exames de apoio diagnostico, com alto percentual de encaminhamento para o ambulatorio do Programa de Controle da Tuberculose. CONCLUSOES: A procura pela Atencao Primaria a Saude para o diagnostico resultou em maior tempo ate a descoberta da doenca. O ambulatorio do Programa de Controle da Tubercu lose apresentou desempenho mais efetivo para o diagnostico da tuberculose devido ao preparo da equipe e ao acolhimento ordenado com oferta de exames de apoio diagnostico.

Vínculo doente-profissional de saúde na atenção a pacientes com tuberculose

Objective: To evaluate the effectiveness of health care services in the management of tuberculosis in Ribeirao Preto, SP, during the year of 2007 in promoting interaction between patient and health care professionals. Methods: An adapted questionnaire that contains 10 indicators of interaction was used. The sample consisted of 100 patients with tuberculosis. Results: More than 60% of patients reported they engaged in conversations about other issues besides tuberculosis with their health care professionals. The majority of the sample (90%) reported they have enough time to clarify their questions about the treatment of tuberculosis. More than 50% of patients from each outpatient clinic reported to contact their physician when they were in need for food or transportation voucher. Conclusion: The structure of the delivery of health care by specialized health care teams from the “Programs for Tuberculosis Control” had good indicators of interaction between patient and health care professionals, which may contribute to the identification of patients’ needs and searching for resources to address those needs.

A porta de entrada para o diagnóstico da tuberculose no sistema de saúde de Ribeirão Preto/SP

O primeiro contato do doente de tuberculose (TB) com o sistema de saude se da na porta de entrada, e e fundamental para o acesso ao diagnostico. Objetivou-se identificar e analisar a porta de entrada no sistema de saude de Ribeirao Preto para o diagnostico da TB. Baseou-se em um instrumento do Primary Care Assessment Tool, adaptado para a TB no Brasil. Realizou-se entrevista estruturada com 100 doentes de TB diagnosticados entre Junho de 2006 e Julho de 2007. Destes, 61% chegaram ao local de diagnostico por encaminhamento e apenas 29% se apresentaram espontaneamente; 66% procuraram por servicos de atencao primaria, 34% por servicos de nivel secundario e terciario. Ademais, 89% foram diagnosticados em servicos publicos e destes, 44% foram diagnosticados nos pronto-atendimentos. Alem disso, 88% foram diagnosticados fora de sua area de abrangencia. Apesar dos doentes terem procurado atendimento na atencao primaria e mais proximo de suas residencias, o diagnostico se deu na atencao secundaria e terciaria.

Enfoque familiar e orientação para a comunidade no controle da tuberculose

This study aimed to describe tuberculosis control actions in the context of Family Health Teams, regarding the dimensions family focus and community orientation. A cross-sectional evaluative research was carried out in 2008, with 84 healthcare workers. The Primary Care Assessment Tool was used, validated and adapted to assess tuberculosis care in Brazil. Respondents answered each question according to a pre-determined scale, (Likerts scale) ranging from zero to five. Data were tabulated using the Statistical Package for the Social Sciences software and were analyzed according to frequency and median. In the first dimension, outcomes revealed that 67.9% of health workers evaluate contact cases with diagnostic tests; 63.1% use radiology tests; 64.3% include the household to face the disease; 77.4% identify risk factors; 41.7% interface with other sectors to find solutions for the identified problems. In the second dimension, 73.8% of them perform case search; 40.5% provide inputs for sputum collection; 50% take educational actions in the community; 14.3% recognize social participation in tuberculosis control. Therefore, the efficiency of such services requires taking actions that give special attention to family and community, and the development of skills to create new spaces for professionals to act and to strengthen the interface with other sectors of society.

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.

Interaction between patient and health care professionals in the management of tuberculosis

Objective: To evaluate the effectiveness of health care services in the management of tuberculosis in Ribeirao Preto, SP, during the year of 2007 in promoting interaction between patient and health care professionals. Methods: An adapted questionnaire that contains 10 indicators of interaction was used. The sample consisted of 100 patients with tuberculosis. Results: More than 60% of patients reported they engaged in conversations about other issues besides tuberculosis with their health care professionals. The majority of the sample (90%) reported they have enough time to clarify their questions about the treatment of tuberculosis. More than 50% of patients from each outpatient clinic reported to contact their physician when they were in need for food or transportation voucher. Conclusion: The structure of the delivery of health care by specialized health care teams from the “Programs for Tuberculosis Control” had good indicators of interaction between patient and health care professionals, which may contribute to the identification of patients’ needs and searching for resources to address those needs.

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.

O vínculo na atenção à saúde: revisão sistematizada na literatura, Brasil (1998-2007)

Objective: To review the Brazilian scientific literature on bond in health care. Methods: The review was limited to the period from 1998 to 2007. A literature search was conducted in the LILACS and SciELO databases using the following key words: primary health care, acceptance, tuberculosis (indexed), bond, adhesion, health, basic care, continuity, and abandon (not indexed). Initially 50 publications were selected and categorized. Results: The findings suggest a greater interest on the topic after 2004. There was a predominance of publications on primary health care in journals that value community health. Conclusions: Bond was found to be an important factor in primary health care and led to better understanding of the real problems of the population receiving care in those services. In addition, bond facilitated the interactions between clients and health care professionals.

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.