Roxana Isabel Cardozo Gonzales

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.

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.

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.

Cobertura do tratamento diretamente observado (DOTS) da Tuberculose no Estado de São Paulo (1998 a 2004)

The Supervised Treatment (ST) in the 36 priority municipalities for TB control of the State of Sao Paulo between 1998 and 2004 was analyzed with the aim of describing the coverage of the DOTS. This exploratory study used information from the State of Sao Paulos Health Secretarys EPI-TB data-base. An instrument of data collection was elaborated and the coverage of the ST was calculated. The data was put in the Excel program. In the municipalities that implemented the ST in 1998, coverage was under 20%. In 1999 half of the municipalities had coverage between 11% and 49%. In 2000, the implementation was 100%, but the maximum coverage was 61%. Between 2001 and 2002 the coverage increased in 69.44% of the municipalities. In 2003, coverage was below of 50% in 22 municipalities. In 2004 there was a trend to increasing coverage in 63.89% of the municipalities.The Supervised Treatment (ST) in the 36 priority municipalities for TB control of the State of São Paulo between 1998 and 2004 was analyzed with the aim of describing the coverage of the DOTS. This exploratory study used information from the State of São Paulos Health Secretarys EPI-TB database. An instrument of data collection was elaborated and the coverage of the ST was calculated. The data was put in the Excel program. In the municipalities that implemented the ST in 1998, coverage was under 20%. In 1999 half of the municipalities had coverage between 11% and 49%. In 2000, the implementation was 100%, but the maximum coverage was 61%. Between 2001 and 2002 the coverage increased in 69.44% of the municipalities. In 2003, coverage was below of 50% in 22 municipalities. In 2004 there was a trend to increasing coverage in 63.89% of the municipalities.

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.

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.

A GERÊNCIA DAS AÇÕES DE CONTROLE DA TUBERCULOSE EM MUNICÍPIOS PRIORITÁRIOS DO INTERIOR PAULISTA

The aim of this study was to analyze tuberculosis control action management in counties in the interior of the Brazilian state of Sao Paulo. Data was collected in June of 2005 through semi-structured interviews with coordinators of Tuberculosis Control Program of seven priority municipalities, and subjected to thematic content analysis. The statements taken pointed out criticisms regarding raising and maintaining financial incentives to support human resources and means of transportation; inadequate and unprepared human resources; unfamiliarity concerning the destination of budget appropriations for Tuberculosis Control and a lack of autonomy in managing such resources; communication and interaction difficulties involving the project managers; a lack of policies prioritizing the disease in the political agenda; prioritization of appeals with political repercussions; and the need for partnerships. We conclude that the Project Coordinators work under pressure, occupying a double transmission position both on a hierarchical level and in environmental relationships, not always disposing of adequate and sufficient resources. DESCRIPTORS: Tuberculosis. Health Services Administration. Primary health care.The aim of this study was to analyze tuberculosis control action management in counties in the interior of the Brazilian state of Sao Paulo. Data was collected in June of 2005 through semi-structured interviews with coordinators of Tuberculosis Control Program of seven priority municipalities, and subjected to thematic content analysis. The statements taken pointed out criticisms regarding raising and maintaining financial incentives to support human resources and means of transportation; inadequate and unprepared human resources; unfamiliarity concerning the destination of budget appropriations for Tuberculosis Control and a lack of autonomy in managing such resources; communication and interaction difficulties involving the project managers; a lack of policies prioritizing the disease in the political agenda; prioritization of appeals with political repercussions; and the need for partnerships. We conclude that the Project Coordinators work under pressure, occupying a double transmission position both on a hierarchical level and in environmental relationships, not always disposing of adequate and sufficient resources. DESCRIPTORS: Tuberculosis. Health Services Administration. Primary health care. GESTION DE PROGRAMAS DE CONTROL DE LA TUBERCULOSIS EN MUNICIPIOS DEL INTERIOR DEL ESTADO DE SAO PAULO RESUMEN: La investigacion tuvo como objetivo analizar la gestion de programas de control de la tuberculosis en municipios del interior del Estado de Sao Paulo. La recoleccion de datos se realizo en junio de 2005, a traves de entrevistas semiestructuradas con los coordinadores del Programa de Control de la Tuberculosis de los siete municipios prioritarios. Para el analisis de los datos se empleo el Analisis de Contenido Tematico. Las encuestas senalaron nudos criticos en la captacion y manutencion de presupuestos para recursos humanos y vehiculos; recursos humanos insuficientes y sin preparo; desconocimiento del destino de los presupuestos asignados al combate a la tuberculosis y falta de autonomia en la gestion de dichos recursos; dificultades de comunicacion e integracion con gestores; falta de priorizacion de la enfermedad en la agenda politica; priorizacion de otras enfermedades con repercusion politica mas visible y necesidad de coparticipacion. Se concluye que los coordinadores trabajan bajo presion; ocupan doble posicion de transmision, tanto en el plan jerarquico como en las relaciones con el ambiente y ni siempre disponen de recursos adecuados y suficientes. DESCRIPTORES: Tuberculosis. Gestion de servicios de sanidad. Atencion primaria de salud.

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.

Indicadores de desempenho do DOT no domicílio para o controle da tuberculose em município de grande porte, SP, Brasil

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.