Tiemi Arakawa

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.

Barreiras econômicas na acessibilidade ao tratamento da tuberculose em Ribeirão Preto - São Paulo

The objective of this study was to analyze the financial challenges that patients have to deal with to access the Tuberculosis (TB) Care Reference Centers in Ribeirao Preto. Adjustments were made to the Primary Care Assessment (PCAT) and an opinion poll was made with one-hundred patients following treatment and 16 health care professionals working at TB Reference Centers in Ribeirao Preto. Anova, Kruskall Wallis and chi-square tests were used. Most patients were males and most health care professionals were female. Differences were found between Centers C and A, in that Center C (p=0.028) offers a bus pass, and in A (p=0.010) patients paid for their own transportation. The indicator medical appointment in 24 hours showed a satisfactory level. There were disagreements between the reports from patients and health professionals as to the center offering the bus pass. Patients face challenges in their treatment, such as costs with transportation or being late for work, which result in losses in the family income.

Latent Tuberculosis Infection Diagnostic and Treatment Cascade among Contacts in Primary Health Care in a City of Sao Paulo State, Brazil: Cross-Sectional Study.

Background Diagnosis and treatment of latent tuberculosis infection (LTBI) is a tool for global TB control, especially in close contacts. But data is scarce in high burden countries, under field conditions, including data on the benefits of LTBI management. Objective To analyze the LTBI diagnosis and treatment cascade among contacts in primary health care (PHC) services in São José do Rio Preto—SP, Brazil. Methods Cross-sectional design, conducted with contacts of pulmonary TB patients followed in all PHC services. Data was collected from May to September 2014 in the Reporting System for TB cases (TBWEB) and Reporting System for Chemoprophylaxis. Medical records and treatment follow-up forms were reviewed and all the nurses responsible for TB in PHC services were interviewed. Results Among 336 contacts included, 267 (79.4%) were screened for TB or LTBI, according to the presence or not of respiratory symptoms. Among those contacts screened, 140 (52.4%) were symptomatic, 9 (3.4%) had TB disease, 106/221 (48%) had positive TST result, meeting the criteria for LTBI treatment, and 64/106 (60.4%) actually started it. Overall, among 267 screened, only 64 (24%) started LTBI treatment. The completion rates of treatment among the contacts who started it, those with positive TST result and those screened were 56.3% (36/64), 16.3% (36/221) and 13.5% (36/267), respectively. Nurses claimed that asymptomatic TB contacts pay no attention to preventive health care and do not seek medical care as they do not have symptoms of the disease. In reviewing the medical records, high proportions of contacts without evaluation, incomplete assessment, incorrect records of contraindication for LTBI treatment, lack of notes regarding the identification and evaluation of contacts were identified. Conclusions There is a need for better organization of the surveillance and investigation routine for contacts in PHC, considering the reorganization of the work process and the features of the local health system.

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.

Factors associated to clinical learning in nursing students in primary health care: an analytical cross-sectional study

Serrano-Gallardo P, Martínez-Marcos M, Espejo-Matorrales F, Arakawa T, Magnabosco GT, Pinto IC. Factors associated to clinical learning in nursing students in primary health care: an analytical cross-sectional study. Rev. Latino-Am. Enfermagem. 2016;24:e2803. [Access ___ __ ____]; Available in: ____________________. DOI: http://dx.doi.org/10.1590/1518-8345.0327.2803. dia mês ano URL Artigo Original

Evaluation of the performance of Tuberculosis Control Programs in Brazil and Spain: an integrative review of the literature

This is an integrative review of the literature, which sought to locate evidence regarding the evaluation of the performance of tuberculosis control programs in the Brazilian and Spanish contexts. Articles indexed in databases, search directories and virtual libraries produced in Brazil and Spain from 2002 to 2013 were selected. A total of 17 articles (9 Brazilian and 8 Spanish) were included for analysis. The intention was to identify program evaluation concepts, methodologies and indicators for TB control program evaluation in both countries. In the Spanish context, a concern with results-oriented management and the attempt to develop broader indicators for the assessment of a series of health programs, including those related to tuberculosis control, was identified. The Brazilian references showed greater proximity to the classic methods of evaluation research, and a greater variety of objects of study regarding the activities expected in a control program. The findings highlight the complexity of program evaluation activities, which involve multiple and diverse stakeholders, and point to the need for integration of epidemiological and operational indicators in tuberculosis.