Abandono de tratamento e recidiva da tuberculose: aspectos de episódios prévios, Campinas, SP, Brasil, 1993-1994

Abstract

OBJETIVO: Os indivíduos que retornam ao tratamento da tuberculose, seja por abandono prévio ou recidiva, têm-se acumulado nas unidades de saúde, trazendo sérias dificuldades aos doentes e aos serviços. Assim, foi estabelecida a seqüência desse retorno e os aspectos de episódios prévios em pacientes readmitidos, avaliando as irregularidades quanto aos aspectos relacionados ao paciente, à medicação e à organização dos serviços. MÉTODOS: Estudo descritivo das características pessoais, de tratamentos prévios e de retomada do tratamento de 108 pacientes na categoria de abandonos prévios e 88 na de recidivas, para a cidade de Campinas, SP, Brasil, nos anos de 1993 e 1994. Na análise estatística, foram utilizados intervalo de confiança de 95% para qui-quadrado com correção de Yates, teste exato de Fisher, e qui-quadrado de Mantel-Haenszel para comparações com estratificação. RESULTADOS: A seqüência do retorno ao tratamento mostrou reiteração do índice de abandono (63%), sendo menor, mas ainda muito elevado, na categoria das recidivas (28,4%). Apenas 34,1% dos recidivantes não apresentaram irregularidades em tratamento prévio. CONCLUSÕES: Elevada proporção de tratamentos reiniciados e tratamentos prévios inadequados pode propiciar resistências medicamentosas. Esforços devem ser dirigidos para melhorar a eficiência das unidades de atendimento ao paciente com tuberculose, pois várias irregularidades são decorrentes de "falência" na rotina dos serviços.

The Reality of Tuberculosis in Brazilian Prisons

“…This information corroborates with the results of a study in the prisons of the State of Espirito Santo [3]. The death from TB usually occurs when there is no diagnosis and treatment, or even related to AIDS patients who abandoned treatment [18].…”

O abandono do tratamento da tuberculose sob a perspectiva dos gerentes de diferentes centros de saúde de Belo Horizonte-MG, Brasil

“…5,[9][10][11][12][13] Treatment abandonment associated with individual problems has already been well described in literature. Research is lacking, however, about health professionals' perception of the dynamics of health services and the way they have confronted the treatment abandonment problem.…”

“…20 Although the interviewed managers did not report this, aspects related to the Health Center/ Service, such as service quality, organization, medication distribution irregularities, precarious attendance, access difficulties and negligence in patient monitoring are reported in literature as possible causes of non-adherence to treatment. [9][10][12][13] Long waiting times at the service discourage return to that service, and perhaps even treatment continuity, mainly among asymptomatic patients. 12 Other factors are related to health professionals, such as non compliance with times, affecting the quality of clinical exams and patient interaction.…”

“…Different studies appoint that drinking is one of the main treatment abandonment factors, as well as drugs use. 5,[9][10][11][12][13][26][27][28] Another factor mentioned was the action of medication side effects and the improvement after the start of treatment: 'I'm gonna throw up The patients' feeling of wellbeing after the initial treatment phase and the occurrence of medi-cation side effects have also been one of the most appointed reasons for abandonment. 5,[12][13]21,26,29 One manager's report is interesting, mentioning that, after explaining that improvement does not mean cure, the patient returned to the treatment, again revealing the importance of the professional's relation with the patient.…”

Representações sociais sobre a tuberculose

“…We believe the investments related to the tuberculosis control have been important, however not enough, considering the development of the disease in Brazil. One of the main sources of this situation is the non-completion of the treatment regimen, with frequent dropouts and inadequate use of drugs possibly linked to the treatment side effects and its long-term effect; to the clinical improvement during the first months of treatment; to difficulties in attendance at health units; to the non-acceptance of the disease; and failures in the tuberculosis control program (3)(4) .…”