Desempenho de serviços de saúde no tratamento diretamente observado no domicílio para controle da tuberculose

Abstract

RESUMOEste é um estudo exploratório de natureza quantitativa e qualitativa, que avalia o desempenho dos serviços de saúde na execução do DOT no domicílio em um município de grande porte. Para a análise quantitativa foram construídos indicadores que avaliaram a otimização dos recursos materiais/ humanos e a efetivação da observação da ingestão da medicação. Identificou-se que o desempenho dos serviços é influenciado pela disponibilidade de recursos humanos/ materiais, organização interna dos serviços e ausência do doente no domicílio. Para a análise qualitativa, utilizou-se a técnica de análise de conteúdo, modalidade temática. A Debilidade de recursos materiais e humanos dos serviços de saúde e o Contexto só-cio-cultural e econômico do doente foram identificados como os principais fatores que influenciam no desempenho dos serviços de saúde. Considera-se necessário uma permanente qualificação gerencial, organizativa e técnico-assistencial dos profissionais no controle da TB. DESCRITORESTuberculose. Terapia diretamente observada. Serviços de assistência domiciliar. Avaliação de serviços de saúde. ABSTRACTExploratory 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 person's socialcultural and economic context. Concluding, it is necessary permanent managerial, organizational and techno-assistance qualification of the health professionals in the TB control. KEY WORDSTuberculosis. Directly observed therapy. Home care services. Health services evaluation. RESUMENEstudio exploratorio de tipo cuantitativo y cualitativo, que evalúa el desempeño de los servicios de salud al realizar el DOT en el domicilio en una ciudad grande. Para el análisis cuantitativo fueron construidos indicadores que evalúan la optimización de los recursos materiales/humanos y la observación de la ingestión de los medicamentos. Se identificó que el desempeño es influenciado por la disponibilidad de recursos humanos/materiales, organización interna de los servicios y la ausencia del enfermo en el domicilio. Para el análisis cualitativo, se utilizó la técnica de análisis de contenido por temática. La Debilidad en cuanto a recursos materiales y humanos en los servicios de salud y el Contexto sociocultural y económico del enfermo fueron identificados como principales factores que influyen en el desempeño de los servicios de salud. Es importante una permanente calificación gerenc...

Tuberculose: tratamento supervisionado nas Coordenadorias de Saúde Norte, Oeste e Leste do Município de São Paulo

“…Snacks are offered to the majority of patients and bus passes are offered when they need to have an exam at another health service. The incentives have been adopted by several Brazilian cities to facilitate adherence and are assumed to be an alternative for the establishment of bonds with health professionals (18) . However, the staple food basket seems to generate embarrassing situations: on the one hand, patients need the basket because of their social and economic situation-in general patients are socially and economic excluded; on the other hand, professionals resent not being totally truthful with patients, since they guarantee the benefit but it is not regularly supplied.…”

“…The author of this study states that such practice, […] not being well managed can result in further exclusion of these patients… Another study suggests that the heterogeneity of incentive distribution in the city of São Paulo has negative repercussions on the Brazilian Tuberculosis Control Program (TCP) and that ST cannot depend on arrangements in which only some sub-districts include patients in the program, while others depend on donations (3) . In a study carried out in Ribeirão Preto evaluating the performance of health services in the implementation of DOTS in households, the authors identified the discontinuity of incentives as something that might interfere with adherence (18) .…”

Cuidado ao doente de tuberculose na Estratégia Saúde da Família: percepções de enfermeiras

“…No Brasil, é crescente o número de estudos que tratam da avaliação do desempenho da Atenção Básica à Saúde (ABS) nas ações de controle da TB (6)(7) . Dentre esses, são encontrados aqueles estudos que apontam o enfermeiro como o profissional que mais estabelece vínculo com o doente de TB (8)(9) .…”

Light, camera, tuberculosis: professional actors, supporting weaknesses or vice versa?

“…12 It is essential then get a new professional profile, however, if the formation is not modified since the former institution, there will be no changes in the daily practices, because the reality of SUS transcends the issues management, putting the human resources as a priority theme in the current agenda of health. 13 In research conducted (14) it was noted as serious fragility the difficulty of finding qualified individuals not only in relation to the technical and managerial skills, but above all in terms of interpersonal skills and emotional support to cope with the adversities of the reality of the patient and his family in the home context. It is believed that the insecurity in the qualification of human resources reflects absolutely in the arrangement of services and performance of health teams, preventing recognition of the problems to be faced in the process of assistance to patients with TB.…”

“…For this reason, it is a fact that there is a decrease in commitment and in the availability of articulation with the health team, which is essential for the management of TB control actions. 14 In research conducted in the State of São Paulo "lack and turnover of professionals were identified as obstacles to the Organization of attention to TB in the municipalities." 11:111 The turnover just interfering in efficaciousness ABS services, because the maintenance of qualified teams prevent, sensitized and ready to provide effective assistance to patients (3) .…”