Tratamento supervisionado em pacientes portadores de tuberculose utilizando supervisores domiciliares em Vitória, Brasil

Abstract

Objective: To evaluate the use of family members as supervisors of directly observed therapy (DOT) in patients with tuberculosis. Methods: This was a prospective descriptive study involving patients diagnosed with pulmonary tuberculosis. The sample comprised 98 patients. A standardized protocol was implemented in order to train the patient and their families. After the training, the patient was allowed to choose either a family member or a health care worker as a supervisor. Absolute and relative frequencies were used in descriptive data analysis. Results: A family member supervisor was chosen by 94 patients (96%). The cure rate was 99%. The partner was chosen by 49% of the patients, and other family members were chosen by 28%. The heath care team needed to take over DOT in 3% of the cases. Regular attendance at follow-up appointments was 67%. It was observed that 24% of the problems in this DOT model referred to the family supervisor forgetting to administer the medication or to the patient forgetting to take it; 39% of the patients forgot to take the medication for one day, and 31% forgot to take it for two days. There was change of supervisor in 9% of the sample, medication was lost by the patient sometime during treatment in 9%, and patient drug intolerance occurred in 8%. Conclusions: DOT supervised by a family member has proven an effective and low-cost technique. However, compliance is not due to one single factor but to the combination of strategies adopted: bus passes; educational measures and especially the individualized approach.Keywords: Directly observed therapy; Tuberculosis; Patient compliance. ResumoObjetivo: Avaliar a utilização de supervisores domiciliares para dose supervisionada do tratamento(DOT), em pacientes portadores de tuberculose. Métodos: Trata-se de um estudo descritivo prospectivo com amostra composta por pacientes com diagnóstico de tuberculose pulmonar. Participaram deste estudo 98 pacientes. Um protocolo de capacitação do paciente e sua família foi implementado. Após este treinamento, o paciente poderia escolher entre um supervisor domiciliar e um profissional de saúde. Os métodos de análise descritiva utilizados foram a freqüência absoluta e relativa. Resultados: Um supervisor familiar foi escolhido por 94 pacientes (96%). O percentual de cura foi de 99%. O parceiro foi escolhido por 49% e algum outro familiar o foi por 28% dos pacientes. A equipe de pesquisa precisou assumir o DOT em 3% dos casos. O comparecimento regular para a supervisão foi de 67%. Verificou-se que 24% dos problemas encontrados neste modelo de DOT referiram-se ao esquecimento em administrar ou tomar as medicações, por parte do supervisor e do paciente, respectivamente, sendo que 39% dos pacientes deixaram de tomar a medicação por um dia e 31% esqueceram-se de tomá-la por dois dias durante o tratamento. Houve troca de supervisor em 9% da amostra, perda de medicação pelo paciente em algum momento do tratamento em 9% e intolerância do paciente à medicação em 8%. Conclusões: O DOT supervisionado pelo fa...

Assessment of the effectiveness of a home-based care program for patients coinfected with tuberculosis and human immunodeficiency virus after discharge from a reference hospital in South-Eastern Brazil

“…22 The TB cure rate achieved by this study were higher than the rates obtained by other national surveys with patients coinfected with HIV who achieved TB cure rates below 58.8%. [23][24][25] However, the success rates recorded for both groups of patients in the present study were lower than those observed in previous studies [26][27][28][29][30][31][32] of populations, containing varying percentages of HIV-infected patients, that had been treated under a directly observed therapy (DOT) Home-based care program for patients coinfected with tuberculosis and human immunodefi ciency virus program. Furthermore, the number of patients who attained a cure under either treatment program in the present survey did not reach the 85% standard set by the World Health Organization.…”

Tuberculose: perfil de doentes, fluxo de atendimento e opinião de enfermeiros

“…These flaws result in delayed diagnoses and represent obstacles to program success, and they also favor the risk of TB transmission at the occupational level (31)(32)(33) . Nevertheless, nurses did not report as problematic the centralization of activities or the lack of autonomy of the local units.…”

Diferenças nas características clínicas e epidemiológicas entre os casos notificados por tuberculose na atenção primária e terciária

“…Quanto à escolaridade, os dois grupos se concentraram principalmente no nível de Ensino Fundamental, o que revela o baixo nível de escolaridade dos pacientes estudados, confirmando a tendência secular da doença, cuja incidência é maior em populações mais desfavorecidas (11) . A distribuição dos pacientes nos dois grupos investigados na presente pesquisa, com relação à faixa etária, esteve entre 16 e 59 anos, estando de acordo com outros estudos (11,12) e se assemelhando com a realidade brasileira, em que a TB atinge principalmente a população economicamente ativa (11) , conferindo significado social à doença.…”