Abordaje de la enfermedad de Chagas en el primer nivel de atención: investigación cualitativa en una zona endémica de Argentina

Abstract

El objetivo de este estudio fue evaluar la percepción de equipos de salud de atención en primer nivel y público objetivo acerca de facilitadores y barreras para el abordaje de Chagas a partir de una intervención multifacética, en una zona endémica. Se realizaron 12 entrevistas semiestructuradas y grupos focales en Centros de Atención Primaria en Resistencia, Chaco. El estudio fue guiado por el Marco Consolidado para la Investigación de la Implementación. Los profesionales tuvieron una impresión positiva de la intervención pero mostraron preocupación acerca de la factibilidad. Los profesionales perciben un número excesivo de programas, pocos insumos y recursos humanos, insuficiente capacitación, material informativo desactualizado, trabas burocrática para pedido de insumos y medicación; asimismo perciben falta de vinculación en niveles de atención y fragmentación de registros. Esta investigación contribuiría a la adaptación de intervenciones según barreras y facilitadores existentes.

Consolidado Dos Estudos Publicados Pela Coorte Sami-Trop Com Pacientes Portadores De Doença De Chagas

“…O estudo de abordagem qualitativa traz à tona os desafios enfrentados pela equipe médica no manejo da DC em áreas remotas 21 . As reflexões e apontamentos sobre a assistência médica ao paciente com DC na APS, tem sido pouco explorada pela literatura, principalmente considerando abordagem qualitativa 40 .…”

Design and feasibility of an implementation strategy to address Chagas guidelines engagement focused on attending women of childbearing age and children at the primary healthcare level in Argentina: a pilot study

“…The theoretical basis for the development of the strategy included a systematic review of effective strategies for implementing clinical practice guidelines [27], the Platform for the comprehensive care of adults with Chagas disease that improved access to diagnosis and treatment in Bolivia [17], and the Patient-Centered Care Model from Colombia [28]. In addition, the strategy was tailored and adapted through formative research [14].…”

“…Flowcharts were distributed among healthcare staff; distributed material included risk screening tools, a description of procedures for managing people at risk and cases of Chagas disease, and printed reminders to show diagnostic tests and follow-up cases (see Additional files 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10). The team's researchers developed the design of the flowcharts and other support materials based on the national guidelines and adapted them according to the findings obtained in the formative research [14]. PHCs were encouraged to identify medical records of patients at risk and to register positive cases and their cohabitants.…”

“…Despite recommendations, women of childbearing age are not always treated, and children are not diagnosed in time because of several barriers at different levels: lack of access to diagnosis tests, complex diagnosis and treatment processes, lack of a pediatric formulation, inadequate medical training, inaccessible specialized care, drug toxicity, insufficient patient and healthcare provider awareness, and shortages of medication [13][14][15][16]. Chagas disease is integrated into national primary care policy: the national Chagas guideline [9] recommends that patients with T. cruzi infection be managed at the primary healthcare level since this facilitates access to diagnosis, treatment, and follow-up.…”

“…To promote healthcare providers' adherence to national recommendations for a comprehensive approach to Chagas disease in Argentina [9], we designed a multi-component implementation strategy based on elements with proven effectiveness in behavior change [17][18][19][20]. This strategy was adapted after a formative research evaluation aimed at assessing stakeholders' perspectives on the acceptability and feasibility of the proposed implementation [14].…”