Atenção Primária à Saúde e tuberculose: avaliação dos serviços

Abstract

Introduction:In order to control tuberculosis, the Brazilian Ministry of Health recommends the decentralization of control actions directed to the Primary Health Care, and there are few studies on the performance of the Tuberculosis Control Program in decentralized contexts. Objective: To evaluate the performance of Primary Health Care services in tuberculosis treatment. Methods: This is an evaluative study with cross-sectional approach conducted in 2011. Two hundred and thirty-nine health professionals from Primary Health Care units were interviewed using a structured instrument based on the evaluation reference of the health services quality (structure -process -results). The performance of these services was analyzed applying techniques of descriptive statistics, validation, and construction of indicators and by determining the reduced variable "Z". Results: The indicators "participation of professionals in tuberculosis patients' care" (structure) and "reference and counterreference" (process) had the best evaluations, whereas "professional training" (structure) and "external actions for tuberculosis control" (process) had the worst results. Conclusion: The decentralization of tuberculosis control actions has been taking place in a vertical manner in Primary Health Care. The challenge of controlling tuberculosis involves overcoming constraints related to the engagement, training, and turnover rates among health professionals, which is a coordination between services and monitoring of control actions in Primary Health Care.

Therapeutic itinerary of people with tuberculosis in face with their health needs

“…Although they have occurred vertically and with fragilities in the process, among them the need for articulation between the points of attention and monitoring. 2 In this context, it is recognized the importance of the work of the Family Health Strategy (FHS) teams, which is taken as a legitimate space for implementation of surveillance actions, prevention and control of the disease. As for the actions of flow regulation, there is still little resolution, since the investigation, diagnosis and treatment of the cases of the disease are redirected to specialized care.…”

Avaliação dos serviços de atenção primária à saúde na tuberculose

“…5 Efficiencies were pointed out in E3 regarding the qualification of professionals with worse performance in both BHU and BFHU, and the reference and counter-reference item was the best evaluation indicator. 16 It can be observed that all three studies shared the same process-related weakness related to the training of professionals to perform the activities inherent in TB care.…”

“…The articles were classified as level of evidence: level 1 -systematic reviews or metaanalysis of relevant clinical trials; level 2evidence derived from at least one welldelineated randomized controlled trial; level 3well-delineated clinical trials without randomization; level 4 -well-delineated cohort and case-control studies; level 5 -systematic review of descriptive and qualitative studies; level 6 -evidence derived from a single descriptive or qualitative study and level 7 -opinion of authorities or report of expert committees. 16 The final sample was composed by 12 articles. From these, 67% of the studies (eight) of the PubMed database were extracted; Scopus, 17% (two); 8% (one), CINAHL and 8% (one), from the Web of Science.…”

Nursing in adherence to treatment of tuberculosis and health technologies in the context of primary care

“…3,6 These factors are limiting in the nurses' performance: absence of a computerized system and periodicity in the accomplishment of the DOT; difficulty in articulating team actions and work overload, 6,20 distancing from welfare practices, intensifying bureaucratic/administrative activities, 21 centralized verticalization of control actions under the PHC; professional training and articulation between health care points and strategies for monitoring fragile TB control actions. 22 Other negative aspects that contribute to the non-adherence of the user identified by PHC nurses are: unpreparedness and lack of interest of other staff members, limited time for drug supervision and insufficient number of employees; determinants for quality care and for interaction between professional and person with TB, which has repercussions on the establishment of a link. 6,12,13,17,21 In this scenario, there is also occupational insecurity under the conditions offered by the work environment, it is pointed out that work permeated by situations different from any kind of violence (physical, psychological) demonstrates that the individual vulnerability of the professional in his occupational locus can produce different reactions in the worker, which assumes meaning and endorses the behaviors that will be adopted in the relationship with the patient.…”