Controle Da Tuberculose Em Município Fronteiriço: Análise Da Capacidade Institucional Dos Serviços De Saúde*

Abstract

Objetivo: analisar a Atenção Primária à Saúde quanto ao controle da tuberculose em Foz do Iguaçu, Paraná. Método: estudo transversal, tipo inquérito, com abordagem quantitativa das dimensões de organização da Atenção à Tuberculose, articulação com a comunidade, autocuidado apoiado, suporte à decisão e desenho do sistema de prestação de serviços, envolvendo 105 profissionais da saúde de 14 unidades no período de dezembro de 2013 a janeiro de 2014 e no ano de 2015 com a análise descritiva e de variância Anova. Resultados: evidenciou-se como pior desempenho a dimensão de articulação com a comunidade, classificada como básica, que obteve média 3,2 e desvio-padrão de 1,8. O melhor desempenho referiu-se à dimensão de autocuidado apoiado, classificada como razoável, com média de 6,9 e desvio-padrão de 2,1. Conclusão: foi observada a necessidade de capacitação dos profissionais e observância aos princípios e diretrizes dos programas e políticas de controle da tuberculose na atenção primária à saúde.

Atuação do enfermeiro acerca da tuberculose na Atenção Primária à Saúde: revisão de literatura

“…This approach is not sufficient to offer quality care, to act in promoting and preventing TB and LTBI, and to help reduce the incidence of the disease 24,30 to meet the goals of The End TB Strategy.…”

“…This favors assistance focused on the disease clinic, reflecting the lack of recognition of the importance of educational practices and the absence of actions to prevent the spread of the disease. 30,31 It is worth mentioning that, to ensure quality care, nurses need knowledge about the technical-scientific, administrative and political scope to perform transformations and guarantee TB control. Moreover, it is through complementary training that we seek to overcome gaps in training as well as updating concepts and best practices.…”

“…The factors that lead to this are related to FHS absence and barriers to access health services, such as the opening hours, weaknesses in the reception and prolonged waiting time for consultation. 13,30,35 Obstacles such as lack of physical structure, professional training and lack of specific materials for activities, constitute weaknesses for the effectiveness and quality of educational activities. However, actions in community spaces are effective, as they bring health services closer to the community.…”

“…[36][37] For health education to be effective, professionals must be sensitive to the patients" culture. They must take into account their beliefs, which, associated with lack of knowledge about the disease and treatment, imply a delay in the demand for health services, reflecting in the late diagnosis 30,38,39 ; tracking for investigation of contacts; family participation; and adherence to treatment. 34,38 It is worth mentioning that the community approach in groups is a way to minimize misinformation, mistakes and reduction of stigma 39 .…”

Avaliação dos serviços de atenção primária à saúde na tuberculose

“…17 It is suggested, through these results, that professionals are struggling to assume their role as facilitators of the educational process, harming the promotion of a health education that fosters the autonomy of users, to deal with the healthdisease-care process, a fact that may be related to the persistence of the hegemony of the biomedical model of health care and the conservative (or traditional) and authoritarian posture of practicing health education aimed at patients with TB. 18 The strengthening of the link between the professionals, the SS and the TB patient is encouraged, the production of care in the perspective of co-management through a relationship of trust and sharing of commitments. The link has a close relationship with the care practices, since both promote harmony, exchange of affections and coexistence potentially reconstructive of autonomies.…”