Patients' perception regarding the influence of individual and social vulnerabilities on the adherence to tuberculosis treatment: a qualitative study

Background: Tuberculosis remains an important disease which mainly affects the majority of vulnerable individuals in society, who are subjected to poor living conditions and difficulties to access the services of public health. Under these circumstances, the present study aims to understand patients' perception in relation to the influence of individual and social vulnerabilities on the adherence to tuberculosis treatment. Methods: A qualitative descriptive cross sectional study was conducted in one large municipality at the state of Paraiba, Northeast of Brazil. The study subjects, who were residents of the study site, covered all tuberculosis cases diagnosed between March and June 2015. The sample was defined by the criteria of response saturation. All interviews were audio recorded, and data analysis was developed through the hermeneutic dialectic method and the theory of Generative Route Sense. The project was approved by the Research Ethics Committee of the University of Sao Paulo (USP). Results: A total of 13 individuals were interviewed and the responses were identified into two analytical categories: the difficulties they had and the enabling factors they could mention during their tuberculosis treatment. Patients brought up social exclusion as an obstacle to treatment adherence, which, along with stigmatization, weakened their link with family members and health professionals. Moreover, economic precariousness was a major hindrance to the maintenance of a proper diet and transportation access to health centers. However, social support and directly observed treatment helped to break down barriers of prejudice and to promote individual and family empowerment. Finally, patients also reported that their will to live and faith gave them the strength to continue with the treatment. Conclusions: According to patients in this study, social support and the strengthening of links with family members and health professionals may reduce social exclusion and other difficulties they face, thus encouraging them to the adhere to tuberculosis treatment.Univ Estadual Paraiba, Campina Grande, Paraiba, BrazilUniv Fed Rio Grande do Norte, Natal, RN, BrazilUniv Sao Paulo, Escola Enfermagem, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Escola Paulista Enfermagem, Sao Paulo, BrazilFac Santa Maria, Cajazeiras, Paraiba, BrazilUniv Fed Sao Paulo, Escola Paulista Enfermagem, Sao Paulo, BrazilWeb of Scienc

Health services performance for TB treatment in Brazil: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Researches to evaluate Primary Health Care performance in TB control in Brazil show that different cities aggregate local specificities in the dynamics of coping with the disease. This study aims to evaluate health services' performance in TB treatment in cities across different Brazilian regions.</p> <p>Methods</p> <p>This cross-sectional study was conducted in five cities that are considered priorities for TB control in Brazil: Itaboraí (ITA), Ribeirão Preto (RP) and São José do Rio Preto (SJRP) in the Southeast; Campina Grande (CG) and Feira de Santana (FS) in the Northeast. Data were collected through interviews with 514 TB patients under treatment in 2007, using the <it>Primary Care Assessment Tool </it>adapted for TB care in Brazil. Indicators were constructed based on the mean response scores (Likert scale) and compared among the study sites.</p> <p>Results</p> <p>"Access to treatment" was evaluated as satisfactory in the Southeast and regular in the Northeast, which displayed poor results on 'home visits' and 'distance between treatment site and patient's house'. "Bond" was assessed as satisfactory in all cities, with a slightly better performance in RP and SJRP. "Range of services" was rated as regular, with better performance of southeastern cities. 'Health education', 'DOT' and 'food vouchers' were less offered in the Northeast. "Coordination" was evaluated as satisfactory in all cities. "Family focus" was evaluated as satisfactory in RP and SJRP, and regular in the others. 'Professional asking patient's family about other health problems' was evaluated as unsatisfactory, except in RP.</p> <p>Conclusions</p> <p>Two types of obstacles are faced for health service performance in TB treatment in the cities under analysis, mainly in the Northeast. The first is structural and derives from difficulties to access health services and actions. The second is organizational and derives from the way health technologies and services are distributed and integrated. Incentives to improve care organization and management practices, aimed at the integration of primary, secondary and tertiary services, can contribute towards a better performance of health services in TB treatment.</p

Investigação sobre o acesso ao tratamento de tuberculose em Itaboraí/RJ Investigación sobre el acceso al tratamiento de tuberculosis en Itaboraí/RJ Investigation about access to treatment of tuberculosis in Itaborái/RJ

Diante dos problemas apontados na literatura relacionados ao acesso na atenção primária à saúde, o estudo teve como objetivo analisar o acesso ao tratamento do doente com tuberculose em Itaboraí.Um estudo exploratório, quantitativo, com 100 indivíduos entrevistados em agosto e setembro/2007. Utilizou-se o instrumento Primary Care Assessment Tool validado e adaptado para tuberculose. RESULTADOS: 71% sempre conseguem atendimento médico; 54% disseram que o profissional que acompanha seu tratamento nunca visita em casa; 77% fazem tratamento na unidade mais perto da sua casa; 66% nunca deixam de trabalhar e utilizam transporte motorizado, 62% pagam transporte; 93% relataram que nunca faltou medicamento; 63% relataram que nunca demora mais de 60 minutos para consulta. Aspectos como a visita domiciliar e a distribuição do auxílio transporte devem ser revistos. O atendimento médico, o tratamento próximo à residência, a oferta das medicações e a espera pelo atendimento foram satisfatórios.<br>Dados los problemas descritos en la literatura relacionados con el acceso en la atención primaria de la salud, el estudio trató de examinar el acceso al tratamiento de los pacientes con tuberculosis en Itaboraí. Estudio exploratorio, cuantitativo, con 100 personas entrevistadas en agosto y setiembre/2007. Se utilizó el instrumento Primary Care Assessment Tool validado y adaptado para tuberculosis. El 71% siempre reciben la atención médica, 54% dijeron que el profesional que les acompaña en el tratamiento nunca los ha visitado en casa, 77% realizan el tratamiento en la unidad más cerca de casa, 66% nunca dejan de trabajar y hacen el uso de transporte motorizado, 62% pagan el transporte, 93% informaran que nunca les faltó medicación, 63% dijeron que nunca se necesita más de 60 minutos para consulta. Aspectos como visitas a domicilios y la distribución de la ayuda de transporte deben ser revisados. La atención médica, el tratamiento cerca de casa, la oferta de medicamentos y el tiempo de espera para el atendimiento fueron satisfactorios.<br>Looking for the problems indicated in literature related to the access in primary health care, this study aimed to analyze the access to the treatment of tuberculosis in Itaboraí. It was a quantitative study, with 100 patients interviewed between August and September/2007. A Primary Care Assessment Tool instrument was validated and adapted to tuberculosis and used. RESULTS: 71 % always get medical service in 24 hours; 54 % related that the professional who supervises the treatment never visits their homes; 77 % receive treatment near their homes; 66% never miss the job and use motorized transportations; 62 % spend money for transportation; 93 % reported that never had lack of medications; 63 % reported that never wait more than 60 minutes for attendance. The fact is that some aspects like home visit, distribution of credit to transport needs to be reviewed. The medical service, the treatment near home, the offering of medications and the waiting for attendance was satisfactory

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

Analisar percepções de enfermeiras sobre o controle da tuberculose, segundo o eixo teórico da integralidade em saúde e os conceitos de vínculo e trabalho em equipe. Pesquisa qualitativa que envolveu 13 enfermeiras da Estratégia Saúde da Família de município prioritário da região Metropolitana de João Pessoa, Paraíba, Brasil. As informações foram coletadas mediante grupo focal e analisadas conforme a técnica de análise de conteúdo e modalidade temática. Elementos potencializadores do controle da tuberculose: tratamento supervisionado, medicação gratuita e oferta de insumos. Elementos fragilizadores: rotatividade dos profissionais, retaguarda laboratorial, falta de incentivos para os doentes e ações educativas incipientes. Os elementos que fragilizam o cuidado ao doente de tuberculose, identificados pelos enfermeiros, devem ser refletidos por gestores, profissionais, usuários e formadores, de modo que na prática seja possível redefinir ações de cuidado que fortaleçam o vínculo, a integralidade e o trabalho em equipe