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

Health services in tuberculosis control: family focus and community orientation Servicios de salud para controlar la tuberculosis: enfoque en la familia y orientación para la comunidad Serviços de saúde no controle da tuberculose: enfoque na família e orientação para a comunidade

This study aimed to assess, according to patients' perception, the performance of the Health Services responsible for tuberculosis (TB) control, concerning the dimensions family focus and community orientation. A cross-sectional evaluative research was carried out with 108 TB patients. A questionnaire developed by Starfield and Macinko was used, adapted for TB care by Villa and Ruffino-Netto. Results evidence, in the first dimension, that health professionals (HP) are concerned with patients' signs and symptoms; and, at a lower level, with other health problems of relatives, endangering the comprehensive healthcare. In the second dimension, HP show little concern with the active search of cases, deficiency in HP training, and low rates of examined contacts. Results show the need to broaden HP's epidemiological view, as their attention is focused on patients, with few preventive actions concerning family/community. This evidences the need for a closer relationship among HP/patients/family/community.<br>Se evaluó, bajo la percepción de enfermos, el desempeño de Servicios de Salud responsables por controlar la tuberculosis (TB) en las dimensiones: enfoque en la familia y orientación para la comunidad. Como método, fue utilizada la investigación evaluativa transversal con 108 enfermos de TB. Se utilizó cuestionario de Starfield y Macinko, adaptado para atender la TB por Villa y Ruffino-Netto. Los resultados apuntan que, en la primera dimensión, los profesionales de la salud (PS) demuestran preocupación con señales/síntomas de pacientes y, en menor grado, con otros problemas de salud de familiares, comprometiendo el cuidado completo. En la segunda dimensión, los PS muestran poca preocupación con la búsqueda activa de casos, con la deficiencia de capacitación de PS, y con la baja tasa de contactos examinados. Se concluye que es necesario ampliar la visión epidemiológica de PS, cuya atención está focalizada en el enfermo, con pocas acciones preventivas sobre familia/comunidad, lo que muestra que es imprescindible una mayor aproximación entre PS/enfermos/familiares/comunidad.<br>O objetivo deste estudo foi avaliar, na percepção dos doentes, o desempenho dos Serviços de Saúde responsáveis pelo controle da tuberculose (TB) em relação às dimensões enfoque na família e orientação para a comunidade. Como método, foi usada a pesquisa avaliativa transversal com 108 doentes de TB. Utilizou-se questionário elaborado por Starfield e Macinko, adaptado para a atenção à TB por Villa e Ruffino-Netto. Os resultados apontam que, na primeira dimensão, os profissionais de saúde (PS) demonstram preocupação em relação aos sinais/sintomas dos pacientes e, em menor grau, sobre outros problemas de saúde dos familiares, comprometendo a integralidade do cuidado. Na segunda dimensão, os PS mostram pouca preocupação quanto à busca ativa dos casos, deficiência na capacitação de PS, baixa taxa de contatos examinados. Conclui-se pela necessidade de ampliar a visão epidemiológica dos PS, cuja atenção está focalizada no doente, com poucas ações preventivas sobre a família/comunidade, o que evidencia ser imprescindível maior aproximação entre PS/doentes/familiares/comunidade

Nursing’s role in tuberculosis control: a discussion from the perspective of equity El rol de la enfermería em el control de la tuberculosis: uma discusión desde la perspectiva de la equidad O papel da enfermagem no controle da tuberculose: uma discussão sob a perspectiva da equidade

This paper aims to analyze nurses’ role in tuberculosis control from the perspective of equity in the context of Latin American countries. Tuberculosis is frequently associated with poverty, but many other determinants play an important role in its prevalence. Latin American countries fight against the presence of this illness and nursing professionals play a protagonist role in TB control, proposing comprehensive interventions in different spheres - individuals, families and society. The focus of nursing intervention ranges from public policy proposals, based on epidemiological research, through the establishment of multi-sector programs, to direct care and client education at the operative level. Different professional nursing institutions can play a decisive role in this problem’ integral approach, both in national and international scopes. This requires the establishment of educative, social, technical and politically integrated support networks.<br>El objetivo del presente artículo es analizar el rol de la enfermera en el control de la tuberculosis desde la perspectiva de la equidad, en el ámbito de los países latinoamericanos. La tuberculosis está asociada frecuentemente con la pobreza, pero muchos otros determinantes juegan un rol importante en su prevalencia. Los países latinoamericanos luchan contra la presencia de esta enfermedad y la enfermería juega un rol protagónico en el control de este problema planteando intervenciones integrales en diferentes esferas del individuo, de la familia y de la sociedad. La intervención de enfermería se extiende desde el planteamiento de políticas públicas, basadas en estudios de base epidemiológica, mediante la implementación de programas multisectoriales, hasta la atención directa y la educación de los usuarios en el plan operativo. Las diferentes instituciones profesionales de enfermería pueden desarrollar un papel decisivo en el abordaje integral del problema, no sólo en el ámbito nacional sino también en el internacional, para esto se requiere establecer redes de apoyo con integración educativa, social, técnica y política.<br>O objetivo do presente artigo foi analisar o papel do profissional da enfermagem no controle da tuberculose, sob a perspectiva da equidade, no âmbito dos países da América Latina. A tuberculose está frequentemente associada à pobreza, mas muitos outros determinantes contribuem de modo importante para sua prevalência. Os países sul-americanos lutam contra essa enfermidade e a enfermagem possui papel de protagonista no controle desse problema, reivindicando intervenções integrais, voltadas para as diferentes esferas: individual, familiar e social. A intervenção da enfermagem é enfocada desde o desenho das políticas públicas, com base em estudos epidemiológicos, mediante a implementação de programas multissetoriais, até a assistência direta e a educação dos usuários no plano operativo. Diferentes instituições profissionais da enfermagem podem desenvolver atuação decisiva para a abordagem integral do problema, no âmbito nacional e internacional, devendo, para isso, estabelecer redes de apoio integradas às dimensões educativas, social, técnica e política