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Previous issue date: 2011-12-09 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / Tuberculosis is a disease of great impact on the world context today. In Brazil, the disease management was directed to the Primary Health Care, due to the determination of the Ministry of Health to decentralize health actions for primary care. Thus, since the actions of diagnosis, treatment and control of the disease should happen in this context, however, there are still many barriers that may hinder the realization of these determinations. This study aims to analyze the development of tuberculosis control activities conducted in the services of primary health care from the patient's vision. This is a descriptive, cross-sectional and quantitative study. The population consists of 517 tuberculosis patients treated in units of Primary Health Care in the city of Natal-RN; the sample consists of 93 TB patients. The collect instrument is structured, based in The Primary Care Assessment Tool (PCAT), validated in Brazil and adapted to assess attention to TB in Brazil, with modifications. This instrument was divided into blocks: the first one describes the socio-demographic information of patients with TB and the second one describes the health services working in control, diagnosis and treatment of TB, and includes issues related to the dimensions of primary care: access, bond, services, coordination of care, guidance to the community and family focus. For quantitative analysis, were built indicators for each item of the instrument. The response patterns are followed according to the Likert scale, which was assigned a value between one and five meant that the degree of preference relation (or agreement) of the statements. Values between 1 and 3 were considered unsatisfactory for the indicator, between 3 and less than 4, regular, and between 4 and 5, satisfactory. The results indicate that 62.37% of patients are male, 27.96% aged 41 to 50 years old, and 34.41% unemployed, with low education and low family income. It was found that the reference hospital services are the front door to the patient (59.14%), and are also the local diagnosis of the disease (72.04%). On access, the conditions satisfactory found are: the number of times the patients need to pick up the health care issue, the marking and the facility to get a consultancy in the HS, assistance provided without harm to the individual's attendance labor and facilities related to the proximity between the residence and services; were considered unsatisfactory conditions related to travel to the HS, and on hours and days of operation of services. As for the cast of services were satisfactory and regular actions related to the request for examination to become viable in the first HS, the availability of pot to perform smear and medicines for the treatment, as well as consultations control and receiving information about the disease and the treatment performed; it is considered unsatisfactory the performance of the home care for patients with TB by the HS that acts as a front door, for implementation of the Directly Observed Treatment (DOT), home visits during treatment, the provision of transportation allowance to the patient and the existence of groups for TB patients. Regarding the coordination of care, resulted in regular the action of referring the patient to other HS to obtain examinations, and as unsatisfactory referral to obtain medications. The relationship bond between patient and health team were considered satisfactory in the majority or regular. As for the family and community focus, is satisfactory only the indicator relating to questions from professionals to the patient about the existence of respiratory symptoms in the family. It is considered that there is need for greater commitment from government entities to the incentives required to TB control, as well as the availability of necessary inputs and training of human resources working in the PHC in the ongoing quest to strengthen primary care, as a place of broader host needs to contact the user with the actions and health professionals. It is recommended the
adoption of management mechanisms possible to expand the capacity of the health PHC, promoting the service delivery to the user and ensuring attention to population health. / A tuberculose (TB) ? uma doen?a de grande repercuss?o no contexto mundial atual. No Brasil, o controle da doen?a foi direcionado para a Aten??o Prim?ria ? Sa?de, em virtude da determina??o do Minist?rio da Sa?de de descentralizar as a??es de sa?de para a Aten??o B?sica. Dessa forma, desde ent?o as a??es de diagn?stico, controle e tratamento da doen?a devem acontecer nesse contexto, por?m, ainda existem muitos entraves que podem dificultar a realiza??o dessas determina??es. Este estudo tem o objetivo analisar o desenvolvimento das a??es de controle de TB desenvolvidas nos servi?os de Aten??o Prim?ria ? Sa?de, a partir da vis?o do doente. O estudo ? descritivo, de corte transversal e quantitativo. A popula??o ? constitu?da por 517 doentes de tuberculose em tratamento nas Unidades de Aten??o Prim?ria ? Sa?de no Munic?pio de Natal/RN; a amostra ? formada por 93 doentes de TB. O instrumento de coleta ? estruturado, baseado no The Primary Care Assessment Tool (PCAT), validado no Brasil e adaptado para avaliar a aten??o ? TB no Brasil, com modifica??es. Tal instrumento foi dividido em blocos: o primeiro correspondeu ?s informa??es sociodemogr?ficas do doente de TB e o segundo ?s a??es de controle, diagn?stico e tratamento de TB nos servi?os de sa?de (SS), e inclui quest?es relacionadas ?s dimens?es da aten??o prim?ria: acesso, v?nculo, elenco de servi?os, coordena??o da aten??o, orienta??o ? comunidade e enfoque na fam?lia. Para an?lise quantitativa, constru?ram-se indicadores para cada item do instrumento. Os padr?es de respostas s?o seguidos de acordo com a escala de Likert, ? qual se atribuiu um valor entre 1 e 5, que significaram o grau de rela??o de prefer?ncia (ou concord?ncia) das afirma??es. Os valores entre 1 e 3 foram considerados insatisfat?rios para o indicador; entre 3 e menores que 4, regulares; e, entre 4 e 5, satisfat?rios. Os resultados indicam que 62,37% dos doentes eram homens, 27,96% com faixa et?ria de 41 a 50 anos, sendo 34,41% desempregados, de baixa escolaridade e baixa renda familiar. Verificou-se que os servi?os hospitalares de refer?ncia s?o a porta de entrada para o doente (59,14%), e tamb?m os locais de diagn?stico da doen?a (72,04%). Sobre o acesso, as condi??es encontradas foram satisfat?rias quanto: ao n?mero de vezes em que precisavam busc?-lo at? o atendimento ao problema de sa?de, ? marca??o e ? facilidade para conseguir consulta no SS, ? realiza??o do atendimento sem preju?zos ao comparecimento do indiv?duo ao trabalho, e ?s facilidades referentes ? proximidade entre a resid?ncia e os servi?os; foram consideradas insatisfat?rias as condi??es relacionadas ao deslocamento at? o SS, e sobre hor?rio e dias de funcionamento dos servi?os. No que se refere ao elenco de servi?os, foram satisfat?rias ou regulares as a??es relacionadas ? solicita??o de exames at? a sua viabiliza??o no primeiro SS, ? disponibiliza??o de pote para realiza??o de baciloscopia e de medicamentos para o tratamento, al?m da realiza??o de consultas de controle e recebimento de informa??es sobre a doen?a e o tratamento realizado; considerou-se insatisfat?rias a realiza??o de atendimento domiciliar ao doente de TB por parte do SS que atua como porta de entrada, a realiza??o do Tratamento Diretamente Observado (TDO), de visitas domiciliares durante o tratamento, de oferta de aux?lio-transporte ao doente e de exist?ncia de grupos para doentes de TB. Em rela??o ? coordena??o da aten??o, resultou em regular a a??o de encaminhamento do doente a outros SS para obten??o de exames; e como insatisfat?rio o encaminhamento para obten??o de medicamentos. J? as rela??es de v?nculo entre doente e equipe de sa?de foram consideradas em sua maioria satisfat?rias ou regulares. Quanto ao enfoque familiar e comunit?rio, foi satisfat?rio apenas o indicador referente aos questionamentos dos profissionais ao doente sobre a exist?ncia de sintom?ticos respirat?rios na fam?lia. Considera-se que h? necessidade de maior compromisso dos agentes governamentais
para com os incentivos obrigat?rios ao controle da TB, assim como da disponibiliza??o dos insumos necess?rios e capacita??o dos recursos humanos que atuam na APS, na cont?nua busca de fortalecimento da aten??o prim?ria, como lugar do mais amplo acolhimento ?s necessidades de contato do usu?rio com as a??es e os profissionais de sa?de. Recomenda-se a ado??o de mecanismos de gest?o poss?veis de ampliar a capacidade resolutiva da APS, promovendo a presta??o dos servi?os ao usu?rio e assegurando a aten??o ? sa?de da popula??o.
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.ufrn.br:123456789/14741 |
| Date | 09 December 2011 |
| Creators | Cirino, Illa Dantas |
| Contributors | CPF:17599750444, http://lattes.cnpq.br/5190926575194616, Enders, Bertha Cruz, CPF:25444816415, http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4781295D6&dataRevisao=null, Miranda, Francisco Arnoldo Nunes de, CPF:04960360330, http://lattes.cnpq.br/9242337504601387, Pinto, ?rika Simone Galv?o, CPF:85208426404, http://lattes.cnpq.br/2135320432342059, Menezes, Rejane Maria Paiva de |
| Publisher | Universidade Federal do Rio Grande do Norte, Programa de P?s-Gradua??o em Enfermagem, UFRN, BR, Assist?ncia ? Sa?de |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Repositório Institucional da UFRN, instname:Universidade Federal do Rio Grande do Norte, instacron:UFRN |
| Rights | info:eu-repo/semantics/openAccess |
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