Desempenho dos servi?os de aten??o prim?ria do munic?pio de Natal/RN para o diagn?stico e controle da tuberculose
| Autor: | Garcia, Maria Concebida da Cunha |
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| Jazyk: | portugalština |
| Rok vydání: | 2012 |
| Předmět: | |
| Zdroj: | Repositório Institucional da UFRNUniversidade Federal do Rio Grande do NorteUFRN. |
| Druh dokumentu: | masterThesis |
| Popis: | Made available in DSpace on 2014-12-17T14:46:51Z (GMT). No. of bitstreams: 1 MariaCCG_DISSERT.pdf: 2302501 bytes, checksum: 97cbbe5d4b5a91a6182b0e5e8c2d02fc (MD5) Previous issue date: 2011-12-08 Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico Tuberculosis (TB) is one of the most important health problems being faced worldwide. In Brazil, the responsibility for the actions of to diagnosis and control of this disease was transferred to the municipalities within the Primary Health Care (PHC), aiming at improvement in epidemiological indicators, requiring reorientation of the practice of family health teams and requiring methodologies to analyze the extent to which components of the PHC are being achieved. Thus, this study aims to analyze the performance of primary care services in the city of Natal-RN for the diagnosis and control of TB, from the perspective of health professionals (doctors and nurses). The study is descriptive, cross-sectional and quantitative. Data collection was conducted from March to July 2011 and involved 121 health professionals working in 52 health units (family health unit, basic health unit and mixed units). The instrument is structured based on the Primary Care Assessment Tool (PCAT), validated and adapted to assess attention to TB in Brazil, and includes questions regarding the Structure and Process components of health services. For quantitative analysis, it was constructed indicators, whose response patterns are followed according to the Likert scale between one and five, which meant the degree of preference relation (or agreement) of the claims. Values between 1 and 3 were considered unsatisfactory for the indicator, between 3 and less than 4, regular, and between 4 and 5, satisfactory. With regard to inputs and equipment, the units had satisfactory condition for form ( = 4.26), consultation ( = 4.02) and basic basket ( = 4.24); regular condition to pot ( = 3.56) and unsatisfactory conditions for transportation tickets ( = 1.50) and sputum smear microscopy ( = 2.42) and X-rays ( = 1.07). In relation to actions, there was satisfactory development for those focused on the individual patient. Actions aimed at the collective level, as the search for respiratory symptoms (RS), monitoring of contacts and guidelines for the community ranged from regular to unsatisfactory ( = 3.16 - = 1.34). With regard to training, 94,2% received training to identify RS. As regards the time for diagnosis, the median time elapsed between the identification of RS and the beginning of treatment it was 22 days. In relation to the difficulties faced by professionals in the diagnosis of TB, 56,2% reported that they are related only to health services, especially for the failure in the rearguard laboratory and in the specialized services reference, the lack of human and material resources and low performing an active search. The professionals perceive the performance of diagnosis and control of TB, permeated with limitations and barriers to organizational and operational character of various sizes, emerging the need for effective coordination of various sectors and key stakeholders of TB care, to adoption of a new intersectoral strategies that aim to increase the responsiveness of the PHC, providing the best performance in service delivery to the user, family and community, and ensuring effective action and resolving the needs of this population group. A tuberculose (TB) ? um dos principais agravos ? sa?de a ser enfrentado em ?mbito global. No Brasil, a responsabilidade pelas a??es de diagn?stico e controle dessa doen?a foi transferida aos munic?pios, no ?mbito da Aten??o Prim?ria ? Sa?de (APS), visando melhorias nos indicadores epidemiol?gicos, impondo reorienta??o da pr?tica das equipes de sa?de da fam?lia e requerendo metodologias que analisem em que medida os componentes da APS est?o sendo alcan?ados. Destarte, este estudo tem o objetivo de analisar o desempenho dos servi?os de APS do Munic?pio de Natal/RN para o diagn?stico e controle da TB, sob a perspectiva dos profissionais de sa?de (m?dicos e enfermeiros). O estudo ? descritivo, de corte transversal e quantitativo. A coleta de dados foi realizada de mar?o a julho de 2011, e envolveu 121 profissionais de sa?de, que atuam em 52 unidades de sa?de (USF, UBS e Unidades Mistas). O instrumento de coleta ? estruturado, baseado no Primary Care Assessment Tool (PCAT), validado e adaptado para avaliar a aten??o ? TB no Brasil, e inclui quest?es referentes aos componentes Estrutura e Processo dos servi?os de sa?de. Para an?lise quantitativa, constru?ram-se indicadores, cujos padr?es de respostas s?o seguidos de acordo com a escala de Likert, entre 1 e 5, que significou 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. No tocante aos insumos e equipamentos, as unidades apresentaram condi??es satisfat?rias, para formul?rio (=4,26), consulta m?dica ( =4,02) e cesta b?sica ( =4,24); condi??o regular para pote ( =3,56); e condi??es insatisfat?rias para vale-transporte ( =1,50), e realiza??o da baciloscopia ( =2,42) e raioX ( =1,07). Em rela??o ?s a??es, observou-se desenvolvimento satisfat?rio para aquelas centradas no indiv?duo doente. As a??es voltadas para o ?mbito coletivo, como a busca de sintom?ticos respirat?rios (SR), controle de comunicantes e orienta??es para comunidade, variaram de regular a insatisfat?rias ( =3,16 - =1,34). Quanto ? capacita??o, 94,2% receberam treinamentos para identificar SR. No que se refere ao tempo para o diagn?stico, a mediana do tempo decorrido entre a identifica??o do SR e o in?cio do tratamento foi de 22 dias. Em rela??o ?s dificuldades enfrentadas pelos profissionais para o diagn?stico da TB, 56,2% referiram que estas est?o relacionadas somente aos servi?os de sa?de, com destaque para defici?ncia na retaguarda laboratorial e na refer?ncia para os servi?os especializados, o d?ficit de recursos humanos e materiais e a baixa realiza??o de busca ativa. Os profissionais percebem o desempenho das a??es de diagn?stico e controle da TB permeados por limita??es e entraves de car?ter organizacional e operacional de diversas dimens?es, emergindo a necessidade de articula??o efetiva dos diversos setores e atores-chave da aten??o ? TB, para ado??o de novas estrat?gias intersetoriais que visem ? amplia??o da capacidade de resposta da APS, promovendo o melhor desempenho na presta??o dos servi?os ao usu?rio, fam?lia e comunidade, e assegurando a??es efetivas e resolutivas ?s necessidades deste grupo populacional. |
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