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| Author(s): |
Maria Amélia Zanon Ponce
Total Authors: 1
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| Document type: | Doctoral Thesis |
| Press: | Ribeirão Preto. |
| Institution: | Universidade de São Paulo (USP). Escola de Enfermagem de Ribeirão Preto (PCARP/BC) |
| Defense date: | 2012-06-27 |
| Examining board members: |
Tereza Cristina Scatena Villa;
Aline Aparecida Monroe;
Antonio Ruffino Netto;
Reinaldo Antonio da Silva Sobrinho;
Silvia Helena Figueiredo Vendramini
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| Advisor: | Tereza Cristina Scatena Villa |
| Abstract | |
The study aimed to analyze the performance of the first health care sought for the diagnosis of TB, in Sao Jose do Rio Preto (2009), according to the patients perception. A descriptive inquiry epidemiological study was conducted, which adopted as methodological framework the components of health services assessment: structure and process. The study included 99 TB patients, aged 18 years and in treatment, interviewed using a questionnaire based on the Primary Care Assessment Tool (PCAT), adapted to assess TB care and that included dimensions of first contact care and access to diagnosis. Data analysis was performed using absolute and relative frequency and indicators development, by ratios and confidence intervals, according to the type of health service sought by the first time when the perception of signs / symptoms, grouped as follows: Primary Health Care (PHC), Emergency Services (ES) and Specialized Services (SS). The epidemiological profile of patients interviewed shows the prevalence of new cases of TB among males, in productive and reproductive age with low income and low education. The main first contact care in the city was the ES. Regarding the structure component, we found that the ES and, especially, the PHC are identified as services closest to the patients home, however, PHC was not accessible, since most of those failed to get a medical appointment within 24 hours. Regarding the process component, there was a low suspicion of TB in the three types of services examined. The greatest proportion of diagnosis exams requirement occurred in SS, followed by PHC. There was a low proportion of referrals to performing sputum smear test, in the three types of services. ES and PHC refer the majority of patients to perform x-ray and medical examinations to another service, especially extrapulmonary cases. TB patients, who sought first the PHC, needed to look for more health services and over 50% of these had a delay in diagnosis. The ES was the one who less diagnosed TB suspect case, and the SS (especially hospitals) showed the best performance, particularly for the diagnosis of extrapulmonary cases. For effective control of this disease, first contact care should be prepared for suspicion and diagnosis, and strategies of reference between the first health care sought and other services need to be developed, building a network of care so that it ensured the continuity of it. (AU) | |