[Control and management strategies in multidrug-resistant tuberculosis: literature reviewEstrategias de control y atención de la tuberculosis multirresistente: una revisión de la literatura]. / Estratégias de controle e atenção à tuberculose multirresistente: uma revisão da literatura.

OBJECTIVE: To identify control and patient management strategies for multidrug-resistant tuberculosis (MDR-TB). METHODS: An integrative review of the literature was performed through research in three health databases (LILACS, PubMed and CINAHL) and one multidisciplinary database (Scopus). Original articles published in English, Spanish or Portuguese, from 2006 to 2016, describing strategies to implement MDR-TB patient care, were included. The information collected was organized according to the strategies identified by the investigators, which were grouped into theme categories. RESULTS: Based on a sample of 13 articles, four categories were identified: a) DOTS-plus: reorganization of health services, improvement of local structures, standardization of professional protocols and behaviors, provision of directly observed treatment; b) service decentralization: bringing health professionals closer to patients, especially in areas with high disease burden; c) use of communication tools: software and telephone calls that allowed consultations with specialists and/or optimization of care within multiprofessional teams; d) social protection of patients: establishment of mechanisms to provide emotional, social and/or economic support to patients under treatment, strengthening adherence to drug therapy. CONCLUSIONS: Several strategies were identified beyond pharmacological measures, supporting the idea that the control of MDR-TB requires mechanisms that allow comprehensive care, consistent with the peculiarities and potentialities of the different scenarios where the disease occurs.

OBJETIVO: Identificar estrategias de control de la tuberculosis multirresistente (TBMR) y de atención a los pacientes afectados. MÉTODOS: Se realizó una revisión integrativa de la literatura en tres bases de datos del área de la salud (LILACS, PubMed y CINAHL) y en uma base de datos multidisciplinaria (Scopus). Se seleccionaron artículos originales que registraran las estrategias utilizadas para la atención al paciente con TBMR, publicados en inglés, español o portugués entre 2006 y 2016. Se organizaron los datos de acuerdo a las estrategias de implementación de la TBMR identificadas por los investigadores, que fueron agrupadas en categorías temáticas. RESULTADOS: Con base en una muestra de 13 artículos, se identificaron cuatro categorías: a) DOTS-plus: reorganización de los servicios de salud, mejoramiento de la estructura local, estandarización de protocolos y comportamientos profesionales, administración de tratamiento supervisado; b) descentralización del servicio: aproximación entre profesionales de la salud y pacientes en tratamiento, principalmente en los lugares con alta carga de la enfermedad; c) uso de herramientas de comunicación: programas informáticos y llamadas telefónicas que permitieran la realización de consultas con especialistas o la optimización de la asistencia dentro de los equipos multiprofesionales; d) protección social de los pacientes: creación de mecanismos que proporcionaron apoyo emocional, social o económico a los pacientes en tratamiento, fortaleciendo la adhesión al tratamiento farmacológico. CONCLUSIONES: Se identificaron diversas estrategias que van más allá de los aspectos farmacológicos, lo que corroboró la idea de que el control de la TBMR exige mecanismos que posibiliten una atención integral de acuerdo a las particularidades y potencialidades de los diferentes escenarios donde ocurre la enfermedad.

Detection of tuberculosis: the structure of primary health care. / Detecção da tuberculose: a estrutura da atenção primária à saúde.

OBJECTIVE: To analyze the structure of primary health care for the detection of tuberculosis cases in two municipalities of Rio Grande do Sul. METHOD: Descriptive, evaluative mixed methods research, with direct observation of the physical structure of 69 primary health care units; and semi-structured interviews with 10 subjects. Conducted between 2014 and 2016. Using descriptive statistics and content analysis for data analysis. RESULTS: In the 50 units in Pelotas there was an absence of: pots (24%); forms (53.1%), register books (48%) and of transportation of material to the laboratory (86%). In the 19 units of Sapucaia do Sul, these inputs were available. The absence of professionals, the turnover of human resources and the lack of training, emerged as the main structural deficiencies. CONCLUSION: There are structural differences between municipalities. The study suggests that Pelotas should adopt tuberculosis care coordination.

[Performance of tuberculosis control services in municipalities of Paraná: family centeredness]. / Desempenho dos serviços de controle da tuberculose em municípios do Paraná: enfoque na família.

OBJECTIVE: To analyse and compare the performance of tuberculosis control services from the perspective of healthcare service users in relation to family centeredness. METHODS: A descriptive, quantitative and qualitative study with 89 patients undergoing TB treatment in the 15th regional health district of Paraná. Data were collected from April to June 2012 using semi-structured interviews. The quantitative data were submitted to variance analysis or to the Kruskal-Wallis test and the qualitative data were subjected to content analysis. RESULTS: The quantitative data showed that the health units performed better for the indicators 'healthcare professionals know the people who live with the user' (p = 0.1340) and 'evaluation of family members with specific tests' (p = 0.1430), while the benchmark outpatient units performed better for 'dialogue with family members about tuberculosis' (p = 0.5203) and 'treatment' (p = 0.4788). Analysis of the qualitative data produced two categories: 'family involvement in the treatment of tuberculosis' and 'disconnection of the health service from the family of patients with tuberculosis'. CONCLUSIONS: Healthcare teams should support and guide the families since they provide the care to patients undergoing tuberculosis treatment.

Tuberculosis treatment during the COVID-19 pandemic: actions offered and case profile.

OBJECTIVE: To analyze the association between the provision of tuberculosis treatment actions and the sociodemographic and clinical characteristics of cases during the COVID-19 pandemic. METHOD: Cross-sectional study conducted with data from secondary sources of 134 tuberculosis cases that underwent treatment in 2020 in the city of Pelotas, RS, Brazil. Data were analyzed using descriptive statistics, Chi-square test, and Fisher's exact test. RESULTS: The least frequently offered actions in the period were: three or more control smear microscopies (12.7%), smear microscopy at the end of treatment (16.7%), chest X-ray at sixth month (48.5%) and sputum culture (49%). The number of medical and nursing consultations did not reach six in 52.9% and 83.3% of cases, respectively. The lower offer of treatment actions was associated with: retreatment (p<0.001); comorbidities (p=0.023); HIV infection (p<0.001); mental disorder (p=0.013); illicit substance use (p=0.018); normal chest X-ray (p=0.024); and special treatment regimen (p=0.009). CONCLUSION: After the COVID-19 pandemic, it is essential to invest in cases follow-up, especially those undergoing retreatment, with comorbidities, drug use, normal chest X-ray results, and special treatment regimens.

Primary Health Care and Tuberculosis Detection during the COVID-19 Pandemic: Crucial Actions for Intensifying Efforts.

BACKGROUND: Tuberculosis has been considered a global emergency since 1993, and controlling it has become even more challenging since 2020 due to the health and social crisis resulting from the COVID-19 pandemic. This study aimed to identify the impact of the COVID-19 pandemic on tuberculosis case detection activities within primary health Care in the largest city in Brazil. METHODS: This is a cross-sectional and analytical study on the provision of tuberculosis detection actions in primary healthcare units during the pandemic period. A descriptive analysis was performed for characterization, and Generalized Mixed Models were used for evaluating associations, with a Bonferroni post hoc test applied. RESULTS: The study sample comprised 80 health units in the municipality. There was a moderate alteration level in the provision of consultations for individuals with signs and symptoms of tuberculosis in 2020 (13.8%) and in 2021 (15.1%). Statistical significance (p < 0.05) was found between the pandemic period and detection actions, with a lower alteration level in 2022. CONCLUSIONS: Tuberculosis detection activities underwent changes due to the COVID-19 pandemic, mainly in 2020, which was associated with alterations in consultation and case notification provision.

[The tuberculosis control program in Pelotas/RS, Brazil: home contact investigations]. / O programa de controle da tuberculose em Pelotas/RS, Brasil: investigação de contatos intradomiciliares.

The aim of this study is to evaluate the investigation actions of home contacts of tuberculosis (TB) index cases in the Tuberculosis Control Program (TCP) of Pelotas/RS - Brazil. This cross-sectional descriptive study was based on data from the records of index cases. The sample consisted of 163 contacts of 68 subjects with pulmonary TB in treatment in the TCP between June and August, 2009. These contacts were predominantly female, over 10 years of age and the daughters of index cases. The requested examination was a chest radiography and bacilloscopy. Active TB was found in 1.8 % of contacts. Results show that assistance for TB patients in Pelotas-Brazil, which is centralized in a single specialized service, hinders the investigation of home contacts. Primary care is required to narrow the gap between professionals and the family, and facilitate early diagnosis and interruption of the TB transmission chain in a timely manner.

Level of Trust of the Population in the Unified Health System in the Midst of the COVID-19 Crisis in Brazil.

OBJECTIVE: to assess the level of trust in health services during the COVID-19 pandemic in Brazil. METHODS: A cross-sectional study, carried out between 2020 and 2021, among Brazilians over 18. Nonprobabilistic sampling was used. Descriptive and inferential statistics were applied, using the local bivariate Moran's technique to verify the existence of spatial dependence between the incidence and mortality of COVID-19 and trust in health services. Furthermore, multinomial regression was also used to analyze the factors associated with the confidence level, with the calculation of the odds ratio and with a confidence interval of 95%. RESULTS: A total of 50.6% reported trust in hospital services, while 41.4% did not trust primary health care services. With the application of the local bivariate Moran, both for the incidence and mortality of COVID-19, the trust in tertiary care and primary care services showed a statistically significant spatial association predominant in the Midwest (high-low) and North (low-high) regions of Brazil. The level of trust was associated with education, religion, region of the country and income. CONCLUSIONS: The level of trust in hospital services, more than primary health care services, may be related to the population's culture of prioritizing the search for hospital care at the detriment of health promotion and disease prevention.

Predictors of favorable results in pulmonary tuberculosis treatment (Recife, Pernambuco, Brazil, 2001-2004).

Based on data available in the Information System for Notifiable Diseases, predictive factors of favorable results were identified in the treatment of pulmonary tuberculosis, diagnosed between 2001 and 2004 and living in Recife-PE, Brazil. Uni- and multivariate logistic regression methods were used. In multivariate analysis, the following factors remained: Age (years), 0 to 9 (OR = 4.27; p = 0.001) and 10 to 19 (OR = 1.78; p = 0.011), greater chance of cure than over 60; Education (years), 8 to 11 (OR = 1.52; p = 0.049), greater chance of cure than no education; Type of entry, ne wcase s (OR = 3.31; p < 0.001) and relapse (OR = 3.32; p < 0.001), greater chances of cure than restart after abandonment; Time (months) 2, 5--6 (OR = 9.15; p < 0.001); 6--9 (OR = 27.28; p < 0.001) and More than 9 (OR = 24.78; p < 0.001), greater chances of cure than less than 5; Health Unit District, DSII (OR = 1.60; p = 0.018) and DSIIV (OR = 2.87; p < 0.001), greater chance sof cure than DS II.

Exercise of rights of tuberculosis patients undergoing pharmacological treatment.

OBJECTIVES: to know how people with tuberculosis undergoing treatment exercise their rights throughout daily life while experiencing illness. METHODS: this qualitative study was developed from April to May 2015, with people with tuberculosis undergoing treatment in an outpatient clinic of the Municipal Tuberculosis Control Program in the city of Pelotas. Data were collected through semi-structured interviews and verified by content analysis, under the thematic modality. RESULTS: people announced aspects that involved human rights pertaining to their experiences, and they had difficulties to achieve full rights to dignity, health, social security, and social services. Such rights were neither guaranteed by the State nor by their families. FINAL CONSIDERATIONS: it is necessary for health professionals and services to inform and equip people with tuberculosis, directly or indirectly, for the full exercise of their rights.

Nursing practices centered on individuals with tuberculosis: an interface with democracy.

OBJECTIVE: To analyze whether user-centered nursing practices in TB DOT are being carried out and are contributing to democracy. METHOD: A cross-sectional, exploratory, descriptive study with 123 nurses in three capital cities with high incidence of TB (Manaus-AM, João Pessoa-PB, Porto Alegre-RS) in Brazil. Data were collected from January to June 2014. Descriptive and multiple correspondence analyzes were used. RESULTS: It was identified that the most user-centered care actions had scores below 50%, considered unfavorable to the exercise of democracy. In the analysis of the general user-centered practice score per municipality, Manaus and João Pessoa presented unfavorable results, and the municipality of Porto Alegre was partially favorable. CONCLUSION: The three municipalities need to advance in the implementation of user-centered practices in DOT, because their health system still has difficulties and challenges to overcome.

Tuberculosis: health care and surveillance in prisons.

OBJECTIVE: To identify tuberculosis-related health care and surveillance actions in Prison Health Units. METHOD: Cross-sectional study, of quantitative, exploratory and descriptive character. We visited 13 Teams of Prison Health, and nurses and technicians were interviewed regarding epidemiological surveillance instruments, physical structure and materials. RESULTS: Search for respiratory symptoms in admission was reported by 6 (46.2%) of the teams, and the smear microscopy was the most requested test. The Logbook of Respiratory Symptoms and the Logbook for Monitoring Tuberculosis Cases were used in 7 (53.8%) institutions. Two of them (15.4%) had a location for sputum collection and 1 (7.7%) had a radiographer. The Directly Observed Therapy was reported in 7 (53.8%) units. CONCLUSION: Health care actions related to the search for respiratory symptoms and Directly Observed Therapy should be expanded, as well as surveillance actions and recording in official documents of the National Tuberculosis Control Program.

Tuberculosis treatment during the COVID-19 pandemic: actions offered and case profile / Tratamiento de Tuberculosis durante Pandemia de COVID 19: acciones ofrecidas y perfil de casos / Tratamento da tuberculose durante a pandemia de COVID-19: ações ofertadas e perfil dos casos

ABSTRACT Objective: To analyze the association between the provision of tuberculosis treatment actions and the sociodemographic and clinical characteristics of cases during the COVID-19 pandemic. Method: Cross-sectional study conducted with data from secondary sources of 134 tuberculosis cases that underwent treatment in 2020 in the city of Pelotas, RS, Brazil. Data were analyzed using descriptive statistics, Chi-square test, and Fisher's exact test. Results: The least frequently offered actions in the period were: three or more control smear microscopies (12.7%), smear microscopy at the end of treatment (16.7%), chest X-ray at sixth month (48.5%) and sputum culture (49%). The number of medical and nursing consultations did not reach six in 52.9% and 83.3% of cases, respectively. The lower offer of treatment actions was associated with: retreatment (p<0.001); comorbidities (p=0.023); HIV infection (p<0.001); mental disorder (p=0.013); illicit substance use (p=0.018); normal chest X-ray (p=0.024); and special treatment regimen (p=0.009). Conclusion: After the COVID-19 pandemic, it is essential to invest in cases follow-up, especially those undergoing retreatment, with comorbidities, drug use, normal chest X-ray results, and special treatment regimens.

RESUMEN Objetivo: Analizar la asociación entre la oferta de acciones de tratamiento para tuberculosis con las características sociodemográficas y clínicas de los casos durante la pandemia de COVID-19. Método: Estudio transversal realizado con datos de fuente secundaria de 134 casos de tuberculosis que realizaron tratamiento en 2020 en Pelotas-RS. Los datos fueron analizados por estadística descriptiva, Chi-cuadrado y prueba exacta de Fisher. Resultados: Las acciones ofertadas en el periodo fueron: radiografía de tórax al sexto mes (48,5%), cultivo de esputo (49%), tres o más microscopía de frotis (12,7%) y microscopía al final del tratamiento (16,7%). El número de consultas médicas y de enfermería no alcanzó seis en 52,9% y 83,3% de los casos, respectivamente. La menor oferta de acciones de tratamiento se asoció a: retratamiento (p=0,001); comorbilidades (p=0,023); VIH (p<0,001); trastorno mental (p=0,013); uso de sustancias ilícitas (p=0,018); resultado normal de la radiografía de tórax (p=0,024); y régimen especial de tratamiento farmacológico (p=0,009). Conclusión: Después de la pandemia de COVID-19, es esencial invertir en el seguimiento de los casos, especialmente aquellos en retratamiento, con comorbilidades, radiografía normal y régimen de tratamiento especial.

RESUMO Objetivo: Analisar a associação entre a oferta de ações de tratamento para tuberculose com as características sociodemográficas e clínicas dos casos durante a pandemia da COVID-19. Método: Estudo transversal, realizado com dados de fontes secundárias de 134 casos de tuberculose que realizaram tratamento em 2020 em Pelotas-RS. Os dados foram analisados por estatística descritiva, teste Qui-quadrado e exato de Fisher. Resultados: As ações menos ofertadas no período foram: três ou mais baciloscopia de controle (12,7%), baciloscopia ao final do tratamento (16,7%), radiografia de tórax no sexto mês (48,5%) e cultura de escarro (49%). O número de consultas médicas e de enfermagem não atingiram seis em 52,9% e 83,3% dos casos, respectivamente. A menor oferta de ações de tratamento esteve associada à: retratamento (p<0,001); comorbidades (p=0,023); infecção por HIV (p<0,001); transtorno mental (p=0,013); uso de substâncias ilícitas (p=0,018); imagem de tórax normal (p=0,024); e esquema especial de tratamento (p=0,009). Conclusão: Após a pandemia da COVID-19, é imprescindível investir no acompanhamento dos casos, principalmente daqueles em retratamento, com comorbidades, uso de drogas, radiografia normal e esquema especial de tratamento.

Performance indicators of DOT at home for tuberculosis control in a large city, SP, Brazil.

The study had the objective to analyze the performance of the health services that implement the Directly Observed Therapy at home for tuberculosis control. This study analyzed four Tuberculosis Control Programs, referred to as A, B, C, and D, using the following indicators: Resource use; Performance quickness; Monitoring medication administration; Time spent per home visit. Data were collected during visits to 47 patients receiving DOT at home. Resource use was higher in program B (91.3%); program A showed quicker performance (5.8) and more visits during which medication administration was monitored (77.4%); program C had the longest time spent per home visit (14.7 minutes) and program A the shortest (10.4 minutes). The best or worst performance numerically expresses how resources are being used and whether the observation of medication intake is being achieved.

[The performance of health services in providing DOTs in households to control tuberculosis]. / Desempenho de serviços de saúde no Tratamento Diretamente Observado no domicílio para controle da tuberculose.

Exploratory study of qualitative and quantitative nature that evaluates the performance of the health services in providing DOT in households of a big city in Brazil. For the quantitative analysis, indexes were created to evaluate the optimization of material/human resources and the observation of the medicine ingestion. It was observed that performance of services is influenced by the availability of human/material resources, the internal organization of services and the absence of the ill person in the household. For the qualitative analysis it was used the content analysis, thematic modality. The main factors influencing the performance of the health service were found to be its insufficiency of material and human resources and the ill person's social-cultural and economic context. Concluding, it is necessary permanent managerial, organizational and techno-assistance qualification of the health professionals in the TB control.

[Coverage of directly observed treatment (DOTS) of tuberculosis in the state of São Paulo (1998-2004)]. / Cobertura do tratamento diretamente observado (DOTS) da Tuberculose no Estado de São Paulo (1998 a 2004).

The Supervised Treatment (ST) in the 36 priority municipalities for TB control of the State of São Paulo between 1998 and 2004 was analyzed with the aim of describing the coverage of the DOTS. This exploratory study used information from the State of São Paulo's Health Secretary's EPI-TB database. An instrument of data collection was elaborated and the coverage of the ST was calculated. The data was put in the Excel program. In the municipalities that implemented the ST in 1998, coverage was under 20%. In 1999 half of the municipalities had coverage between 11% and 49%. In 2000, the implementation was 100%, but the maximum coverage was 61%. Between 2001 and 2002 the coverage increased in 69.44% of the municipalities. In 2003, coverage was below of 50% in 22 municipalities. In 2004 there was a trend to increasing coverage in 63.89% of the municipalities.

[Involvement of health primary care teams in the control of tuberculosis]. / Envolvimento de equipes da atenção básica à saúde no controle da tuberculose.

This study was aimed at analyzing the involvement of Health Primary Care teams in the tuberculosis control actions in the perception of the Tuberculosis Control Program coordinators of nine priority municipalities of the State of São Paulo. It is a qualitative research whose data were collected in June of 2005 through semistructured interviews with nine coordinators. The content thematic modality was used for the analysis of the data. The results pointed out to difficulties in the implementation of the tuberculosis control actions in primary care related to quantitative and qualitative deficiencies of human resources and to a centralized and fragmented view regarding the organization of these actions in the health system. The integration of tuberculosis control activities in primary care is possible provided the system is organized according to primary care principles and a policy of human resources that ensures continuous education and capacity-building of health teams is elaborated/implemented.

Detection of tuberculosis: respiratory symptoms flow and results achieved.

OBJECTIVE: to analyze the flow of care to the person with symptoms of tuberculosis and the results achieved in the detection of cases in Primary Health Care units of two municipalities of Rio Grande do Sul. METHOD: descriptive of mixed methods, developed between 2013 and 2016. We used secondary data of 69 units and semi-structured interviews with 10 professionals. Descriptive statistical analysis and content analysis were used. RESULTS: it was observed that the fragmented flow of attention to the respiratory symptoms in Pelotas resulted in low detection of cases by Primary Care, 8.8% of the diagnoses of the municipality. The Sapucaia do Sul flow presents continuity of care, and Primary Care performed 50% of the diagnoses of the municipality. CONCLUSION: the organization of flows by municipal management was instrumental in promoting or limiting the commitment of Primary Health Care teams in coordinating care and consequently in achieving the goals of disease control.

Exiguidade nas estratégias de enfrentamento à tuberculose na atenção primária no Sul do Brasil / Exiguity in strategies to combat tuberculosis in primary care in Southern Brazil / Exigüidaden las estrategias de combate a la tuberculosis en la atención primaria en el Sur de Brasil

Objetivo: descrever as ações de detecção de casos da tuberculose (TB) realizadas pela Atenção Básica de Saúde dos municípios de Uruguaiana, Pelotas e Santa Maria, no estado do Rio Grande do Sul. Método:transversal, quantitativo, realizado com 385 profissionais de saúde, utilizando um questionário estruturado autopreenchido sobre a organização e o planejamento das ações de detecção de sintomáticos respiratórios. Resultados:identificou-se que, em Uruguaiana, cerca de um quarto dos profissionais referem que sua unidade planejou ações de detecção de TB, enquanto a proporção nos demais municípios não alcançou um décimo dos profissionais. Observou-se, que a busca de casos na comunidade, assim como a orientação dos ACS sobre sinais e sintomas da TB foi considerada praticamente inexistente em Santa Maria. Conclusão:apesar dos municípios estudados serem prioritários para o controle da TB, os profissionais da unidade de saúde não são estimulados a manter um olhar diferenciado sobre essa problemática no seu território.

Objective: to describe the actions to detect tuberculosis (TB) cases carried out by Primary Health Care in the municipalities of Uruguaiana, Pelotas and Santa Maria, in the state of Rio Grande do Sul. Method: cross-sectional, quantitative, carried out with 385 health professionals, using a self-administered structured questionnaire on the organization and planning of actions to detect respiratory symptomatics.Results:it was identified that, in Uruguaiana, about a quarter of professionals reportthat their unit planned TB detection actions, while the proportion in the other municipalities did not reach one tenth of professionals. It was observed that the search for cases in the community, as well as the guidance of CHAs on signs and symptoms of TB was considered practically non-existent in Santa Maria. Conclusion:although the municipalities studied are priorities for TB control, health unit professionals are not encouraged to maintain a differentiated look at this problem in their territory.

Objetivo: describir las acciones para detectarcasos de tuberculosis (TB) llevadas a cabo por la Atención Primaria de Salud en los municipios de Uruguaiana, Pelotas y Santa María, en el estado de Rio Grande do Sul.Método: transversal, cuantitativo, realizado con 385 profesionales de la salud, utilizando un cuestionario estructurado autoadministrado sobre la organización y planificación de acciones para detectar la sintomática respiratoria.Resultados: se identificó que, en Uruguaiana, alrededor de una cuarta parte de los profesionales informan que su unidad planeaba acciones de detección de tuberculosis, mientras que la proporción en los otros municipios no llegó a una décima parte de los profesionales. Se observó que la búsqueda de casos en la comunidad, así como la orientación de CHA sobre signos y síntomas de tuberculosis, se consideró prácticamente inexistente en Santa María.Conclusión: aunque los municipios estudiados son prioridades para el control de la tuberculosis, no se alienta a losprofesionales de las unidades de salud a mantener una mirada diferenciada a este problema en su território.

Avaliação da integralidade na atenção primária à saúde de acordo com modelos assistenciais / Evaluación de la integralidad en la atención primaria de salud según modelos de atención / Evaluation of integrality in primary health care according to care models

Objetivo: avaliar o atributo integralidade em serviços de Atenção Primária de uma Coordenadoria Regional de Saúde do Rio Grande do Sul. Método: estudo quantitativo, desenvolvido de fevereiro a junho de 2015, abrangendo 32 municípios, com o Instrumento Primary Care Assessment Tool aplicado aos usuários que avaliaram serviços e ações ofertadas. Foi realizada distribuição relativa e absoluta das variáveis e calculada as medidas de tendência central, bem como a regressão de Poisson para investigar a associação. Resultados: entrevistaram-se 1070 pessoas, o menor Índice de Desenvolvimento Humano Municipal (p≤0,001) esteve associado ao alto escore para serviços prestados (RP=1,73; IC=1,29-2,32) e disponíveis (RP=1,89; IC=1,60-2,24). Para o serviço disponível, o modelo de atenção misto teve escore maior (p=0,001) e, para o serviço prestado, a Estratégia Saúde da Família teve melhor avaliação (p=0,001). Conclusão: as unidades tradicionais têm piores avaliações para o atributo integralidade quando comparadas à Estratégia Saúde da Família e mistas.

Objective: This research aims to evaluate the integrality attribute in Primary Care services of a Regional Health Coordination in Rio Grande do Sul. Method: For this, a quantitative approach method is used, developed from February to June 2015, covering 32 municipalities, based on the Primary Care Assessment Tool, applied to users who evaluated services and actions offered. Relative and absolute distribution of variables was performed and measures of central tendency were calculated, as well as Poisson regression to investigate the association. Results: In short, 1070 people were interviewed. As main results, the following stand out: the lowest Municipal Human Development Index (p=<0.001) was associated with a high score for provided (PR=1.73; CI=1.29-2.32) and available services (PR=1.73; CI=1.29-2.32). =1.89; CI=1.60-2.24). For the service available, the mixed care model had a higher score (p=0.001) and, for the service provided, the Family Health Strategy had a better evaluation (p=0.001). Conclusion: Finally, it is concluded that the traditional units have worse evaluations for the integrality attribute when compared to the Family Health Strategy and mixed ones.

Objetivo: Esta investigación tiene como objetivo evaluar el atributo de integralidad en los servicios de Atención Primaria de una Coordinación Regional de Salud en Rio Grande do Sul. Método: Para ello, se utiliza un método de abordaje cuantitativo, desarrollado de febrero a junio de 2015, que abarca 32 municipios, basado en la Herramienta de Evaluación de Atención Primaria, aplicada a los usuarios que evaluaron los servicios y acciones ofrecidas. Se realizó la distribución relativa y absoluta de las variables y se calcularon las medidas de tendencia central, así como la regresión de Poisson para investigar la asociación. Resultados: se entrevistó a 1070 personas. Como principales resultados, se destacan los siguientes: el Índice de Desarrollo Humano Municipal más bajo (p=<0,001) se asoció con un alto puntaje para el proporcionado (PR=1,73; IC=1,29-2,32) y servicios disponibles (PR=1,73; IC=1,29-2,32). =1,89; IC=1,60-2,24). Para el servicio disponible, el modelo de atención mixta tuvo una puntuación más alta (p=0,001) y, para el servicio prestado, la Estrategia de Salud de la Familia tuvo una mejor evaluación (p=0,001). Conclusión: Finalmente, se concluye que las unidades tradicionales tienen peores evaluaciones para el atributo de integralidad en comparación con la Estrategia de Salud de la Familia y las mixtas.

[Geographical and organizational aspects of primary health care services in detecting tuberculosis cases in Pelotas, Rio Grande do Sul, Brazil, 2012]. / Aspectos geográficos e organizacionais dos serviços de atenção primária à saúde na detecção de casos de tuberculose em Pelotas, Rio Grande do Sul, 2012.

OBJECTIVE: to evaluate the geographical and organizational aspects of primary health care services in detecting tuberculosis cases in Pelotas-RS, Brazil. METHODS: this was a descriptive evaluation study involving 276 health professionals in 2012; data were collected using a structured questionnaire covering geographical and organizational aspects which received a score using a Likert scale of 1 to 5. RESULTS: average use of motorized transport by symptomatic respiratory patients having a cough for more than three weeks to get to a healthcare service was considered regular by respondents; although there was satisfactory availability of health professionals, human resource turnover and time-keeping were considered unsatisfactory; average time of more than 60 minutes waiting to see the doctor and average time spent with the doctor were considered regular. CONCLUSION: organizational and geographic characteristics identified as unsatisfactory may interfere with the detection of tuberculosis cases in Pelotas-RS.