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Quality of tuberculosis care at different levels of health care in Brazil in 2013 / Calidad de la asistencia de la tuberculosis en los diferentes niveles de atención de salud del Brasil en el 2013
Rev Panam Salud Publica ; 39(1),ene. 2016
Artigo em Inglês | PAHO-IRIS | ID: phr-28195
Biblioteca responsável: BZ1.1
ABSTRACT
Objective. To assess 1) the burden and socio-demographic and clinical characteristics of tuberculosis (TB) cases, and 2) the quality of TB care provided to patients who entered and remained within each health care service level (primary, secondary, or tertiary) and those who moved from one level to another, using process and results indicators. Methods. This cross-sectional operational research study assessed new smear-positive pulmonary TB cases diagnosed in Brazilian state capitals in 2013 using TB program records and the TB surveillance system. Quality of care was assessed based on process and results indicators including HIV screening, TB contact screening, Directly Observed Treatment (DOT), sputum smear microscopy monitoring, and treatment outcomes. Results. There were 12 977 new smear-positive TB cases reported. Of these, 7 964 (61.4%) cases were diagnosed and treated at the primary care level, 1 195 (9.2%) at the secondary level, 1 521 (11.7%) at the tertiary level, and 2 296 (17.7%) at more than one level, with 65% of the latter group moved from the tertiary level to the primary level. The proportion of cases tested for HIV was significantly higher in patients receiving care at the primary level compared to those receiving care at the secondary level (prevalence ratio (PR) 1.17; 95% confidence interval (CI) 1.07–1.28) and those attending more than one service level. Patients attending the tertiary health care level had a 122% higher PR for not doing DOT (“DOT not done”) compared to patients at the primary level (PR 2.22; CI 2.12–2.32). When the two levels were compared, the prevalence for an unfavorable outcome (lost to follow-up, death from TB, death with TB, transferred out, or not evaluated) was higher at the tertiary health care level. Conclusions. Primary health services are successfully incorporating the management of new smear-positive TB cases. Primary health care obtained better operational indicators than secondary or tertiary levels.
Assuntos
Texto completo: Disponível Coleções: Bases de dados de organismos internacionais Contexto em Saúde: Doenças Negligenciadas Problema de saúde: Doenças Negligenciadas / Tuberculose Base de dados: PAHO-IRIS Assunto principal: Pesquisa Operacional / Política / Atenção Primária à Saúde / Tuberculose / Brasil / Serviços de Saúde Tipo de estudo: Estudo observacional / Estudo de prevalência / Fatores de risco Aspecto: Determinantes sociais da saúde País/Região como assunto: América do Sul / Brasil Idioma: Inglês Ano de publicação: 2016 Tipo de documento: Artigo
Texto completo: Disponível Coleções: Bases de dados de organismos internacionais Contexto em Saúde: Doenças Negligenciadas Problema de saúde: Doenças Negligenciadas / Tuberculose Base de dados: PAHO-IRIS Assunto principal: Pesquisa Operacional / Política / Atenção Primária à Saúde / Tuberculose / Brasil / Serviços de Saúde Tipo de estudo: Estudo observacional / Estudo de prevalência / Fatores de risco Aspecto: Determinantes sociais da saúde País/Região como assunto: América do Sul / Brasil Idioma: Inglês Ano de publicação: 2016 Tipo de documento: Artigo
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