[Delay in seeking initial care for tuberculosis diagnosis]. / Atraso na procura pelo primeiro atendimento para o diagnóstico da tuberculose.

Descriptive study, which aimed to analyze the time between the perception of TB symptoms onset and the first search for health services, according to TB patient characteristics in São José do Rio Preto - SP. 97 TB patients in treatment were interviewed with a structured instrument. The delay was identified by the median time between the perception of TB symptom's onset and the patients demand for care (> 15 days). To identify the variables related to delay the prevalence ratio were calculated. There was a delay seeking care among: male patients, aged 18 to 29 and 50 to 59 years, lower education and higher family income, pulmonary cases without HIV co-infection, presenting milder symptoms, users of alcoholic beverages and tobacco, those who did not perform preventive health control, and who sought health services closer to home. The recognition of users' profiles in the search for care is paramount for defining strategies that favor the use of services in a timely manner.

[Assessment of tuberculosis treatment accessibility for patients co-infected or not with the human immunodeficiency virus]. / Avaliação do acesso ao tratamento de tuberculose por coinfectados ou não pelo vírus da imunodeficiência humana.

This study aimed to evaluate accessibility to treatment for people with TB co-infected or not with HIV. This cross-sectional study addressed issues regarding accessibility to treatment in a city in the interior of São Paulo state, Brazil. The instrument Primary Care Assessment Tool was utilized with 95 people. To evaluate access to treatment, Student's t test was used. The mean scores of variables were analyzed separately and compared between two groups (people with TB co-infected with HIV and people with TB not co-infected with HIV ). Mean scores showed that HIV co-infected people presented greater difficulties in gaining access than those not co-infected. Professionals visited co-infected people more often when compared to those not co-infected; the co-infected people almost never accessed treatment for their disease in the Health Unit nearest their home. There is, therefore, the need for greater integration and communication between the programs for treatment of Tuberculosis and STD/AIDS.

Analysis of vaccine loss due to temperature change.

OBJECTIVES: to analyze vaccine losses in a Health Region in the Northwest of São Paulo. METHODS: retrospective cross-sectional study with secondary data obtained from Temperature Change Notification Forms used by the Epidemiological Surveillance Group XXIX of São José do Rio Preto between 2010 and 2017. Descriptive and inferential analysis were performed using multiple linear regression and significance level of 95%. RESULTS: in total, 341 notifications of temperature changes were analyzed, of which 70.1% were caused by structural reasons, 57.8% in industrial refrigerators and 91.2% in primary care services. Of the doses that suffered a change in temperature, 41.4% were lost and 58.6% were administered to the population. The highest percentage of lost doses compared to those applied occurred in smaller municipalities, although they reported less. CONCLUSIONS: nursing workers who work in vaccination rooms should make efforts to prevent temperature changes and avoid losses and higher public expenses.

Health services in tuberculosis control: family focus and community orientation.

This study aimed to assess, according to patients' perception, the performance of the Health Services responsible for tuberculosis (TB) control, concerning the dimensions family focus and community orientation. A cross-sectional evaluative research was carried out with 108 TB patients. A questionnaire developed by Starfield and Macinko was used, adapted for TB care by Villa and Ruffino-Netto. Results evidence, in the first dimension, that health professionals (HP) are concerned with patients' signs and symptoms; and, at a lower level, with other health problems of relatives, endangering the comprehensive healthcare. In the second dimension, HP show little concern with the active search of cases, deficiency in HP training, and low rates of examined contacts. Results show the need to broaden HP's epidemiological view, as their attention is focused on patients, with few preventive actions concerning family/community. This evidences the need for a closer relationship among HP/patients/family/community.

The epidemiological dimension of TB/HIV co-infection.

This study aimed to analyze the epidemiological indicators of TB/HIV co-infection in São José do Rio Preto, São Paulo, Brazil from 1998 to 2006. Data of new TB cases that initiated treatment between January 1998 and December 2006 were obtained from the TB Notification System (EPI-TB) and 306 cases were reported. The incidence rate was 5.1/100,000 inhabitants in 2006. Most cases were men (72.5%) with ages ranging between 20 and 59 years (96.4 %). The majority (51%) had incomplete primary education. Pulmonary TB was the most common type (52.9%) and 46.1% of the patients received supervised treatment. In 2006, the cure rate was 33.3%, 14.3% death rate and no patient abandoned the treatment. Diagnosis occurred at the hospital in 60% of the cases. Results show the need of improved coordination between the city's Tuberculosis Control Program and the Sexually Transmitted Diseases and HIV Program.

Profile and speech-language rehabilitation of patients with laryngeal cancer. / Perfil e reabilitação fonoaudiológica de pacientes com câncer de laringe.

PURPOSE: to describe the clinical and sociodemographic profile and analyze the voice rehabilitation outcomes of patients with laryngeal cancer. METHODS: cross-sectional study with 204 individuals with laryngeal cancer treated between 1989 and 2015. The variables describing the patients' profile were presented in absolute values (n) and percentage (%). The association between the speech-language therapy outcome and the sociodemographic and clinical characterization variables was verified by means of uni- and multivariate techniques. RESULTS: 95.1% of the patients are male; 53.43% are aged 60 or more; 77.37% have elementary education; 44.12% are in the service industry; 81.63% smoke and consume alcohol; 30.4% are stage T3. Absence of nodules was found in 72.00%, and of metastasis, in 85.6% of patients. The most frequent therapeutic procedure was complete or partial laryngectomy (69.61%). There was an association among education, disease stage, habits, and therapeutic outcome with speech-language therapy (p<0.001). CONCLUSION: Several causes can affect the prognosis of vocal rehabilitation in patients with laryngeal cancer. Optimization and diversification of new therapeutic procedures are challenges for these patients' speech-language rehabilitation.

OBJETIVO: descrever o perfil clínico e sociodemográfico e o desfecho da reabilitação fonoaudiológica de pacientes com câncer de laringe. MÉTODO: estudo transversal com 204 pessoas atendidas entre 1989 e 2015. A associação entre desfecho da fonoterapia e variáveis de caracterização sociodemográfica e clínicas foi verificada por técnicas univariadas e multivariadas. RESULTADOS: prevalência do gênero masculino (95,10%), 60 anos ou mais (53,43%), ensino fundamental (77,37%), setor de serviços (44,12), tabagistas e etilistas (81,63%); estágio T3 (30,4%), ausência de nódulos (72,00%) e de metástase (85,6%). O procedimento terapêutico mais frequente foi a laringectomia total ou parcial (69,61%). Houve associação da escolaridade, estágio da doença, hábitos e procedimento terapêutico com desfecho da fonoterapia (p<0,001). CONCLUSÃO: fatores sociodemográficos e clínicos podem interferir no prognóstico da reabilitação vocal de pessoas com câncer de laringe. A otimização e diversificação de novos procedimentos terapêuticos são desafios na reabilitação fonoaudiológica destas pessoas.

Tuberculosis contact control in Brazil: a literature review (1984-2004).

This study aims to review plans for tuberculosis control through the analysis of measures for tuberculosis contact tracing in Brazil from 1984 to 2004. This article presents a literature review on tuberculosis control published in manuals of the Ministry of Health and the State Department of Health of Sao Paulo, and in Medline and Lilacs databases. There was a gap in the standardization of control measures in the decade from 1984 to 1994. It was concluded that health professionals need to incorporate TB control and prevention actions from the perspective of health surveillance and systematic monitoring.

[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.

Current epidemiological aspects of tuberculosis and the impact of the DOTS strategy in disease control.

This article aims to present the current situation of tuberculosis and how the DOTS (Directly Observed Treatment Short Course) strategy has impacted national tuberculosis control programs worldwide, in Latin America and in Brazil. Data reveal a tendency towards a slow decline in disease rates (1%) around the world in 2003. In Brazil, data indicate a constant downward tendency of approximately 3% a year in incidence levels. The DOTS strategy has been recommended to all countries. Brazil needs to improve its tuberculosis surveillance efforts, particularly in terms of confirming negative sputum smear results at the end of treatment.

Primary Health Care and tuberculosis: services evaluation. / Atenção Primária à Saúde e tuberculose: avaliação dos serviços.

INTRODUCTION:: In order to control tuberculosis, the Brazilian Ministry of Health recommends the decentralization of control actions directed to the Primary Health Care, and there are few studies on the performance of the Tuberculosis Control Program in decentralized contexts. OBJECTIVE:: To evaluate the performance of Primary Health Care services in tuberculosis treatment. METHODS:: This is an evaluative study with cross-sectional approach conducted in 2011. Two hundred and thirty-nine health professionals from Primary Health Care units were interviewed using a structured instrument based on the evaluation reference of the health services quality (structure - process - results). The performance of these services was analyzed applying techniques of descriptive statistics, validation, and construction of indicators and by determining the reduced variable "Z". RESULTS:: The indicators "participation of professionals in tuberculosis patients' care" (structure) and "reference and counterreference" (process) had the best evaluations, whereas "professional training" (structure) and "external actions for tuberculosis control" (process) had the worst results. CONCLUSION:: The decentralization of tuberculosis control actions has been taking place in a vertical manner in Primary Health Care. The challenge of controlling tuberculosis involves overcoming constraints related to the engagement, training, and turnover rates among health professionals, which is a coordination between services and monitoring of control actions in Primary Health Care.

Latent Tuberculosis Infection Diagnostic and Treatment Cascade among Contacts in Primary Health Care in a City of Sao Paulo State, Brazil: Cross-Sectional Study.

BACKGROUND: Diagnosis and treatment of latent tuberculosis infection (LTBI) is a tool for global TB control, especially in close contacts. But data is scarce in high burden countries, under field conditions, including data on the benefits of LTBI management. OBJECTIVE: To analyze the LTBI diagnosis and treatment cascade among contacts in primary health care (PHC) services in São José do Rio Preto-SP, Brazil. METHODS: Cross-sectional design, conducted with contacts of pulmonary TB patients followed in all PHC services. Data was collected from May to September 2014 in the Reporting System for TB cases (TBWEB) and Reporting System for Chemoprophylaxis. Medical records and treatment follow-up forms were reviewed and all the nurses responsible for TB in PHC services were interviewed. RESULTS: Among 336 contacts included, 267 (79.4%) were screened for TB or LTBI, according to the presence or not of respiratory symptoms. Among those contacts screened, 140 (52.4%) were symptomatic, 9 (3.4%) had TB disease, 106/221 (48%) had positive TST result, meeting the criteria for LTBI treatment, and 64/106 (60.4%) actually started it. Overall, among 267 screened, only 64 (24%) started LTBI treatment. The completion rates of treatment among the contacts who started it, those with positive TST result and those screened were 56.3% (36/64), 16.3% (36/221) and 13.5% (36/267), respectively. Nurses claimed that asymptomatic TB contacts pay no attention to preventive health care and do not seek medical care as they do not have symptoms of the disease. In reviewing the medical records, high proportions of contacts without evaluation, incomplete assessment, incorrect records of contraindication for LTBI treatment, lack of notes regarding the identification and evaluation of contacts were identified. CONCLUSIONS: There is a need for better organization of the surveillance and investigation routine for contacts in PHC, considering the reorganization of the work process and the features of the local health system.

Analysis of vaccine loss due to temperature change / Análisis de pérdida de vacuna por cambio de temperatura / Análise da perda de vacinas por alteração de temperatura

ABSTRACT Objectives: to analyze vaccine losses in a Health Region in the Northwest of São Paulo. Methods: retrospective cross-sectional study with secondary data obtained from Temperature Change Notification Forms used by the Epidemiological Surveillance Group XXIX of São José do Rio Preto between 2010 and 2017. Descriptive and inferential analysis were performed using multiple linear regression and significance level of 95%. Results: in total, 341 notifications of temperature changes were analyzed, of which 70.1% were caused by structural reasons, 57.8% in industrial refrigerators and 91.2% in primary care services. Of the doses that suffered a change in temperature, 41.4% were lost and 58.6% were administered to the population. The highest percentage of lost doses compared to those applied occurred in smaller municipalities, although they reported less. Conclusions: nursing workers who work in vaccination rooms should make efforts to prevent temperature changes and avoid losses and higher public expenses.

RESUMEN Objetivos: analizar las pérdidas de vacunas en una Región de Salud del Noroeste de São Paulo. Métodos: estudio transversal retrospectivo, con datos secundarios obtenidos de los formularios de notificación de cambios de temperatura utilizados por el Grupo XXIX de Vigilancia Epidemiológica de São José do Rio Preto entre 2010 y 2017. Se realizó el análisis descriptivo e inferencial y se utilizó la regresión lineal múltiple y nivel de significancia del 95%. Resultados: se analizaron 341 notificaciones de cambios de temperatura, de las cuales el 70,1% fueron por motivos estructurales, el 57,8% en frigoríficos industriales y el 91,2% en los servicios de atención primaria. De las dosis que sufrieron un cambio de temperatura, el 41,4% se perdieron y el 58,6% se administraron a la población. El mayor porcentaje de dosis perdidas en comparación con las aplicadas se produjo en los municipios más pequeños, aunque informaron menos. Conclusiones: los trabajadores de enfermería que laboran en las salas de vacunación deben esforzarse por prevenir cambios de temperatura, evitando pérdidas y aumento de los gastos públicos.

RESUMO Objetivos: analisar as perdas de vacinas em uma Região de Saúde do Noroeste paulista. Métodos: estudo transversal retrospectivo, com dados secundários obtidos das fichas de notificação de alteração de temperatura utilizadas pelo Grupo de Vigilância Epidemiológica XXIX de São José do Rio Preto, entre 2010 e 2017. Foi realizada análise descritiva e inferencial, utilizando regressão linear múltipla e nível de significância de 95%. Resultados: foram analisadas 341 notificações de alteração de temperatura, sendo 70,1% causadas por motivos estruturais, 57,8% em refrigeradores industriais e 91,2% em serviços de atenção básica. Das doses que sofreram alteração de temperatura, 41,4% foram perdidas e 58,6% foram administradas na população. O maior percentual de doses perdidas em relação às aplicadas ocorreu em municípios menores, apesar de eles notificarem menos Conclusões: os trabalhadores de enfermagem que atuam em salas de vacinação devem se empenhar para prevenir alterações de temperatura, evitando perdas e aumento dos gastos públicos.

[Delay in tuberculosis diagnosis in adults in a city of São Paulo State, Brazil, in 2009: a cross-sectional study]. / Atraso do diagnóstico da tuberculose em adultos em um município paulista em 2009: estudo transversal.

OBJECTIVE: to evaluate patient and health service characteristics associated with tuberculosis (TB) diagnosis delay. METHODS: this was a cross-sectional study conducted in São José do Rio Preto-SP in 2009; the 'entry point' and 'access to diagnosis' dimensions of the Primary Care Assessment Tool (PCAT) were selected to analyze patient and HS delay. RESULTS: 99 TB patients were included in the study; the median time related to patient and HS delay was 15 days; delay in seeking services was lower among smokers (PR= 0.71; 95%CI 0.54;0.94) and alcohol users (PR=0.75; 95%CI 0.57;0.99); TB diagnosis delay was related to not being able to get a medical appointment on the same day (PR=1.63; 95%CI 1.22;2.18), TB not being suspected (PR=2.07; 95%CI 1.18;3.62) and seeking care in health services four times or more (PR=2.34; 95%CI 1.55;3.53). CONCLUSION: delay in seeking care was lower among smokers and alcohol users; shortcomings in access to diagnosis characterized health services delay.

Death in patients with tuberculosis and diabetes: Associated factors.

AIMS: Identify factors associated with death in patients with tuberculosis and diabetes. METHOD: The descriptive - analytic epidemiologic study using secondary data of tuberculosis cases reported in TBWEB from 1996 to 2014 is used. The profile analysis of the variables in relation to death controlled by the cure of the patients was performed by the software R, the independent variables that could be associated with the dependent variable in a 20% significance level, using the chi-square test. The analysis was performed on an unconditional logistic regression model. Odds ratio (OR) adjusted measures were obtained in order to evaluate the strength of association between independent variables. RESULTS: Looking into the database TBWEB, from 1996 to 2014, 5361 cases of TB were reported, and from these cases, 4447 contained information about the closure and were complete. Patients with TB and DM represented 306 cases (6.35%). In relation to death, protective factors were: diabetes with OR: 0.69; follow up received during the treatment of medium and high complexity services, with OR: 0.51 and the other type with OR: 0.56. CONCLUSION: Diabetes appeared as a protective factor for death in patients with tuberculosis in this study. The development of studies like this allows the expansion of knowledge on the TB-DM association.

[Tuberculosis in the elderly: concept analysis]. / Tuberculose no idoso: análise do conceito.

The goal of this study is to define the concept of tuberculosis in the elderly expressed in the literature covering the 80's and 90's. We have used concept analysis with emphasis on "essential attributes", "preceding events, and "consequential events", which build up the core sense of the concept to be defined. The elderly tuberculosis is expressed as the recrudescence of infection inactivated for a long time. The elderly is predispose to endogenous and exogenous reinfection. Among the most important "preceding" events are the institutional housing as a contact disease source. The "consequential" events are related to the need of a differentiate treatment and diagnostic in elderly due clinical conditions. We arrive at the conclusion that new studies about the concept analysis need to be developed in order to contribute to the knowledge about the diagnosis, treatment and care to elderly patients.

Dificuldades e facilidades do enfermeiro da Saúde da Família no processo de trabalho / Difficulties and facilities of the Family Health nurse in the work process

Resumo Introdução Os cuidados primários à saúde são discutidos internacionalmente desde 1978 com a Declaração de Alma-Ata. Quinze anos depois, nasceu no Brasil a Saúde da Família, em que se destaca o enfermeiro como um dos principais profissionais com atribuições no processo de trabalho que garante a prestação qualificada da assistência. Objetivo Analisar as dificuldades e as facilidades do processo de trabalho dos enfermeiros das Unidades Básicas de Estratégia Saúde da Família. Método Trata-se de um estudo de natureza descritiva, transversal e abordagem qualitativa, cujos dados foram obtidos a partir de entrevista semiestruturada. Os dados coletados em um período de três meses foram analisados por meio da análise temática. Resultados A análise revelou quatro núcleos de sentido relacionados à dificuldade: alta demanda espontânea, recursos humanos escassos, sobrecarga de atividades e educação permanente reduzida. Para as facilidades, foram identificados dois núcleos de sentido: formação holística e campo rico para pesquisas. Conclusão Os resultados forneceram subsídios para que os gestores de saúde implementem estratégias em prol do processo de trabalho dos enfermeiros, o que, consequentemente, refletirá em benefícios ao indivíduo, à família, à comunidade e a toda equipe de saúde.

Abstract Background Primary health care has been discussed internationally since 1978 with the Alma Ata Declaration. Fifteen years later the Family Health is born in Brazil, which the nurse is the one of the main professionals with attributions in the work process that ensures the qualified provision of the assistance. Objective To analyze the difficulties and facilities of the work process of nurses of the Basic Family Health Strategy Units. Method This is a descriptive, cross-sectional and qualitative study, the data being obtained from a semi-structured interview. The data collected over a period of three months were analyzed through the thematic analysis. Results The analysis revealed four sense nuclei related to the difficulty: high spontaneous demand, scarce human resources, activities overload and reduced permanent education. For the facilities were identified two nuclei of sense: holistic formation and rich field for research. Conclusion The results provide support for health managers to implement strategies for the nurses' work process, which will consequently reflect benefits to the individual, family, community and all health team.

Perfil e reabilitação fonoaudiológica de pacientes com câncer de laringe / Profile and speech-language rehabilitation of patients with laryngeal cancer

RESUMO Objetivo descrever o perfil clínico e sociodemográfico e o desfecho da reabilitação fonoaudiológica de pacientes com câncer de laringe. Método estudo transversal com 204 pessoas atendidas entre 1989 e 2015. A associação entre desfecho da fonoterapia e variáveis de caracterização sociodemográfica e clínicas foi verificada por técnicas univariadas e multivariadas. Resultados prevalência do gênero masculino (95,10%), 60 anos ou mais (53,43%), ensino fundamental (77,37%), setor de serviços (44,12), tabagistas e etilistas (81,63%); estágio T3 (30,4%), ausência de nódulos (72,00%) e de metástase (85,6%). O procedimento terapêutico mais frequente foi a laringectomia total ou parcial (69,61%). Houve associação da escolaridade, estágio da doença, hábitos e procedimento terapêutico com desfecho da fonoterapia (p<0,001). Conclusão fatores sociodemográficos e clínicos podem interferir no prognóstico da reabilitação vocal de pessoas com câncer de laringe. A otimização e diversificação de novos procedimentos terapêuticos são desafios na reabilitação fonoaudiológica destas pessoas.

ABSTRACT Purpose to describe the clinical and sociodemographic profile and analyze the voice rehabilitation outcomes of patients with laryngeal cancer. Methods cross-sectional study with 204 individuals with laryngeal cancer treated between 1989 and 2015. The variables describing the patients' profile were presented in absolute values (n) and percentage (%). The association between the speech-language therapy outcome and the sociodemographic and clinical characterization variables was verified by means of uni- and multivariate techniques. Results 95.1% of the patients are male; 53.43% are aged 60 or more; 77.37% have elementary education; 44.12% are in the service industry; 81.63% smoke and consume alcohol; 30.4% are stage T3. Absence of nodules was found in 72.00%, and of metastasis, in 85.6% of patients. The most frequent therapeutic procedure was complete or partial laryngectomy (69.61%). There was an association among education, disease stage, habits, and therapeutic outcome with speech-language therapy (p<0.001). Conclusion Several causes can affect the prognosis of vocal rehabilitation in patients with laryngeal cancer. Optimization and diversification of new therapeutic procedures are challenges for these patients' speech-language rehabilitation.

[Tuberculosis diagnosis and performance assessment of the first health service used by patients in São José do Rio Preto, São Paulo State, Brazil]. / Diagnóstico da tuberculose: desempenho do primeiro serviço de saúde procurado em São José do Rio Preto, São Paulo, Brasil.

This cross-sectional study aimed to analyze the first health service to which patients turned for tuberculosis diagnosis in São José do Rio Preto, São Paulo, Brazil, 2009. Eighty-one patients in treatment were interviewed with a questionnaire based on the Primary Care Assessment Tool adapted to TB care and used as a reference for health services performance (structure and process). Data analysis used descriptive and multiple correspondence techniques. Nearly half of the patients initially came to emergency care departments (49.4%), and most TB diagnoses were made in hospitals (39.5%) and primary care services (30.9%). Specialized services were associated with the best diagnostic performance, as opposed to emergency departments, with the worst performance. Primary care services were associated with intermediate performance and weaknesses in infrastructure. The reach of effective detection of TB cases in the portals of entry into the health system involves enhanced diagnostic suspicion, thus emphasizing the need for investments in the management of human resources training for the identification of individuals with respiratory symptoms.

Acesso ao diagnóstico da tuberculose em município brasileiro de médio porte / Access to diagnosis of tuberculosis in Brazilian medium-sized municipality / Acceso al diagnóstico de la tuberculosis en un municipio brasileño de mediano porte

RESUMO Objetivo Avaliar o acesso ao diagnóstico de tuberculose, na perspectiva dos doentes. Métodos Estudo transversal, com 108 doentes de tuberculose. Os dados foram coletados utilizando-se o instrumento Primary Care Assessment Tool (PCAT), validado para o Brasil, adaptado para atenção a tuberculose, incluiu indicadores socioeconómicos e demográficos, local do diagnóstico e de acesso ao diagnóstico de tuberculose. A análise dos dados foi de frequência, média, desvio-padrão, intervalo de confiança e teste Qui-quadrado. Resultados A maioria dos casos foi diagnosticada em hospitais (52,8%). O doente procurou a Unidade de Saúde em média três vezes, para conseguir atendimento. Os indicadores dificuldade de deslocamento, gasto com transporte motorizado e consulta no prazo de 24 horas para descoberta da doença foram não satisfatórios e regulares. Conseguir consulta para descobrir a tuberculose em 24 horas, foi não satisfatório. O teste qui-quadrado mostrou associação estatística entre locais de diagnóstico e procura pela unidade de saúde mais próxima da casa. Conclusão O diagnóstico precoce da Tuberculose na Atenção Primária apresenta fragilidades. São muitos desafios a serem enfrentados para o fortalecimento deste nível de atenção a saúde, com capacidade organizacional para a superação das deficiências relacionadas ao doente e ao serviço que dificultam o acesso ao diagnóstico da doença.(AU)

ABSTRACT Objetivo Evaluating access to tuberculosis diagnosis, from the perspective of patients. Methods Cross-sectional study with 108 tuberculosis patients. Data were collected using the brazilian instrument Primary Care Assessment Tool - PCAT-Brazil, adapted for attention to tuberculosis, including socio-economic and demographic indicators, location of diagnosis and diagnostic access tuberculosis. The analysis of the data was of frequency, average, standard deviation, confidence interval and Chi-square test. Results Most cases were diagnosed in hospitals (52.8%). The patient sought the Health Unit on average three times until receiving medical care. The indicators of difficulty of displacement, expenditure on motorized transport and consultation within 24 hours to discover the disease were not satisfactory and regular. The chi-square test showed a statistical association between diagnosis location and seeking the nearest health unit from home. Conclusions There are weaknesses in the early diagnosis of tuberculosis in primary care. There are many challenges to be faced to strengthen this level of health care, with organizational capacity to overcome the shortcomings related to the patient and the service that make it difficult to access the diagnosis of the disease.(AU)

RESUMEN Objetivo Evaluar el acceso al diagnóstico de tuberculosis, desde la perspectiva de los enfermos. Métodos Estudio transversal con 108 pacientes de tuberculosis. Los datos fueron recolectados utilizando el instrumento Primary Care Assessment Tool -PCAT-Brasil- . El análisis de los datos incluyeron frecuencia, media, desviación estándar, intervalo de confianza y prueba Chi-cuadrado. Resultados La mayoría de los casos fueron diagnosticados en hospitales (52,8%). El paciente buscó la Unidad de Salud en promedio tres veces, para conseguir atención. Los indicadores dificultad de desplazamiento, gasto con transporte motorizado y consulta en el plazo de 24 horas para el descubrimiento de la enfermedad, no fueron satisfactorios o regulares. La prueba de Chi-cuadrado mostró una asociación estadística entre el lugar de diagnóstico y la búsqueda de la unidad de salud más cercana al hogar. Conclusión El diagnóstico precoz de la tuberculosis en la Atención Primaria presenta fallas. Son muchos los desafíos a enfrentar para mejorar la atención, la capacidad organizacional para superar las deficiencias relacionadas con el enfermo y el servicio, que dificultan el acceso al diagnóstico de la enfermedad.(AU)

Atenção Primária à Saúde e tuberculose: avaliação dos serviços / Primary Health Care and tuberculosis: services evaluation

RESUMO: Introdução: Visando controlar a tuberculose, o Ministério da Saúde recomenda a descentralização das ações de controle para a Atenção Primária à Saúde, sendo escassos os estudos acerca do desempenho do Programa de Controle da Tuberculose em contextos descentralizados. Objetivo: Avaliar o desempenho dos serviços da Atenção Primária à Saúde no tratamento da tuberculose. Métodos: Estudo avaliativo, realizado de maneira transversal em 2011. Foram entrevistados 239 profissionais de saúde da Atenção Primária à Saúde utilizando um instrumento estruturado com base no referencial de avaliação da qualidade dos serviços de saúde (estrutura, processo e resultado). O desempenho de tais serviços foi analisado mediante técnicas de estatística descritiva, validação e construção de indicadores e cálculo da variável reduzida Z. Resultados: Os indicadores “participação de profissionais no atendimento aos pacientes com tuberculose” (estrutura) e “referência e contrarreferência” (processo) foram os melhores avaliados, enquanto “capacitação dos profissionais” (estrutura) e “ações externas para o controle da tuberculose” (processo) tiveram os piores resultados. Conclusão: A descentralização das ações de controle da tuberculose vem ocorrendo de maneira verticalizada na Atenção Primária à Saúde. O desafio de controlar a tuberculose perpassa pela superação de fragilidades relacionadas ao envolvimento, à capacitação e à rotatividade profissional, que é a articulação entre os pontos de atenção e monitoramento das ações de controle na Atenção Primária à Saúde.

ABSTRACT: Introduction: In order to control tuberculosis, the Brazilian Ministry of Health recommends the decentralization of control actions directed to the Primary Health Care, and there are few studies on the performance of the Tuberculosis Control Program in decentralized contexts. Objective: To evaluate the performance of Primary Health Care services in tuberculosis treatment. Methods: This is an evaluative study with cross-sectional approach conducted in 2011. Two hundred and thirty-nine health professionals from Primary Health Care units were interviewed using a structured instrument based on the evaluation reference of the health services quality (structure - process - results). The performance of these services was analyzed applying techniques of descriptive statistics, validation, and construction of indicators and by determining the reduced variable “Z”. Results: The indicators “participation of professionals in tuberculosis patients’ care” (structure) and “reference and counterreference” (process) had the best evaluations, whereas “professional training” (structure) and “external actions for tuberculosis control” (process) had the worst results. Conclusion: The decentralization of tuberculosis control actions has been taking place in a vertical manner in Primary Health Care. The challenge of controlling tuberculosis involves overcoming constraints related to the engagement, training, and turnover rates among health professionals, which is a coordination between services and monitoring of control actions in Primary Health Care.