Desempenho da Atenção Básica no tratamento da tuberculose no Município de Uberaba-MG

Abstract

The present study aimed to evaluate the assistance provided to tuberculosis patients by basic attention, in the city of Uberaba, in 2011. This is a cross-sectional study for the evaluation of health care services in the control of tuberculosis in the perspective of health professionals. The study population was composed by 216 professionals: physicians, nurses, community health agents and nursing technicians, crowded in 22 health services. We used primary and secondary data sources in order to describe and evaluate the performance of health services in relation to the structure, process and outcome components. For the collection of information on the services was built a structured instrument with closed questions and the data analysed by standardized indicators. To calculate these indicators was used the reference values (P = proportion   p = standard deviation of trait studied) determined from a sample of 1037 health professionals from five Brazilian counties. Reference indicators of constructed structure component were: professional indicator, training Indicator, indicator of access to registry tools, input availability indicator, indicator of health service joint with other levels of attention. Reference indicators of built process component were: information on tuberculosis (TB), directly observed treatment indicator (DOT), external actions indicator for TB control, indicator and benchmark against reference to other health services. Result indicators used were: proportion of cure, abandonment and death of new cases of TB diagnosed during the period from 2008 to 2011. The results for the structure component were: indicator of professionals involved and training indicator for TB care, considered satisfactory to the county with 94.5% and 82.5% respectively. The indicator of access to registry tools (71.0%) regular to the county, with 9 (41.0%) services satisfactory, 3 (18%) regular and 9 (41.0%) unsatisfactory. The indicator of availability of inputs (94.1%) regular to the county, with 12 (54.5%) services satisfactory, 6 (27.3%) regular and 4 (18.2%) unsatisfactory. The indicator of health service joint with other levels of attention (88.0%) regular to the county, with 8 (36.4%) satisfactory services, 10 (45.4%) regular and 4 (18.2%) unsatisfactory. To the process component were: the information on the TB (97.4%) regularly to the county with 12 (54.5%) satisfactory services, 1 (4.5%) regular service and 9 (41.0%) unsatisfactory. The DOT and indicators of external actions for the control of TB considered satisfactory with 94.1% and 99.7%, respectively. The benchmark indicator and reference (64.2%) unsatisfactory in the county, with 3 (13.6%) services satisfactory, 7 (31.8%) and 12 (54.5%) unsatisfactory. The result was considered unsatisfactory for the proportions of cure, abandonment and death by TB, in the county, in 2011. Most of the indicators have been well evaluated in the county, however, several indicators showed unsatisfactory and regular services, which may be harming the performance of the structure and care provided in the treatment of TB and contributing to the poor performance of the healing rates, abandonment and death in the county.