Diagnóstico da tuberculose: avaliação da estrutura dos serviços de saúde que atuam como porta de entrada

Abstract

Introduction: Tuberculosis is a public health problem of worldwide relevance. It is consensus that the efficiency of the treatment is relatated to the way the control actions are carried out in Primary Care System, so that infrastructure, work process organization and access difficulties show to be relevant to the performance. Objectives: Assess the structure of services that act as a gateway for the diagnosis of TB in São José do Rio Preto São Paulo, under the perspectives of the health professionals. Methods and Materials: 160 professionals from Basic Health Unities, Family Health Unities and Emergence Room in São José do Rio Preto São Paulo - were interviewed in 2009. The interviews were carried out through a questionary based on the Likert Scale varing from one to five, with the analysis of the following variables: gender and years of working in the Health Unities, opening hours, the turnover of human resources, availability of professionals in the Health Service, waiting time to be assisted, perception regarding the lack of knowledge of the disease by professional working in the unit, existence of work overload, adequacy of a site for sputum collection in the service, existence of pot to collect sputum, refrigerator for preservation of biological material, sputum smear request form and x-ray room in the unit. These indicators were also analyzed individually and compared among the health services, using analysis of variance (ANOVA), using the F test and multiple comparisons between means for applying the test of Tukey. Results: predominance of female professionals in all services. Median of work time in the Basic Health Unities was 9 years; Family Health Unities, 6,5; Emergence Rooms, 5 years. All health services showed satisfactory performance for opening hours, but Emergence Rooms had improved assessment, however for availability of professionals showed lower performance. Family Health Unities had a better assessment waiting time for users and staff turnover; nevertheless had worst workload assessment. It has not been found difference among the health services for lack of knowledge about the disease, with close to satisfactory assessment and also to adequacy of site to collect sputum, underperforming the three groups. All services showed satisfactory performance for the existence of inputs: pot and request form for sputum smear, but none had x-ray. Conclusions: In general, the services presented suitable structure, for which reason it is believed that the difficulties for the diagnosis of TB is more related to the process (performance), it means, how the activities / actions are arranged and operated on the daily basis of the practices in the health.