Avaliação de serviços de atenção primária à saúde na assistência à pessoa com tuberculose

Abstract

This study aimed to evaluate primary health care services in assisting people with tuberculosis. The first part of this study is an integrative review of scientific articles carried out in Brazil on the evaluation of primary health care services regarding the implementation of tuberculosis control actions, following the PRISMA recommendation for systematic reviews and meta-analyses. 1118 articles were cataloged in the BIREME database, 166 in SCORPUS, and 120 in SCIELO. After applying the eligibility criteria, 14 articles were included for review. The second part of this study is an evaluative study of the primary health care services in the 2nd health region of the state of Paraíba, a descriptive survey, based on the structure, process and result components, with a quantitative approach, and a cutout. cross. The population consisted of 554 professionals working in primary health care services who diagnosed new cases of tuberculosis, from 01/01/17 to 12/31/2019, and, considering a sample error of 0.05, confidence interval of 95% and p-value (population proportion) of 50%, a sample of 228 professionals was obtained. In view of the difficulties imposed by the COVID-19 pandemic, only 01 researcher collected data, carried out from March to August 2021, through questionnaire-type interviews, using a closed structured instrument, organized trichotomously (yes, no, don't know) . The collection of secondary data was carried out through the national registry of health establishments and the information system of notifiable diseases. The research project was approved by the research ethics committee of the state university of paraíba under opinion nº 40255020.5.0000.5187. Regarding the result of the integrative review, in the analyzed studies, several weaknesses were reported, including: difficulties in accessing health services, failures in the active search for respiratory symptoms, difficulties in diagnosing new cases, weaknesses in carrying out treatment directly observed, lack of clinical and laboratory support, lack of investment in primary health care services, among other limitations. As for the evaluation of health services in the 2nd health region of the state of paraíba, out of a total of 26 points, the structure component obtained an average score of 9.96 (SD=1.73), and, out of a total of 23 points , the process component obtained an average score of 16.41 (SD=1.22). In the correlation analyses, in 2017 (RHO = -0.495; p = 0.023), 2018 (RHO = -0.588; p = 0.005), and 2019 (RHO = -0.495; p = 0.023), a negative correlation was evidenced and significant difference between the process component and the incidence indicator. There was also a significant and positive association between the incidence and abandonment indicators in 2017 (RHO = 0.528; p = 0.014) and 2019 (RHO = 0.528; p = 0.014), and a significant and negative association between the abandonment and cure indicators in 2018 (RHO = -0.556; p = 0.009). From the survey of academic articles, it was concluded that primary health care services in Brazil still have important limitations regarding the implementation of tuberculosis control actions, lacking effective interventions on the part of managers and greater commitment from health professionals. health. Regarding the health region addressed, it was concluded that the “process” component, despite lacking advances, obtained a better evaluation when compared to the “structure” component. Taking into account a better result of the evaluation of the process component and the low incidence rates of tuberculosis in the region in the analyzed period, in relation to the state and national rates, it is suggested a good performance of the primary health care services in the assistance to the person with tuberculosis. It was also possible to attest to the capacity of primary health care services to produce results capable of improving tuberculosis indicators, and thus reveals the challenge of decentralizing, with efficiency and quality, tuberculosis control actions for primary care. health, reinforcing the need to reorganize and strengthen this level of care.