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      Assessment of Primary Health Care in the Treatment of Tuberculosis in a Brazilian Locality of the International Triple Frontier

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          Abstract

          Objective:

          To evaluate the performance of Primary Health Care (PHC) in treatment of TB patients in a triple international border municipality.

          Methods:

          The present study was an evaluative survey of cross-sectional and quantitative approach conducted with 225 PHC healthcare professionals. Data was collected through a structured and validated instrument, which provided five indicators of "structure" and four indicators of "process" classified as unsatisfactory, regular or satisfactory.

          Results:

          The "structure" component was unsatisfactory for the indicator of professionals involved in TB care and training, and regular for the indicator of connection between the units and other levels of care. The "process" component was regular for the indicators of TB information, directly observed treatment and reference and counter reference on TB, and unsatisfactory for external actions on TB control.

          Conclusion:

          The "structure" and "process" components points out some weaknesses in terms of management and organization of human resources. Low frequency of training and the turnover influenced the involvement of professionals. Elements of "structure" and "process" show the need for investing in the PHC team and improving the clinical management of cases.

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          Most cited references37

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          Framework for action on interprofessional education and collaborative practice

          (2010)
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            Health-system strengthening and tuberculosis control.

            Weak health systems are hindering global efforts for tuberculosis care and control, but little evidence is available on effective interventions to address system bottlenecks. This report examines published evidence, programme reviews, and case studies to identify innovations in system design and tuberculosis control to resolve these bottlenecks. We outline system bottlenecks in relation to governance, financing, supply chain management, human resources, health-information systems, and service delivery; and adverse effects from rapid introduction of suboptimum system designs. This report also documents innovative solutions for disease control and system design. Solutions pursued in individual countries are specific to the nature of the tuberculosis epidemic, the underlying national health system, and the contributors engaged: no one size fits all. Findings from countries, including Bangladesh, Cambodia, India, Tanzania, Thailand, and Vietnam, suggest that advances in disease control and system strengthening are complementary. Tuberculosis care and control are essential elements of health systems, and simultaneous efforts to innovate systems and disease response are mutually reinforcing. Highly varied and context-specific responses to tuberculosis show that solutions need to be documented and compared to develop evidence-based policies and practice. Copyright 2010 Elsevier Ltd. All rights reserved.
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              Avaliação do acesso às ações de controle da tuberculose no contexto das equipes de saúde da família de Bayeux - PB

              A descentralização das ações de controle da Tuberculose para o âmbito da Atenção Primária à Saúde (APS), vem impondo reorientação da prática das Equipes de Saúde da Família (ESF) e requerendo metodologias que avaliem em que medida os componentes da APS estão sendo alcançados. Este estudo toma como recorte um componente da APS-acesso, com o objetivo de avaliar as ações de controle da Tuberculose no contexto das ESF em Bayeux-PB. Pesquisa avaliativa, de abordagem quantitativa, que envolveu 82 profissionais de saúde. O instrumento utilizado continha sete perguntas fechadas, segundo possibilidades produzidas por escala intervalar tipo Likert. Os dados foram tabulados utilizando-se o programa - Statistical Package for the Social Sciences e analisados segundo frequência e mediana. Os resultados revelaram fragilidades e potencialidades de acesso às ações de controle da Tuberculose (TB). Quanto às potencialidades, constatou-se que a descentralização do tratamento dos casos de TB vem se estabelecendo na prática das ESF: 92,7% dos entrevistados mencionaram que os doentes de TB sempre conseguem consulta nas unidades, sendo possível para 82,9% obtê-la no prazo de 24 horas; os medicamentos específicos apresentaram-se acessíveis para 64,6% das ESF. Como fragilidades, verificou-se que 61% dos entrevistados não realizaram coleta de escarro; 54,9% das unidades não oferecem atendimento no horário de almoço; 89,8% dos entrevistados não contam com auxílio transporte; apenas 40,2% das unidades adotam regularmente a visitação domiciliar. Recomenda-se a adoção de mecanismos de gestão que viabilizem a uniformização e utilização dos recursos existentes, ampliando a capacidade resolutiva das ESF, promovendo eficiência na prestação de serviços e assegurando o acesso da população.
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                Author and article information

                Journal
                Open Nurs J
                Open Nurs J
                TONURSJ
                The Open Nursing Journal
                Bentham Open
                1874-4346
                22 September 2017
                2017
                : 11
                : 124-134
                Affiliations
                [1 ]Universidade Estadual do Oeste do Paraná, Foz do Iguaçu, Brazil
                [2 ]Universidade Federal do Mato Grosso do Sul, Três Lagoas, Brazil
                [3 ]Universidade Federal do Triangulo Mineiro, Uberaba, Brazil
                [4 ]Universidade Federal do Rio Grande do Norte, Natal, Brazil
                [5 ]Universidade de São Paulo, Ribeirão Preto, Brazil
                Author notes
                Address correspondence to this authors at the Universidade Estadual do Oeste do Paraná (UNIOESTE - State University of West of Paraná) Av. Tarquínio Joslin dos Santos, Brazil, 1300. Tel: +55(45) 3575-2733, Fax: +55(45) 3576 8185; E-mails: reisobrinho@ 123456unioeste.br ; reisobrinho@ 123456yahoo.com.br
                Article
                TONURSJ-11-124
                10.2174/1874434601711010124
                5688391
                677bf2c9-b7b2-46ce-90c6-dcb7fe6094a4
                © 2017 Silva-Sobrinho et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 20 March 2017
                : 03 April 2017
                : 04 June 2017
                Categories
                Article

                Nursing
                tuberculosis , program evaluation and health services , primary health care ,health on the border,management,decentralization

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