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Master's Dissertation
DOI
Document
Author
Full name
Kelly Cristina Lino dos Santos
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2018
Supervisor
Committee
Takahashi, Renata Ferreira (President)
Bertolozzi, Maria Rita
Galesi, Vera Maria Neder
Hino, Paula
Title in Portuguese
Avaliação da aplicabilidade de um instrumento para monitorar a ocorrência da tuberculose resistente às drogas na Coordenadoria Regional de Saúde Leste de São Paulo (SP)
Keywords in Portuguese
Enfermagem
Monitoramento epidemiológico
Tuberculose
Tuberculose resistente a múltiplos medicamentos
Vigilância epidemiológica
Abstract in Portuguese
Introdução: A tuberculose droga resistente continua sendo um problema de saúde pública grave e crescente. Dentre as medidas recomendadas para o seu controle, destacam-se o envolvimento de todos os profissionais e serviços de saúde no tratamento e a implementação de um sistema de monitoramento ativo dos casos. Objetivos: descrever o perfil epidemiológico da tuberculose droga resistente na Coordenadoria Regional de Saúde Leste de São Paulo, no período de 01 de janeiro de 2007 a 31 de dezembro de 2016 e analisar a percepção dos profissionais da saúde sobre o conteúdo e a aplicabilidade de um instrumento (MonitoraTBDR) para o monitoramento dos casos na Atenção Básica. Metodologia: trata-se de um estudo exploratório, de caráter aplicado, de abordagem quali-quantitativa, sendo entrevistados 24 profissionais de serviços de saúde e realizada a análise de conteúdo. Resultados: 208 pacientes, 63,5% homens, 45,7% brancos, 82,2% entre 20 e 59 anos, 31,3% com 8 a 11 anos de estudo, 56,7% empregados, 51% procedentes do estado de São Paulo; 93,3% com forma clínica pulmonar, 51,8% primária, 52,4% monorresistentes, 41,8% multirresistentes, 4,4% polirresistentes e 1,4% Extensively Drug-Resistant, 61,1% com alta por cura; 23,6% eram alcoolistas, 21,2% usuários de drogas, 18,8% tinham HIV, 11,1% diabetes, 5,8% eram tabagistas; 75% sem informação da modalidade do tratamento, 18,2% dos contatos foram examinados e 6,4% adoeceram. A maior parte do conteúdo do instrumento MonitoraTBDR foi classificada como clara, pertinente, precisa, relevante e suficiente. O instrumento foi avaliado como viável para o monitoramento dos casos, no entanto foram constadas algumas limitações para sua aplicação, como a obtenção de algumas informações pela dificuldade de comunicação com o serviço de referência e o dispêndio de tempo para consultar várias fontes de dados. Conclusões: o MonitoraTBDR é uma ferramenta viável, que facilitará o monitoramento da tuberculose droga resistente, principalmente se for instituído um sistema informatizado integrado que envolva todos os serviços responsáveis pelo paciente. Além disso, constituir um instrumento de apoio à assistência de enfermagem poderá favorecer a adesão ao tratamento.
Title in English
Evaluation of the applicability of an instrument to monitor the occurrence of drug-resistant tuberculosis at Eastern Health Regional Coordination in Sao Paulo
Keywords in English
Epidemiological Monitoring
Epidemiological Surveillance
Nursing
Tuberculosis
Tuberculosis Multidrug-Resistant
Abstract in English
Introduction: Drug-resistant tuberculosis remains a serious and growing public health problem. Among the measures recommended for its control, the involvement of all health professionals and services in the treatment and the implementation of an active case monitoring system stands out. Objectives: to describe the epidemiological profile of drug-resistant tuberculosis in the Regional Health Coordination East of São Paulo, from January 1st, 2007 to December 31st, 2016, and to analyze the perception of health professionals about the content and applicability of an instrument (MonitoraTBDR) to monitor cases in Primary Care. Methodology: it is an exploratory study, of an applied character, of a qualitative-quantitative approach, 24 professionals of health services hav been interviewed and carried out the analysis of content. Results: 208 patients, 63.5% men, 45.7% white, 82.2% between 20 and 59 years, 31.3% with 8 to 11 years of schooling, 56.7% employed, 51% from the state from São Paulo; 93.3% were clinically pulmonary diagnosis, 51.8% were primary, 52.4% were monoresistant, 41.8% were multiresistant, 4.4% were polyresistant and 1.4% extensively Drug-Resistant, 61.1% with hospital discharge due to healing ; 23.6% were alcoholics, 21.2% were drug users, 18.8% had HIV, 11.1% were diabetics, 5.8% were smokers; 75% without information on the treatment modality, 18.2% of the contacts were examined and 6.4% became ill. Most of the content of the MonitoraTBDR instrument was classified as clear, relevant, accurate, relevant and sufficient. The instrument was evaluated as feasible for the monitoring of the cases, however some limitations were found for its application, such as obtaining some information due to the difficulty of communication with the referral service and the time spent in consulting several data sources. Conclusions: MonitoraTBDR is a viable tool that will facilitate the monitoring of drug-resistant tuberculosis, especially if an integrated computerized system is established, that involves all services in charge of the patient. In addition, establishing an instrument to support nursing care may increase adherence to treatment.
 
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2019-10-23
 
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