Access to tuberculosis diagnosis in health services in the city of Ribeirão Preto SP (2006-2007). / Acesso ao diagnóstico de tuberculose em serviços de saúde do município de Ribeirão Preto - São Paulo (2006 - 2007)

AUTOR(ES)
DATA DE PUBLICAÇÃO

2009

RESUMO

The present study evaluates the access to tuberculosis diagnosis in health services in the city of Ribeirão Preto, in the state of São Paulo. The study was based in an instrument of the Primary Care Assessment Tool (PCAT), developed by Starfield (1998; 2000), adapted and validated to Brazil by Macincko and Almeida (2006) and adapted for TB care by Villa and Ruffino-Netto (2007). The convenience sample consisted of 100 TB patients who live in Ribeirão Preto, diagnosed between June 2006 and July 2007. Data were collected through structured interview. Patients answered the questions according to a 5-point Likert-type scale. Data on patients address and socioeconomic conditions were also collected. Geoprocessing was used to identify the reference services for each patient and the distance between their houses and the health services. Exploratory analysis and the Multiple Correspondence Factorial Analysis (MCFA) were used for data analysis. There was predominance of males, with incomplete primary education and living in owned houses. Regarding the start of the health care, although most patients searched for care at Basic Health Units (UBS), most diagnoses were done in emergency services, hospitals and health services outside the coverage area. Few patients were diagnosed in primary care and private services. Most characteristics evidenced that patients lived in low socioeconomic conditions. Most patients were contacted early by the health services. In total, 24% of the patients reported having difficulties to go to the health services, which can be related to the need of missing a day of work to go to the health appointment, and the need to use and pay for motorized transportation, needed by most patients. The use of MCFA enabled the identification of three groups: Group 1 was identified as patients diagnosed in private health services, with intermediate and high educational levels, who own a vehicle, have received care in health services far from their houses, needed transportation to go to the health services and had to pay for it. Organizational and sociocultural barriers were identified by this group. Group 2 consisted of patients diagnosed at UBDS (Basic Health District Units) and RCS (Reference Care Services), with low educational level, do not have vehicles, searched for care in health services close to their houses, did not use nor paid for transportation and missed a day of work to attend the health appointment. To this group, the greatest barrier was economic. Group 3 consisted of patients diagnosed in public hospitals and UBS, who managed to schedule appointments in at most 24 hours, have never missed the day of work to go to the health services and never faced difficulties to go to the health service. The organizational barrier was the main one identified by the group.

ASSUNTO(S)

primary health care tuberculose diagnosis tuberculosis acesso aos serviços de saúde diagnóstico health services accessibility atenção primária à saúde

ACESSO AO ARTIGO

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