Detecção da tuberculose na atenção primária à saúde: análise das ações em Pelotas e Sapucaia do Sul.

Abstract

Objective: The aim was to evaluate the actions to detect tuberculosis cases in primary health care in Pelotas and Sapucaia do Sul. Methods: This is an evaluative, descriptive, with mixed methods. It was divided into two steps, quantitative and qualitative. The quantitative study was linked to the original project "Primary health care considering the detection of tuberculosis cases in priority municipalities of southern Brazil: challenges and investments in information strategies", with data collection from 2013 to 2014. Data were collected with a checklist application in the 69 units of primary health care (PHC), on the structure for the detection of tuberculosis cases, as well as data from the respiratory symptom register books were collected in the PHC units and Laboratory books. The analysis was performed in StatSoft's Statistic software, applying descriptive statistics. For the qualitative data collection, the project was submitted to Brasil Platform. Data collection was performed with semi-structured interviews applied to two municipal managers responsible for tuberculosis control actions and eight PHC professionals, five in Pelotas and three in Sapucaia do Sul. The interviews, recorded in audio, were transcribed and analyzed using the Hyper Research software, applying the content analysis, Minayo thematic modality. The sections were selected and grouped according to the themes of respiratory symptomatic flow (SF) in the detection and cases of TB; The structure of the PHC units for case detection; Weaknesses and potentialities of the municipal case-finding flow. Results: the quantitative results showed the deficiency of structure for the detection of TB cases, with absence of: pots for sputum collection (24%); Registration forms (53.1%), log book (48%), thermal box to transport the samples (60%) and transportation of the material to the laboratory (86%) in Pelotas. The above items were available at all units examined in Sapucaia . During the qualitative stage, the professionals pointed out as the main structural deficiencies in both municipalities: the absence of professionals, the turnover of human resources , and the deficiency of capacities. In relation to the analysis of the flows, two different streams of detection were obtained, in Pelotas a fragmented flow was verified because of the lack of accountability of the PHC due to the continuity of the SF care, and the results were below the recommended targets, with 8.8% in the city diagnostics in 2012. In contrast, in Sapucaia do Sul, the flow was based on continuity of care from detection to cure, achieving better results, with 50% of the diagnoses of the municipality. Conclusion: The way in which tuberculosis case detection flows are organized by muni cipal management is decisive in promoting or limiting the commitment of PHC teams in coordinating care and, consequently, achieving the goal of disease control.