Gateway to the diagnosis of tuberculosis among elders in Brazilian municipalities

Sá, Lenilde Duarte de; Scatena, Lucia Marina; Rodrigues, Rosalina Aparecida Partezanni; Nogueira, Jordana de Almeida; Silva, Antonia Oliveira; Villa, Tereza Cristina Scatena

doi:10.1590/0034-7167.2015680313i

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Revista Brasileira de Enfermagem

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Sumário

RESEARCH • Rev Bras Enferm 68 (3) • June 2015 • https://doi.org/10.1590/0034-7167.2015680313i copy

Gateway to the diagnosis of tuberculosis among elders in Brazilian municipalities

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to analyze the factors associated with the gateway of the health systems of Brazilian municipalities for the diagnosis of tuberculosis in older people.

Method:

survey study type, with a sample of 91 elders, in a population with 706 cases of tuberculosis. Data were collected by means of an instrument based on the Primary Care Assessment Tool (PCAT) adapted for tuberculosis care, emphasizing the gateway variable. Variables were categorized and compared between primary health care (PHC) and specialized care (SC) services. Bivariate analysis and the Chi-square association test were used.

Results:

a statistically signifi cant association (p = 0.0001) was found between the fi rst health service sought and the unit that diagnosed tuberculosis, showing better performance of specialized care services in the diagnosis.

Conclusion:

it is necessary to improve primary health care services to tackle delayed diagnosis of tuberculosis in older people.

Key words:
Tuberculosis; Health of the Elderly; Primary Health Care

Characteristics	João Pessoa	Feira de Santana	Vitória	São José do Rio Preto	Ribeirão Preto	Foz do Iguaçu	Pelotas
Country region	NE	NE	SE	SE	SE	S	S
Municipal population estimated for 2009	674,762	571,997	317,817	319,189	558,136	319,189	339,934
Number of Family Health Strategies	180	83	20	14	21	31	28
Coverage of the Family Health Program	89%	49%	74%	20%	13%	33%	28%
Number of primary health care units	139	14	28	24	41	33	50
TB control actions	D	D	C	D	C	C	C

Variáveis	First health service sought
	PHC	SC	TOTAL	p value
	n (%)	n (%)	n (%)	p value
TB suspicion at first consultation
No	22 (59.5)	35 (64.8)	57 (62.6)	0.6039
Yes	15 (40.5)	19 (35.2)	34 (37.4)	0.6039
TOTAL	37 (100.0)	54 (100.0)	91 (100.0)
First HS requested Sputum Smear Test
No	20 (54.1)	35 (64.8)	55 (60.4)	0.4445
Yes	17 (45.9)	19 (35.2)	36 (39.6)	0.4445
TOTAL	37 (100.0)	54 (100.0)	91 (100.0)
First HS requested X-ray
No	11 (29.7)	18 (33.3)	29 (31.9)	0.6876
Yes	26 (70.3)	36 (66.7)	62 (68.1)	0.6876
TOTAL	37 (100.0)	54 (100.0)	91 (100.0)
Referred to other services
No	14 (37.8)	25 (46.3)	39 (42.9)	0.5516
Yes	23 (62.2)	29 (53.7)	52 (57.1)	0.5516
TOTAL	37 (100.0)	54 (100.0)	91 (100.0)
Unit that diagnosed TB
PHC	20 (54.1)	9 (16.7)	29 (31.9)	0.0001
SC	17 (45.9)	45 (83.3)	62 (68.1)	0.0001
TOTAL	37 (100.0)	54 (100.0)	91 (100.0)

Primeiro SS procurado	Time in days to the first visit
Primeiro SS procurado	n (%)	Median	Quartiles 25 and 75	p value
Primary Health Care	37 (40.7)	1.0	[0.0; 7.0]	0.0214
Specialized Care	54 (59.3)	0.0	[0.0; 1.0]	0.0214
	Number of times at the HS to discover TB
Service that made the diagnosis	n (%)	Median	Quartiles 25 and 75	p value
Primary Health Care	29(31.9)	3.0	[2.0; 6.0]	0.9763
Specialized Care	62 (68.1)	3.0	[2.0; 4.0]	0.9763
	Time in days to discover TB
Service that made the diagnosis	n (%)	Median	Quartiles 25 and 75	p value
Primary Health Care	29(31.9)	15.0	[6.0; 30.0]	0.5885
Specialized Care	62 (68.1)	15.0	[4.0; 40.0]	0.5885

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] CORRESPONDING AUTHOR: Lenilde Duarte de Sá. E-mail: sa.lenilde@gmail.com