Quality of tuberculosis care at different levels of health care in Brazil in 2013
ABSTRACT Objective To assess 1) the burden and socio-demographic and clinical characteristics of tuberculosis (TB) cases, and 2) the quality of TB care provided to patients who entered and remained within each health care service level (primary, secondary, or tertiary) and those who moved from one...
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| Format: | Article |
| Language: | English |
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Pan American Health Organization
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| Series: | Revista Panamericana de Salud Pública |
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| Online Access: | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892016000100003&lng=en&tlng=en |
| _version_ | 1818467058175705088 |
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| author | Patricia Bartholomay Daniele Maria Pelissari Wildo Navegantes de Araujo Zaida E. Yadon Einar Heldal |
| author_facet | Patricia Bartholomay Daniele Maria Pelissari Wildo Navegantes de Araujo Zaida E. Yadon Einar Heldal |
| author_sort | Patricia Bartholomay |
| collection | DOAJ |
| description | ABSTRACT Objective To assess 1) the burden and socio-demographic and clinical characteristics of tuberculosis (TB) cases, and 2) the quality of TB care provided to patients who entered and remained within each health care service level (primary, secondary, or tertiary) and those who moved from one level to another, using process and results indicators. Methods This cross-sectional operational research study assessed new smear-positive pulmonary TB cases diagnosed in Brazilian state capitals in 2013 using TB program records and the TB surveillance system. Quality of care was assessed based on process and results indicators including HIV screening, TB contact screening, Directly Observed Treatment (DOT), sputum smear microscopy monitoring, and treatment outcomes. Results There were 12 977 new smear-positive TB cases reported. Of these, 7 964 (61.4%) cases were diagnosed and treated at the primary care level, 1 195 (9.2%) at the secondary level, 1 521 (11.7%) at the tertiary level, and 2 296 (17.7%) at more than one level, with 65% of the latter group moved from the tertiary level to the primary level. The proportion of cases tested for HIV was significantly higher in patients receiving care at the primary level compared to those receiving care at the secondary level (prevalence ratio (PR): 1.17; 95% confidence interval (CI): 1.07–1.28) and those attending more than one service level. Patients attending the tertiary health care level had a 122% higher PR for not doing DOT (“DOT not done”) compared to patients at the primary level (PR: 2.22; CI: 2.12–2.32). When the two levels were compared, the prevalence for an unfavorable outcome (lost to follow-up, death from TB, death with TB, transferred out, or not evaluated) was higher at the tertiary health care level. Conclusions Primary health services are successfully incorporating the management of new smear-positive TB cases. Primary health care obtained better operational indicators than secondary or tertiary levels. |
| first_indexed | 2024-04-13T21:04:35Z |
| format | Article |
| id | doaj.art-568af5fc11fc4664bb1602096e555646 |
| institution | Directory Open Access Journal |
| issn | 1680-5348 |
| language | English |
| last_indexed | 2024-04-13T21:04:35Z |
| publisher | Pan American Health Organization |
| record_format | Article |
| series | Revista Panamericana de Salud Pública |
| spelling | doaj.art-568af5fc11fc4664bb1602096e5556462022-12-22T02:30:02ZengPan American Health OrganizationRevista Panamericana de Salud Pública1680-5348391311S1020-49892016000100003Quality of tuberculosis care at different levels of health care in Brazil in 2013Patricia BartholomayDaniele Maria PelissariWildo Navegantes de AraujoZaida E. YadonEinar HeldalABSTRACT Objective To assess 1) the burden and socio-demographic and clinical characteristics of tuberculosis (TB) cases, and 2) the quality of TB care provided to patients who entered and remained within each health care service level (primary, secondary, or tertiary) and those who moved from one level to another, using process and results indicators. Methods This cross-sectional operational research study assessed new smear-positive pulmonary TB cases diagnosed in Brazilian state capitals in 2013 using TB program records and the TB surveillance system. Quality of care was assessed based on process and results indicators including HIV screening, TB contact screening, Directly Observed Treatment (DOT), sputum smear microscopy monitoring, and treatment outcomes. Results There were 12 977 new smear-positive TB cases reported. Of these, 7 964 (61.4%) cases were diagnosed and treated at the primary care level, 1 195 (9.2%) at the secondary level, 1 521 (11.7%) at the tertiary level, and 2 296 (17.7%) at more than one level, with 65% of the latter group moved from the tertiary level to the primary level. The proportion of cases tested for HIV was significantly higher in patients receiving care at the primary level compared to those receiving care at the secondary level (prevalence ratio (PR): 1.17; 95% confidence interval (CI): 1.07–1.28) and those attending more than one service level. Patients attending the tertiary health care level had a 122% higher PR for not doing DOT (“DOT not done”) compared to patients at the primary level (PR: 2.22; CI: 2.12–2.32). When the two levels were compared, the prevalence for an unfavorable outcome (lost to follow-up, death from TB, death with TB, transferred out, or not evaluated) was higher at the tertiary health care level. Conclusions Primary health services are successfully incorporating the management of new smear-positive TB cases. Primary health care obtained better operational indicators than secondary or tertiary levels.http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892016000100003&lng=en&tlng=enTuberculosisatención primaria de saludservicios de saluddescentralizacióninvestigación operativaBrasil |
| spellingShingle | Patricia Bartholomay Daniele Maria Pelissari Wildo Navegantes de Araujo Zaida E. Yadon Einar Heldal Quality of tuberculosis care at different levels of health care in Brazil in 2013 Revista Panamericana de Salud Pública Tuberculosis atención primaria de salud servicios de salud descentralización investigación operativa Brasil |
| title | Quality of tuberculosis care at different levels of health care in Brazil in 2013 |
| title_full | Quality of tuberculosis care at different levels of health care in Brazil in 2013 |
| title_fullStr | Quality of tuberculosis care at different levels of health care in Brazil in 2013 |
| title_full_unstemmed | Quality of tuberculosis care at different levels of health care in Brazil in 2013 |
| title_short | Quality of tuberculosis care at different levels of health care in Brazil in 2013 |
| title_sort | quality of tuberculosis care at different levels of health care in brazil in 2013 |
| topic | Tuberculosis atención primaria de salud servicios de salud descentralización investigación operativa Brasil |
| url | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892016000100003&lng=en&tlng=en |
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