Public Health

Diagnosis of TB can take up to 30 days in Ribeirao Preto

The data are from a survey conducted by USP. The city is one of the largest centers for health services of high complexity of the country

Foto: Marcos Santos/USP Imagens
Diagnosis was only detected in 90% of cases, the Specialized Services
Diagnosis was only detected in 90% of cases, the Specialized Services

In Ribeirão Preto, one of the largest centers polarizers health services of high complexity of the country, a patient can wait up to 30 days to get the diagnosis of tuberculosis in the health care system of the city. The number is the result of research conducted by the School of Nursing of Ribeirão Preto (EERP), USP. Among 100 respondents, 62% had tuberculosis as a diagnostic hypothesis in the first health service visited, or were not informed about what could be the complaint.

According to the author of the study, the nurse Maria Eugenia Firmino Brunello, in 58% of cases, was requested some kind of exam at the first service, although this factor was not crucial to the diagnosis was clear on the first visit. Patients who sought UAB [Basic Health Units] and PA [Ready-Calls] had to go through three or more health services for the diagnosis.

The diagnosis was only detected in 90% of cases, the Specialized Services. The time of diagnosis was similar among those who first sought the UABs and PAs, being respectively 33.5 and 33 days says Maria Eugenia. The researcher rescued, through interviews, the route of 100 patients from the moment he felt sick to search for the first service of health and disease diagnosis.

The nurse says that of the 100 patients interviewed, 63% had along the way the health services at the request of sputum smears and 59% X-Ray request. The application of these specific tests for the clarification of the case could have been higher, but the fact that the patient sometimes be nonspecific in reporting symptoms to professionals can also delay the diagnosis.

The nurse obtained records relating to patient records and information about health services and professionals who treated the patient, in addition to the exams through information systems WEB-TB, TB records system exclusive of the State of São Paulo and Hygia-WEB system of electronic medical records in Ribeirão Preto.

Considered by the Ministry of Health of the priority lines in the national policy of Primary Brazilian tuberculosis leads to death about six thousand people a year in the country According to Professor Antonio Ruffino Netto, Faculty of Medicine of Ribeirão Preto (FMRP), USP, coughing, fever, lack of appetite, weakness, weight loss, sputum with streaks of blood, and chest pain are symptoms of the disease. If handled properly, almost all patients progress to healing. If there abandoned the treatment, the disease can develop into a chronic tuberculosis, with greater difficulty to cure. Without treatment, about 50% progress to death over a period of five years, Ruffino Netto explains.

<b> Performance Indicators </ b>

The researcher developed indicators related to the performance of health services for the diagnosis of tuberculosis, considering the categories: equity offerings; service flow from the first health service to diagnosis; solving cases. The results showed that 69% of TB patients sought Ready room (ER) as the first health service, followed by the Primary Care Unit (UAB) and Specialized Services (SE).

It would be important to have a spatial local health system, with adequate support network for the laboratory tests, diagnostic support services, and knowledgeable staff to determine the shortest possible time to the diagnosis of the disease. It is necessary to implement the communication and integration between health services to improve service to users and avoid unnecessary repetition of procedures, highlights.

The nurse said that due to the high proportion of users using PAs, it is extremely important that professionals who work in these services are able to quickly recognize the patient with suspected tuberculosis, which could bring a positive impact on case detection 's disease.

The survey was conducted between June and December 2009. Nevertheless, the situation in 2013 remains the same: Maria Eugenia explains that there are still difficulties in the municipality of Primary Care in diagnosing the disease, and the intense search and preference of patients for emergency care units. Coordination Program for Tuberculosis Control in Ribeirão do with constant training community health workers and nursing staff, trying to raise awareness and encourage this level of care to check for respiratory symptoms in the community, he says.

The thesis route the user's health system: performance of health services for the diagnosis of tuberculosis in Black (2009) was directed by Professor Tereza Cristina Scatena Villa, the EERP, and defended in February 2013.

With information from USP Agency