Determinantes individuais: fatores predisponentes à utilização dos serviços de saúde na atenção ao diagnóstico da tuberculose

• Ano de defesa: 2011
• Autor(a) principal: Trigueiro, Débora Raquel Soares Guedes
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal da Paraí­ba; BR; Enfermagem; Programa de Pós-Graduação em Enfermagem; UFPB
• Palavras-chave em Português: Tuberculose; Diagnóstico tardio; Acesso aos Serviços de Saúde; Utilização; Individualidade; Tuberculosis; Delayed diagnosis; Health Services Accessibility; Utilization; Individuality; CIENCIAS DA SAUDE::ENFERMAGEM
• Link de acesso: https://repositorio.ufpb.br/jspui/handle/tede/5071

The delay in diagnosing Tuberculosis (TB) has been used to reflect the quality and opportunity of access by patients to the health care. Among many aspects which must be incorporated to evaluate the access, the present study aims to identify the influence of individual determinants about the pattern of service utilization in the attention to TB diagnostic, supported by the theoretic axis of the behavioral model proposed by Aday and Andersen, and the integrality of caring. It was considered that the behavior of looking for health care is determined by the following components: predisposition, availability, necessities and previous utilization experience. The interaction of these factors is defining of the time interval in which the sick person postpones to search for health assistance and to know his diagnostic and by the type of service searched. This is an epidemiological, sectional and evaluative research, with quantitative approach, which was developed in João Pessoa PB. The research involved 101 sick people under TB treatment. The data were collected from July to October, 2009, by means of a structured questionnaire, which was validated and adapted to the attention to TB in Brazil. The studied variables were categorized or dichotomized according to their specificities, which were compared between the different health services and submitted to statistical treatment by means of bivariate analysis, chi-square association test (2), median and non-parametric tests of Mann Whitney and Kruskal Wallis. The research found that 46.5% of TB patients searched for Primary Care Services (PCS) when they started to feel the signals and symptoms of TB. 36.6% of them opted by the Specialized Services (SS), and 16.8% looked for the ambulatory of TB Control Program (TBCP). Moreover, the research verified predominance of male sex patients (72.3%), age group from 18 to 40 years (56.4%), brown skin (57.5%), and low level of education (79.2%). The seriousness of symptoms provoked the search for care in 72.3% of cases. In addition, 62.4% used the health services previously. However, only 21.8% of patients did them as preventive control. In relation to the existence of association between individual determinants and the health service searched first, it was evidenced that patients with lower income used PCS (p= 0.0191), and the proximity of PCS units in relation to patients home influenced the utilization of this service (p= 0.0000). In relation to the time interval of searching for care, it was estimated a median value of 20 days to the general delay of infected patients. Then, the research verified that unmarried patients with less than 8 years of study and unemployed, students, separated or household, were the ones who delayed more in looking for a health service (30 days). The theoretic model used confirmed the presence of predisposing factors which favored the inequalities in the searching and obtainment of care. It was observed that the PCS has gradually conquered expressive opening to the entrance of sick people into the health system. Nevertheless, it demands an effort of recognition and articulation of elements of the process of care production in contexts in which unfolds the life of different subjects. The inclusion of subjective dimension in guarantee of integral care can contribute to the renovation of practices and reduction of iniquities of individuals affected by TB.