Abstract
BackgroundHealth-service evaluation studies are fundamental for proposing interventions and ensuring improvements in healthcare quality. The present study assesses the performance of health services for indigenous and non-indigenous populations with regard to tuberculosis (TB) control.MethodsInterviews with TB patients who underwent treatment between 2009 and 2011 were conducted using the Primary Care Assessment Tool adapted for TB care in Brazil.ResultsPrimary healthcare (PHC) was the first treatment for most patients at symptom onset, and the diagnoses were typically performed by specialized services. Many patients experienced delayed TB diagnoses that required more than three medical appointments (51% and 47% for indigenous and non-indigenous populations, respectively). Indigenous people received social support, such as basic-needs grocery packages (2.19 ± 1.63 vs. 1.13 ± 0.49 for non-indigenous people, p < 0.01) and home visits from health professionals, with an emphasis on the performance of directly observed treatment strategies (DOT; 4.57 ± 0.89 vs. 1.68 ± 1.04 for non-indigenous people, p < 0.01).ConclusionsRegardless of the differences between indigenous and non-indigenous populations, the time needed to receive a TB diagnosis was unsatisfactory for both groups. Furthermore, DOT must be performed with better coverage among non-indigenous patients.
Highlights
Health-service evaluation studies are fundamental for proposing interventions and ensuring improvements in healthcare quality
The secondary database is used for epidemiological surveillance; the results found in this study are limited by the absence of important variables related to treatment default, as described in the literature, such as social characteristics, smoking, malnutrition, housing conditions, intravenous drug use, socioeconomic status, and access to health services
One hundred and eighty-six patients with TB were notified during the study period, and 46 patients (24.7%) were excluded for not having a confirmed diagnosis or being in a seclusion regimen
Summary
Health-service evaluation studies are fundamental for proposing interventions and ensuring improvements in healthcare quality. The present study assesses the performance of health services for indigenous and non-indigenous populations with regard to tuberculosis (TB) control. Many efforts have been made to increase the coverage of Primary Health Care (PHC). 50% of Brazilians have coverage for primary care [11], the majority of diagnoses of tuberculosis are performed in the emergency department or in secondary and tertiary hospitals [12,13]. PHC presents the longest time to diagnosis and the lowest proportion of diagnoses [14]. Increased coverage does not result in an improvement in the success rate of treatment [15]
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