Speeches of managers about the policy of the directly observed treatment for tuberculosis

Oliveira, Rita de Cassia Cordeiro de; Sá, Lenilde Duarte de; Dias, Dayse Caetano Beserra; Pinheiro, Patrícia Geórgia Oliveira Diniz; Palha, Pedro Fredemir; Nogueira, Jordana de Almeida

doi:10.1590/0034-7167.2015680611i

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Revista Brasileira de Enfermagem

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RESEARCH • Rev. Bras. Enferm. 68 (6) • Nov-Dec 2015 • https://doi.org/10.1590/0034-7167.2015680611i copy

Speeches of managers about the policy of the directly observed treatment for tuberculosis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to analyze the managers' speeches about the policy transfer of the directly observed treatment (DOT) for tuberculosis control in the city of João Pessoa, Paraíba, Brazil.

Method:

this is a qualitative study developed in May and June, 2013 through semi-directed interviews with twenty health professionals in five health districts in João Pessoa/PB. The empirical material produced was analyzed according to the theoretical-analytical basis of the French Discourse Analysis by Pêcheux.

Results:

the study demonstrated weaknesses in the conduction and organization of actions in relation to the DOT. It revealed that the lack of knowledge of the managers about this policy has direct implications to the care of tuberculosis patients.

Conclusion:

the management should trace strategic plans to rethink the care practices and thus, reorganize the entire care network to users in order to effectively contribute to user adherence in the fight against tuberculosis.

Keywords:
Tuberculosis; Public Policies; Health Management

Textual fragments
The importance of creating the bond, the continuous monitoring of users, of being closer, since, in most cases, users are quite complicated. (G5)
It is the matter of co-responsibility of all actors involved in this process. It's actually the co-responsibility of all, and not just the manager's or just the user's or the professional's, it's of all actors involved [...]. So, when there is a conversation, communication, and when there is observation of this treatment, adherence happens much more easily. (G12)
It's an active search, we will not let patients run loose, right? We're always behind, to see if they're following the treatment normally, properly, correctly, if they're taking the drugs. That was the improvement, to be always searching. (G9)
There are many positive things, first, the patients ... they're more in loco, closer to their residences. (G2)
It's the guarantee of treatment until the end. (G1)
They (the professionals) used to have a great difficulty with the closure, and after the DOT, they (the professionals) are actually seeing more results at the completion of the monitoring. (G3)
We are increasing the cure rate and there is a higher treatment rate. I think these would be the favorable aspects of decentralization, by increasing the access of users to treatment. (G14)
The monitoring of users each day and on weekends, trying to provide this coverage, then, it's a favorable point for the DOT. (G6)
The community health agent's view, especially at the time of medication administration. Usually many CHAs visit the home of users early to check if they are really taking the medication, you know, and we see this as a real improvement. (G4)
Everyone (the professionals) should have the knowledge and know how to deal with this treatment. (G13)

Textual fragments
I identify as a barrier when the family health team has no bonds with the user; then, they (professionals) create a barrier and this complicates the process of monitoring that user. (G1)
Mostly, what people (users) report is the difficulty with monitoring, they complain a lot, for example, of the units opening hours, the user wakes up much earlier, has to go to work and cannot wait for the health agent's visit to watch the medication intake. (G5)
There are some professionals who resist to adhere to the policy, you know? (G2)
Involvement is more complicated. We have a lot of difficulty; for example, the dentists' adherence compared to other promotional activities that are not specific of oral health. (G5)
I think it's more a question of bureaucratization of this process. Often, when we are more attached to the bureaucratic aspect of the paper, sometimes, when we demand only that part of the paper, there may be weaknesses in the process. (G12)
The issue of drugs, which is what we experience on a daily basis with our users with tuberculosis, the majority, you know? We've faced a lot of difficulties here, with monitoring; these users' difficulty with completion, since they are already associated with other social and economic problems. (G8)
The main barrier I see is the fact that nowadays the health units do not have eating facilities inside, to provide for users, you know? (G3)

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
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[1] CORRESPONDING AUTHOR: Rita de Cassia Cordeiro de Oliveira. E-mail: ritaoliver2002@yahoo.com.br