Tuberculosis Control Program and patient satisfaction, Rio de
          Janeiro, Brazil

Portela, Margareth Crisóstomo; Lima, Sheyla Maria Lemos; Brito, Cláudia; Ferreira, Vanja Maria Bessa; Escosteguy, Claudia Caminha; Vasconcellos, Maurício Teixeira Leite de

doi:10.1590/S0034-8910.2014048004793

Acessibilidade / Reportar erro

Brasil

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Sumário

Public Health Practice • Rev. Saúde Pública 48 (3) • June 2014 • https://doi.org/10.1590/S0034-8910.2014048004793 copy

Tuberculosis Control Program and patient satisfaction, Rio de Janeiro, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

To evaluate factors associated with users’ satisfaction in the Tuberculosis Control Program.

METHODS

A cross-sectional study of 295 patients aged ≥ 18 years, with two or more outpatient visits in the Tuberculosis Control Program, in five cities in the metropolitan region of Rio de Janeiro, RJ, Southeastern Brazil, in 2010. Considering an estimated population of 4,345 patients, the sampling plan included 15 health care units participating in the program, divided into two strata: units in Rio de Janeiro City, selected with probability proportional to the monthly average number of outpatient visits, and units in the other four cities. In the units, four temporal clusters of five patients each were selected with equal probability, totaling 300 patients. A questionnaire investigating the users’ clinical and sociodemographic variables and aspects of care and service in the program relevant to user satisfaction was applied to the patients. Descriptive statistics about users and their satisfaction with the program were obtained, and the effects of factors associated with satisfaction were estimated.

RESULTS

Patients were predominantly males (57.7%), with a mean age of 40.9 and with low level of schooling. The mean treatment time was 4.1 months, mostly self-administered (70.4%). Additionally, 25.8% had previously been treated for tuberculosis. There was a high level of satisfaction, especially regarding medication provision, and respect to patients by the health professionals. Patients who were younger (≤ 30), those on self-administered treatment, and with graduate level, showed less satisfaction. Suggestions to improve the services include having more doctors (70.0%), and offering exams in the same place of attendance (55.1%).

CONCLUSIONS

Patient satisfaction with the Tuberculosis Control Program was generally high, although lower among younger patients, those with university education and those on self-administered treatment. The study indicates the need for changes to structural and organizational aspects of care, and provides practical support for its improvement.

Tuberculosis; Antitubercular Agents, supply & distribution; Patient Satisfaction; Program Evaluation; Communicable Disease Control; Cross-Sectional Studies

Variable	n	%	SE
Age (in complete years) ^a a Secretaria de Estado de Saúde do Rio de Janeiro. Programa de controle de tuberculose. Informe epidemiológico. Rio de Janeiro; 2011.	40.9 (EP = 0.7); Min = 18; Max = 78
Sex
Female	1,839	42.3	3.2
Male	2,506	57.7	3.2
Education
Illiterate	165	3.8	1.0
Can read and write	237	5.5	1.8
Elementary/secondary education incomplete	1,312	30.2	2.9
Secondary education complete	1,144	26.3	2.0
High school	1,274	29.3	3.7
Undergraduate education	213	4.9	2.0
Treatment time (months)^a	4.1 (EP = 0.2); Min = 1.0; Max = 24.0
Previous treatment for tuberculosis
No	3,210	73.9	3.7
Yes	1,120	25.8	3.7
No information	15	0.3	0.3
Completion of previous treatment (N = 1,120)
No	359	32.0	5.4
Yes	709	63.4	5.9
No information	52	4.6	2.7
Current type of treatment
Self-administered	3,059	70.4	7.5
DOTS	1,286	29.6	7.5

Variable	n	%	SE
General satisfactiona	9.2 (EP = 0.2); Min = 2.0; Max = 11.0
Information and clarification about the disease and treatment during first consultation
Excellent	1,589	36.6	3.9
Good	2,416	55.6	4.2
Regular	232	5.3	1.6
Poor	58	1.3	0.8
Very poor	50	1.2	0.4
Opportunity for questions/express concerns
Excellent	1,372	31.6	3.8
Good	2,600	59.8	3.9
Regular	264	6.1	1.3
Poor	59	1.4	0.6
Very poor	50	1.1	0.5
Supply of medication by the clinic
Excellent	2,208	50.8	4.3
Good	1,929	44.4	4.3
Regular	124	2.9	1.2
Poor	27	0.6	0.4
Very poor	48	1.1	0.7
No information	9	0.2	0.2
Form of administration of medication and their treatment
Excellent	1,519	35.0	3.9
Good	2,405	55.3	4.3
Regular	225	5.2	1.4
Poor	104	2.4	1.0
Very poor	79	1.8	0.9
No information	13	0.3	0.3
Privacy during attendance
Excellent	1,562	36.0	4.7
Good	2,307	53.1	5.5
Regular	290	6.7	1.8
Poor	76	1.7	0.7
Very poor	83	1.9	0.9
No information	27	0.6	0.4
Ease of making first appointment
Excellent	1,725	39.7	5.1
Good	1,914	44.1	5.4
Regular	423	9.7	3.0
Poor	171	3.9	1.4
Very poor	112	2.6	1.1
Waiting time for appointment
Excellent	679	15.6	3.4
Good	1,821	42.0	5.1
Regular	1,023	23.5	4.3
Poor	467	10.7	2.2
Very poor	318	7.3	1.9
No information	37	0.9	0.6
Cleanliness of the clinic
Excellent	546	12.6	3.0
Good	2,211	50.9	4.1
Regular	917	21.1	3.1
Poor	287	6.6	1.7
Very poor	370	8.5	1.5
No information	14	0.3	0.3
Respect on the part of the professionals
Excellent	1,882	43.3	4.2
Good	2,214	51.0	4.3
Regular	157	3.6	1.3
Poor	66	1.5	0.8
Very poor	26	0.6	0.4
Accessibility of doctor during the consultation
Excellent	1,764	40.6	4.7
Good	2,154	49.6	5.2
Regular	248	5.7	1.7
Poor	86	2.0	0.7
Very poor	93	2.1	1.2
Availability of facilities to do examinations in the clinic
Excellent	784	18.0	3.2
Good	2,242	51.6	4.6
Regular	605	14.0	2.5
Poor	441	10.2	2.5
Very poor	228	5.2	1.4
No information	45	1.0	0.5

Suggestion for improvement of services	n	%	SE
Increased number of doctors	3,040	70.0	3.3
Increased number of nurses	1,744	40.1	5.3
Extended opening hours	1,626	37.4	5.3
Consultation by appointment	2,244	51.6	4.7
Assistance with transport	1,971	45.4	5.2
Increase in security of the clinic	1,065	24.5	4.9
Examinations in the same place as attendance	2,394	55.1	5.5
Reduction in the number of medicines	892	20.5	3.6
Improvement in the comfort of the clinic	2,328	53.6	5.8
Improvement in the cleanliness of the clinic	2,268	52.2	6.7

Variable	More satisfied			Less satisfied			χ² (p)

	n	%	SE	n	%	SE
Received previous treatment for tuberculosis							0.2739
No	2,202	68.3	4.4	1,023	31.7	4.4
Yes	850	75.9	5.6	270	24.1	5.6
Sex							0.6779
Female	1,267	68.9	4.7	572	31.1	4.7
Male	1,785	71.2	4.5	721	28.8	4.5
Age (years)							0.0025
18 to 30	672	53.3	6.8	589	46.7	5.8
31 to 40	600	66.6	5.9	301	33.4	5.9
41 to 50	853	83.5	4.6	169	16.5	4.6
51 to 60	627	80.8	7.4	149	19.2	7.4
61 to 70	235	78.6	8.4	64	21.4	8.4
> 70	65	75.8	20.6	21	24.2	20.6
Education							0.0086
Illiterate/ Can read and write	338	84.1	8.3	64	15.9	8.3
Elementary/secondary education incomplete	912	69.5	4.1	400	30.5	4.1
Secondary education complete	776	67.9	6.9	368	32.1	6.9
High school	968	76.0	5.3	306	24.0	5.3
Undergraduate education	58	27.4	9.8	155	72.6	9.8
Type of treatment							0.0253
Self-administered	2,036	66.6	4.3	1,023	33.4	4.3
Supervised treatment (DOTS)	1,016	79.0	4.6	270	21.0	4.6

Variable	Intercept	Standard Error	p	Odds ratio
Variable	Intercept	Standard Error	p	Estimate	95%CI
Age (ref: 18 to 30 years)	-0.33	0.41	0.4233
31 to 40 years	0.84	0.41	0.0415	2.33	1.03;5.24
41 to 50 years	1.66	0.46	0.0003	5.26	2.15;12.87
51 to 60 years	1.51	0.59	0.0105	4.51	1.42;14.31
> 60 years	1.42	0.65	0.0291	4.14	1.16;14.83
Education (ref: up to secondary level)
High school level	0.73	0.43	0.0853	2.08	0.9;4.8
Undergraduate level	-1.33	0.62	0.0314	0.27	0.08;0.89
Type of treatment (ref: self-administrated)
Supervised - DOTS	0.64	0.32	0.0440	1.90	1.02;3.55

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E-mail: revsp@usp.br

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[1] Correspondence: Margareth C. Portela Departamento de Administração e Planejamento em Saúde Escola Nacional de Saúde Pública - Fiocruz Rua Leopoldo Bulhões, 1480 Sala 724 Manguinhos 21041-210 Rio de Janeiro, RJ, Brasil E-mail: mportela@ensp.fiocruz.br