Adherence to tuberculosis treatment in Primary Health Care: perception of patients and professionals in a large municipality

Beraldo, Aline Ale; Andrade, Rubia Laine de Paula; Orfão, Nathália Halax; Silva-Sobrinho, Reinaldo Antônio da; Pinto, Érika Simone Galvão; Wysocki, Anneliese Domingues; Brunello, Maria Eugênia Firmino; Monroe, Aline Aparecida; Scatena, Lúcia Marina; Villa, Tereza Cristina Scatena

doi:10.1590/2177-9465-EAN-2017-0075

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RESEARCH • Esc. Anna Nery 21 (04) • 2017 • https://doi.org/10.1590/2177-9465-EAN-2017-0075 copy

Adherence to tuberculosis treatment in Primary Health Care: perception of patients and professionals in a large municipality

Adhesión a tratamiento antituberculoso en Atención Primaria de Salud: percepción de enfermos y profesionales en municipio importante

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

Analyze the actions developed in Primary Health Care (PHC) to promote adherence to tuberculosis (TB) treatment in the perception of patients and nursing team.

Methods:

Cross-sectional epidemiological study conducted at the PHC of Campinas-SP, through structured interviews with 18 corresponding questions on the perception of professionals (183) and patients (165). Chi-square test and Fisher's exact test were used.

Results:

Actions such as the promotion of autonomy and time for the patient to talk about doubts and concerns, guidance to seek information in books and/or on the Internet on the disease, and for the family to perform TB tests, undergo directly observed treatment, schedule monthly consultations, delivery of written information on treatment and incentive were actions more perceived by the professionals than patients reported receiving.

Conclusions:

The identification of gaps in the offer of actions for adherence to TB treatment can help health services to change and improve the practice and the epidemiological scenario of the disease.

Keywords:
Tuberculosis; Primary Health Care; Medication Adherence; Nursing Team

Profile	Variables		N	%
Sex	Male		121	73.3
Sex	Female		44	26.7
Education	Less than eight years of education		37	22.4
Education	Eight or more years of education		128	77.6
Housing	House		162	98.2
Housing	Homeless		3	1.8
Living arrangement	Alone		6	3.6
Living arrangement	Family members		159	96.4
Type of case	New		158	95.8
Type of case	Retreatment		7	4.2
Clinical form	Pulmonary		159	96.4
Clinical form	Pulmonary + extra-pulmonary		6	3.6
Use of alcohol	Yes	Occasionally	25	15.2
	Yes	Every day	12	7.3
	No		128	77.5
Use of tobacco	Yes	Occasionally	4	2.4
	Yes	Every day	35	21.2
	No		126	76.4

Profile of the nursing professionals		n	%
Professional category	Nurse	109	59.6
Professional category	Nursing aide/technician	74	40.4
Sex	Female	158	86.3
Sex	Male	25	13.7
Searches for information about tuberculosis in books and/or on the Internet	Yes	161	88.0
	No	22	12.0
Takes training courses to provide care to tuberculosis patients	Yes	136	74.3
	No	47	25.7

Actions developed		Patient n (%)	Professional n (%)	p
1. Guidance about tuberculosis	Yes	165 (100.0)	183 (100.0)	-
1. Guidance about tuberculosis	No	0 (0.0)	0 (0.0)	-
2. Guidance to seek information about the disease in books and/or on the Internet	Yes	163 (98.8)	154 (84.2)	< 0.0001^* * Chi-square test; ^‡ ‡ statistical significance to the chi-square test or Fisher’s exact test.
	No	2 (1.2)	29 (15.8)
3. Opportunity to speak about the treatment	Yes	92 (55.8)	172 (94.0)	< 0.0001^* * Chi-square test; ^‡ ‡ statistical significance to the chi-square test or Fisher’s exact test.
3. Opportunity to speak about the treatment	No	73 (44.2)	11 (6.0)
4. Scheduling of monthly medical appointments to monitor treatment	Yes	140 (84.9)	183(100.0)	< 0.0001^* * Chi-square test; ^‡ ‡ statistical significance to the chi-square test or Fisher’s exact test.
	No	25 (15.1)	0 (0.0)
5. Awareness-raising about the importance of keeping monthly appointments	Yes	163 (98.8)	183 (100.0)	0.1352^† † Fisher’s exact test;
	No	2 (1.2)	0 (0.0)	0.1352^† † Fisher’s exact test;
6. Guidance about undergoing control exams	Yes	163 (98.8)	182 (99.5)	0.5023^* * Chi-square test;
6. Guidance about undergoing control exams	No	2 (1.2)	1 (0.5)	0.5023^* * Chi-square test;
7. Guidance about how to take the tuberculosis medication	Yes	164 (99.4)	182 (99.5)	0.9414^† † Fisher’s exact test;
7. Guidance about how to take the tuberculosis medication	No	1 (0.6)	1 (0.5)	0.9414^† † Fisher’s exact test;
8. Delivery of written information about the treatment	Yes	92 (55.8)	134 (73.2)	0.0006^* * Chi-square test; ^‡ ‡ statistical significance to the chi-square test or Fisher’s exact test.
8. Delivery of written information about the treatment	No	73 (44.2)	49 (26.8)
9. Encouragement to continue the tuberculosis treatment	Yes	163 (98.8)	182 (99.5)	0.5023^† † Fisher’s exact test;
9. Encouragement to continue the tuberculosis treatment	No	2 (1.2)	1 (0.5)	0.5023^† † Fisher’s exact test;
10. Guidance to seek the health service in case of doubts about treatment	Yes	164 (99.4)	181 (98.9)	0.6237^† † Fisher’s exact test;
	No	1 (0.6)	2 (1.1)	0.6237^† † Fisher’s exact test;
11. Guidance to observe if symptoms improved during treatment	Yes	163 (98.8)	181 (98.9)	0.9170^† † Fisher’s exact test;
	No	2 (1.2)	2 (1.1)	0.9170^† † Fisher’s exact test;
12. Guidance about the conduct to be adopted if symptoms worsen	Yes	163 (98.8)	180 (98.4)	0.7380^† † Fisher’s exact test;
	No	2 (1.2)	3 (1.6)	0.7380^† † Fisher’s exact test;
13. Guidance to adopt healthier life habits	Yes	164 (99.4)	182 (99.5)	0.9414^† † Fisher’s exact test;
13. Guidance to adopt healthier life habits	No	1 (0.6)	1 (0.5)	0.9414^† † Fisher’s exact test;
14. Guidance for family members to undergo tuberculosis exams	Yes	158 (95.8)	182 (99.5)	0.0216^† † Fisher’s exact test; ^‡ ‡ statistical significance to the chi-square test or Fisher’s exact test.
	No	7 (4.2)	1 (0.5)
15. Time for the patient to talk about doubts and/or concerns	Yes	158 (95.8)	182 (99.5)	0.0216^† † Fisher’s exact test; ^‡ ‡ statistical significance to the chi-square test or Fisher’s exact test.
	No	7 (4.2)	1 (0.5)
16. Performs/offers directly observed treatment	Yes	129 (78.2)	143 (78.1)	< 0.0001^* ‡ statistical significance to the chi-square test or Fisher’s exact test. ^‡ ‡ statistical significance to the chi-square test or Fisher’s exact test.
16. Performs/offers directly observed treatment	No	36 (21.8)	40 (2.9)
17. Receives/provides incentives to undergo the treatment	Yes	147 (89.1)	162 (88.5)	0.0003^* * Chi-square test; ^‡ ‡ statistical significance to the chi-square test or Fisher’s exact test.
17. Receives/provides incentives to undergo the treatment	No	18 (10.9)	21 (11.5)
18. Invitation to participate in a group of tuberculosis patients	Yes	59 (35.8)	58 (31.7)	0.4229^* * Chi-square test;
	No	106 (64.2)	125 (68.3)	0.4229^* * Chi-square test;

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[1] Corresponding author: Aline Ale Beraldo. E-mail: li_aab@yahoo.com.br