Evaluation of care coordination of users with multi-drug tuberculosis in the city of Recife, Pernambuco State, Brazil

ABSTRACT This is a cross-sectional evaluative study aimed at evaluating the coordination of care between levels of attention to patients with multidrug-resistant tuberculosis in the city of Recife, State of Pernambuco. It was carried out in three stages: intervention design, elaboration of the judgment matrix and normative analysis. Also physicians and nurses from the three levels of care were interviewed as managers of the Tuberculosis Control Program. Values were assigned to each indicator of the judgment matrix, which was classified as excellent (≥ 75%), good (50% -74%), poor (49% -25%) and critical (<25%). Coordination of care between care levels was considered poor (32.5%), as were administrative coordination (41.2%), information (32.0%) and clinical management (31.0%). It was revealed that the levels of attention are organized separately, with failures in the interconnection of the service network, resulting in uncoordinated and fragmented assistance.

摘要 本研究为横断面评价研究，旨在评估巴西伯南布哥州累西腓市耐多药结核病（multidrug-resistant tuberculosis）患者不同照护层级间的医疗照护协同情况。研究分为三个实施阶段：干预方案设计、评判矩阵构建以及规范性分析。同时，访谈了三级照护体系中担任结核病防控项目（Tuberculosis Control Program）管理人员的医师与护士。研究为评判矩阵的各项指标赋予分值，并将协同情况划分为优秀（≥75%）、良好（50%~74%）、一般（25%~49%）与极差（<25%）四个等级。研究结果显示，照护层级间的医疗协同得分为32.5%，被评定为一般；行政协同、信息互通与临床管理的得分分别为41.2%、32.0%与31.0%，同样被评定为一般。本研究揭示，当地照护体系各层级各自为政，服务网络互联存在缺陷，最终导致医疗照护缺乏协同、呈现碎片化状态。