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
本研究为横断面评估研究，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协作情况。研究分为三个阶段：干预方案设计、评判矩阵构建以及规范性分析。同时访谈了来自三个照护层级的医师与护士，作为结核病控制项目（Tuberculosis Control Program）的管理人员。研究人员为评判矩阵的各项指标赋值，并将协作情况划分为优秀（≥75%）、良好（50%~74%）、较差（25%~49%）以及极差（<25%）四个等级。不同照护层级间的医疗协作得分为32.5%，被评为较差；行政协作、信息协同与临床管理的得分分别为41.2%、32.0%与31.0%，同样处于较差等级。研究结果显示，各照护层级各自为政，服务网络互联互通存在缺陷，最终导致医疗协作不畅、照护服务碎片化。