Healthcare Management of Tuberculosis: Integrating a Teaching Hospital Into Primary Health Care

Abstract

Qualitative, exploratory and interventionist case study at a teaching hospital of Paraná, with the objective of proposing a Tuberculosis Healthcare Management model focused on the hospital discharge, with a view to comprehensive care for patients with tuberculosis. Interviews were conducted with key informants (17 subjects), using the Theory of Nursing Praxis Intervention in Collective Health as the theoretical and methodological framework, with its three interdependent dimensions used as analytical categories. Weakness was revealed in the protocols for hospitalized patient care, insufficient integration between levels of care and the need for direct communication between the hospital and primary care nurses. In view of this result, a Healthcare Management Model, expressed as a flow of care with matrix support, nursing consultation and phone contact between nurses. The implementation of this model will lead to greater integration between the levels of care, permitting improvements in patient monitoring with greater probability of treatment compliance.

Chronic disease in childhood and adolescence: continuity of care in the Health Care Network

“…A study (8) shows that this gap in communication occurs during hospital discharge because the hospital does not come into contact with the FHS for sharing information to ensure the fundamental conditions for the continuity of care.…”

“…However, it has not adequately addressed the demands of children and adolescents with chronic illness and their families, resulting in dissatisfaction and disregard of that service as a trusted source of care (7) . Studies (6,8) indicate that limitations in the continuity of care include gaps in the system of reference and counter reference and the limited coordination of Unified Health System (Sistema Único de Saúde -SUS) as a whole because of the inefficient communication between services and network professionals. Moreover, in the Brazilian states, there is limited access and an unequal distribution of skilled services for the care of children with chronic diseases (9) , which causes the permanent migration of families within the Health Care Network (HCN), often leading to an unsuccessful search for care (10) .…”

<b>Caracterização de crianças e adolescentes com anemia falciforme e os serviços de saúde que utilizam/ Characterization of children and adolescents with sickle cell anemia and the health services they use<b>

“…Dessa forma, o sistema público de saúde deixa lacunas na continuidade do cuidado, desencadeando reflexos nas ações de saúde destinadas a essa população. Além disso, a fragilidade de articulação do sistema de saúde e a ineficácia no sistema de referência e contrarreferência, decorrentes da falta de comunicação da rede de saúde, são apontadas como limitações para a continuidade do cuidado (13,14) . Essas fragilidades contribuem para as alterações no quadro clínico das crianças e dos adolescentes com doenças crônicas epodem acarretar hospitalizações desnecessárias, visto que as demandas dessa população não são supridas por esse cuidado fragmentado e pontual, que tem sido oferecido pelo sistema público de saúde (3) .…”

Reference and counter-reference health care system of infant discharged from neonatal unit: perceptions of primary care health professionals

“…15,18,[23][24][25] The authors suggest that nurses should be responsible for the initial contact with the PCU, passing on important information about the children's period of hospitalization, scheduling the hospital visit and guaranteeing the first consultation at the PCU, and this may be an important strategy in overcoming the gap existent between the hospital and the PCU. 26 Proposals that seek de-hospitalization and propose care at home require agreements and guarantee of access to all levels of health, with well-established flows of reference and counter-reference. [27][28][29] …”