Difficulties in the accessibility to health services for tuberculosis diagnoses in Brazilian municipalities.
OBJECTIVE
To assess difficulties in the accessibility to tuberculosis diagnoses in the health services in Brazil.


METHODS
The study was carried out in 2007 and surveyed tuberculosis patients treated in the primary care services in the cities of Ribeirão Preto, São José do Rio Preto, Itaboraí (these three in Southeastern Brazil), Campina Grande and Feira de Santana (these two in Northeastern Brazil). The instrument 'Primary Care Assessment Tool' was used, adapted to assess tuberculosis care in Brazil. Tuberculosis diagnosis in the health services was assessed by means of multiple correspondence factor analysis.


RESULTS
The accessibility to the diagnosis was represented by the dimensions 'locomotion to the health service' and 'assistance service' in the factorial plan. The patients from Ribeirão Preto and Itaboraí were associated with more favorable conditions to the dimension 'locomotion to the health service' and the patients from Campina Grande and Feira de Santana were associated with less favorable conditions. Ribeirão Preto presented more favorable conditions to the dimension 'assistance service', followed by Itaboraí, Feira de Santana and Campina Grande. São José do Rio Preto presented less favorable conditions to both dimensions, 'locomotion to the health service' and 'assistance service', compared to the other cities.


CONCLUSIONS
The factor analysis enabled the visualization of the organizational characteristics of the services that provide tuberculosis care. The decentralization of the actions to the family health program and reference centers seems not to present a satisfactory performance regarding accessibility to the tuberculosis diagnosis, as the form of services organization was not a determinant factor to guarantee the accessibility to the early diagnosis of the illness.
Scatena
Lúcia Marina
LM
Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil. tite@eerp.usp.br
Villa
Tereza Cristina Scatena
TC
Netto
Antonio Ruffino
AR
Kritski
Afrânio Lineu
AL
Figueiredo
Tânia Maria Ribeiro Monteiro de
TM
Vendramini
Silvia Helena Figueiredo
SH
Assis
Marluce Maria de Araújo
MM
Motta
Maria Catarina Salvador da
MC
D001938:Brazil; D002947:Cities; D005163:Factor Analysis, Statistical; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008124:Locomotion; D011320:Primary Health Care; D014376:Tuberculosis / Q000175:diagnosis*; D055815:Young Adult