Itinerário terapêutico de doentes com tuberculose vivendo em situação de rua no Rio de Janeiro
Itinerário terapêutico de doentes com tuberculose vivendo em situação de rua no Rio de Janeiro
Data
2018
Autores
Zuim, Regina Célia Brazolino
Trajman, Anete
Journal Title
Journal ISSN
Volume Title
Publisher
Physis: Revista de Saúde Coletiva
Resumo
A tuberculose é um grave problema de saúde
na população em situação de rua, com altas taxas de
prevalência e de interrupção do tratamento. Neste estudo,
buscamos compreender o itinerário terapêutico dos doentes
com tuberculose que vivem em situação de rua. O estudo
teve abordagem qualitativa com informações coletadas por
entrevista semiestruturada, revisão de prontuários e busca no
Sistema de Informação de Agravos de Notificação (SINAN).
Metodologia: Para organização e análise dos dados, utilizou-
se a técnica da Análise de Conteúdo de Bardin. O suporte
teórico sobre o itinerário terapêutico foi o modelo de Sistema
de Cuidados à Saúde proposto por Arthur Kleinman, que
descreve o acesso pelos subsistemas popular, profissional
e folk. Resultados e Discussão: Foram realizadas 19
entrevistas. O subsistema popular, representado pelas redes
configuradas nas ruas e por desconhecidos, influenciou
as decisões dos entrevistados na busca pelo cuidado no
subsistema profissional. A principal escolha no subsistema
profissional, o mais utilizado, recaiu sobre os serviços de
pronto atendimento. Nesse subsistema, as práticas foram
diferentes segundo o tipo de serviço acessado, e as trajetórias
traçadas foram, também, influenciadas pelo estigma,
acolhimento, fragmentação da atenção, regras e normas dos
serviços de saúde e precária intersetorialidade. O subsistema
folk não foi acessado nesta amostra.
Tuberculosis continues to be a serious and prevalent health problem in this population, who frequently interrupt treatment. This study aims to describe the therapeutic itinerary of homeless persons with tuberculosis, from the initial perception of the symptoms to the moment of hospitalization. Methods: The study used a qualitative approach, containing information and perceptions collected through semi-structured interviews, medical records and the tuberculosis information system. Interviews were interpreted using the discourse content analysis, proposed by Bardin. The theoretical approach adopted to understand their therapeutic itinerary was the health care system model proposed by Arthur Kleinman, in which the popular, professional and folk subsystems can be accessed. Results and discussion: We conducted nineteen interviews. The popular subsystem, represented by the social street network and the general (anonymous) population, influenced the search for care of the professional subsystem. Their main choice in the professional subsystem, the most assessed, was the emergency services. In this subsystem, the practices were different according to the type of accessed service and traced trajectories were influenced by stigma, greeting by health professionals, fragmentation of attention, rules and norms of health services and unsatisfactory intersectorality. The folk subsystem was not accessed in this sample.
Tuberculosis continues to be a serious and prevalent health problem in this population, who frequently interrupt treatment. This study aims to describe the therapeutic itinerary of homeless persons with tuberculosis, from the initial perception of the symptoms to the moment of hospitalization. Methods: The study used a qualitative approach, containing information and perceptions collected through semi-structured interviews, medical records and the tuberculosis information system. Interviews were interpreted using the discourse content analysis, proposed by Bardin. The theoretical approach adopted to understand their therapeutic itinerary was the health care system model proposed by Arthur Kleinman, in which the popular, professional and folk subsystems can be accessed. Results and discussion: We conducted nineteen interviews. The popular subsystem, represented by the social street network and the general (anonymous) population, influenced the search for care of the professional subsystem. Their main choice in the professional subsystem, the most assessed, was the emergency services. In this subsystem, the practices were different according to the type of accessed service and traced trajectories were influenced by stigma, greeting by health professionals, fragmentation of attention, rules and norms of health services and unsatisfactory intersectorality. The folk subsystem was not accessed in this sample.
Description
Palavras-chave
Itinerário terapêutico, pessoas em situação de
rua, tuberculose, therapeutic itinerary, homeless persons, tuberculosis.
Citação
Zuim RCB, Trajman A. Itinerário terapêutico de doentes com tuberculose vivendo em situação de rua no Rio de Janeiro [Therapeutic itinerary of homeless persons with tuberculosis in Rio de Janeiro]. Physis: Revista de Saúde Coletiva. 2018;28(2):e280205. doi: 10.1590/S0103-73312018280205