de Lima Meiri Vanderlei Nogueira, Oliveira Rosangela Ziggiotti de, de Lima Airton Pereira, Felix Magda Lúcia Oliveira, Silveira Thais Gomes Verzignassi, Rossi Robson Marcelo, Teodoro Ueslei
Universidade Estadual de Maringá, Avenida Colombo 5790, Maringá, PR 87020, Brazil.
Cad Saude Publica. 2007 Dec;23(12):2938-48. doi: 10.1590/s0102-311x2007001200015.
The current study focuses on outpatient treatment of patients (n = 229) with American cutaneous leishmaniasis from 2001 to 2004, before and after decentralization of treatment to the municipal level in northwestern Paraná State, Brazil. While the treatment was still centralized, clinical evaluation and medical records were more complete and detailed, treatment was initiated earlier, and follow-up of the outcome was evaluated in 95% of patients and 100% of cases that received two treatment cycles. Treatment also complied with the guidelines of the American Cutaneous Leishmaniasis Control Manual. After decentralization, treatment was less rigorous: 32% of patients were treated with two cycles of N-methyl glucamine antimoniate without complying with the guidelines; 72.6% of patients received inadequate treatment; 84% of cases failed to received proper clinical follow-up. Lack of information on patient clinical records posed a serious obstacle to evaluation. The current study failed to identify any benefit in decentralizing treatment of American cutaneous leishmaniasis to the local level.
本研究聚焦于2001年至2004年期间巴西巴拉那州西北部将皮肤利什曼病治疗权力下放至市一级之前及之后，对229例美洲皮肤利什曼病患者进行门诊治疗的情况。在治疗仍集中进行时，临床评估和病历更为完整和详细，治疗开始得更早，95%的患者以及接受两个治疗周期的所有病例都对治疗结果进行了随访。治疗也符合《美洲皮肤利什曼病控制手册》的指南。权力下放后，治疗变得不那么严格：32%的患者接受了两个周期的葡甲胺锑酸盐治疗，但未遵循指南；72.6%的患者接受了不充分的治疗；84%的病例未得到适当的临床随访。患者临床记录信息的缺失给评估造成了严重障碍。本研究未能发现将美洲皮肤利什曼病的治疗权力下放到地方层面有任何益处。
