Pieri Flávia Meneguetti, Touso Michelle Mosna, Rodrigues Ludmila Barbosa Bandeira, Yamamura Mellina, Pinto Ione Carvalho, Dessunti Elma Mathias, Crispim Juliane de Almeida, Ramos Antônio Carlos Vieira, Arroyo Luiz Henrique, Neto Marcelino Santos, Garcia Maria Concebida da Cunha, Popolin Marcela Paschoal, Silveira Tatiane Ramos dos Santos, Arcêncio Ricardo Alexandre
Department of Nursing, Universidade Estadual de Londrina, Londrina, Paraná, Brazil.
Nursing and Public Health Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
PLoS Negl Trop Dis. 2014 Nov 20;8(11):e3324. doi: 10.1371/journal.pntd.0003324. eCollection 2014 Nov.
In Brazil, leprosy has been listed among the health priorities since 2006, in a plan known as the "Pact for life" (Pacto pela Vida). It is the sole country on the American continent that has not reached the global goal of disease elimination. Local health systems face many challenges to achieve this global goal. The study aimed to investigate how patients perceive the local health system's performance to eliminate leprosy and whether these perceptions differ in terms of the patients' income.
METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional study was conducted in Londrina, State of Paraná, Brazil. Interviews were performed with the leprosy patients. The local health system was assessed through a structured and adapted tool, considering the domains judged as good quality of health care. The authors used univariate, bivariate and multivariate analyses. One hundred and nineteen patients were recruited for the study, 50.4% (60) of them were male, 54.0% (64) were between 42 and 65 years old and 66.3% (79) had finished elementary school. The results showed that patients used the Primary Health Care service near their place of residence but did not receive the leprosy diagnosis there. Important advances of this health system were verified for the elimination of leprosy, verifying protocols for good care delivery to the leprosy patients, but these services did not develop collective health actions and did not engage the patients' family members and community.
CONCLUSIONS/SIGNIFICANCE: The patients' difficulty was observed to have access to the diagnosis and treatment at health services near their homes. Leprosy care is provided at the specialized level, where the patients strongly bond with the teams. The care process is individual, with limited perspectives of integration among the health services for the purpose of case management and social mobilization of the community to the leprosy problem.
自2006年以来，在一项名为“生命契约”（Pacto pela Vida）的计划中，麻风病已被列入巴西的卫生重点事项。巴西是美洲大陆上唯一尚未实现消除该疾病全球目标的国家。当地卫生系统在实现这一全球目标上面临诸多挑战。该研究旨在调查患者如何看待当地卫生系统在消除麻风病方面的表现，以及这些看法在患者收入方面是否存在差异。
方法/主要发现：在巴西巴拉那州隆德里纳进行了一项横断面研究。对麻风病患者进行了访谈。通过一种结构化且经过调整的工具对当地卫生系统进行评估，该工具考虑了被判定为优质医疗保健的领域。作者采用了单变量、双变量和多变量分析。119名患者被纳入该研究，其中50.4%（60名）为男性，54.0%（64名）年龄在42至65岁之间，66.3%（79名）完成了小学学业。结果表明，患者使用了居住地附近的初级卫生保健服务，但未在那里获得麻风病诊断。该卫生系统在消除麻风病方面取得了重要进展，验证了为麻风病患者提供优质护理的方案，但这些服务未开展集体卫生行动，也未让患者的家庭成员和社区参与进来。
结论/意义：观察到患者在离家较近的卫生服务机构获得诊断和治疗存在困难。麻风病护理在专科层面提供，患者与医疗团队联系紧密。护理过程是个体化的，在病例管理和社区针对麻风病问题的社会动员方面，卫生服务之间的整合视角有限。
