O desafio do manejo integrado da tuberculose e diabetes mellitus na perspectiva de gestores de saúde

Abstract

Tuberculosis (TB) is considered also a major public health problem, particularly in developing countries. The growing epidemic of diabetes mellitus (DM) is a threat to TB control. Studies report that people with diabetes have a risk two to three times more likely to develop TB. The risk of adverse outcomes in the treatment of the two diseases also increases with the association of both diseases. In 2011, the World Health Organization (WHO) and the Union Against Tuberculosis and Lung Disease (UNION) developed a document, "Collaborative framework for care and control of tuberculosis and diabetes," which defines the coordinated management of both diseases. In Brazil, studies addressing this association are incipient and therefore there is a consolidated integrated management policy. Thus, health actions, in this instance, become fragmented and comprehensive care is compromised. This study aims to analyze complicating factors, challenges and opportunities for the integrated management of TB and DM, as public policy, from the perspective of health managers. Data collection occurred from April to August 2015, through semi-structured interviews with 12 managers of TB coordination of the Ministry of Health, State of eight municipalities in the metropolitan region of Belo Horizonte and Hospital Júlia Kubitschek. Data were recorded, transcribed and analyzed using content analysis technique proposed by Bardin. Among the challenges and difficulties mentioned, they have been fragmented care, the difficulty of communication between professionals and sectors; the disarticulation between the spheres of government and levels of care, lack of prioritization of integrated management of TB and DM as public health problems, TB still perceived neglected way, the difficulties in empowering teams and other work processes committed such as high staff turnover and lack of motivation. On the other hand, managers presented as potential for the integrated management the possibility of creating local clinical protocols, continuing education for health professionals and the restructuring of care model to health care based on the Care Networks. The directly observed treatment (DOTS) emerged both as a facilitator as an impediment. It is noticed that the integrated management of TB and DM, despite the recommendations of international health organizations, constitutes still a challenge, but the need to incorporate it as public policy is possible and urgent. Responsibility for its implementation should be shared between the various stakeholders, such as managers, health professionals and researchers of the subject. Only comprehensive care to users and / or patients, health education and the management will for change may contribute to the control of these diseases and the search of comprehensive health.