Fatores clínicos e sociais relacionados com o tempo de hospitalização de pacientes com tuberculose na enfermaria de tisiopneumologia do Hospital Eduardo De Menezes, em Belo Horizonte, no ano de 2008

Abstract

Tuberculosis is an infectious disease that affects millions of people around the world, thus becoming a serious public health problem. Treatment should be done, preferably, on an outpatient basis, as recommended by the DOTS strategy (Directly Observed Treatment).Hospitalization is recommended only in cases of meningoencephalitis, clinical indications and surgical due to tuberculosis or comorbidities, drug intolerance uncontrollable ambulatory, general do not allow day-care, in social affairs, as no fixed abode or groups with higherlikelihood of abandonment, especially if a retreatment or bankruptcy. Despite the limited indications for hospitalization and the huge investments in building a network capable of receiving outpatient care and follow up patients, there were 17,502 admissions in 2008, whichgenerated an expense in the Health System R$ 19,545,384.18. The objective of this research was to know the profile of patients who were admitted to the ward tisiopneumologia Hospital Eduardo de Menezes in 2008 and the factors associated with prolonged hospital stay. One ofthe exclusion criteria was HIV positive or with AIDS, because this ward only interned patients HIV negative. Was defined as that of hospital stay longer than 25 days, and the clinical and social data were analyzed using Epi Info and SPSS. The total number of patients was 64 and the average profile can be characterized as being a man, aged between 35 and 54 years, not white, with incomes below the minimum wage, with schooling up to 1 degree, smoker, user spirit, malnutrition, hypoalbuminemia and anemia, who were treated with regimen 1 and the mean hospital stay of 64 days. Most were sent to the hospital units of emergency care orhospitals. The low educational level and history of noncompliance with treatment had a statistically significant relevance as determinants of prolonged hospitalization (p 0.02 and 0.02, respectively) and hospitalization due to drug intolerance was statistically significant forhospitalization for a period equal to or less than 25 days. The greatest clinical impairment and the precarious social situation of most patients, as well as the small size of the sample, which showed relative homogeneity made it difficult to meet other indicators relevant to prolonged hospitalizations. The low educational level is usually associated with poor social situation and therefore clinic, which prolongs the hospital. The history of early leads in most cases, the prolonged hospital stay for fear of further noncompliance, worsening of the disease and its sequels and also the risk of developing multidrug resistance. Admission motivated by intolerance to medication is discontinued once the patient has medical conditions to continue treatment on an outpatient basis, what happens in most cases, within a time less than 25 days.The proposals that strengthen the strategies of outpatient treatment and effective strategies that help to reduce the length of hospital stay to treat tuberculosis is to implement the strategic research of tuberculosis in hospital emergency rooms in major cities and in groups higher risk,and facilitate patients' access to primary health care and encouraging the ongoing training of health professionals, with emphasis on medical training to identify and intolerance outpatient approach, the construction of common stock between the programs of the SUS and Social System, with epidemiological studies of each area covered by the health units to develop strategies that could reverse the social environment and low education inducers of tuberculosis. Also, the expansion of the Health Program of Family-oriented care to street people. Providing shelter, temporary housing and shelters that can be used in the care ofhomeless patients by the end of treatment. All healthcare staff should be involved to reduce the percentage of abandonment. Establish public policies for improving the quality of food, access to healthy food is affordable and should be part of policies to control tuberculosis