Coordinated care for tuberculosis: data registration and implementation of a computerized system

Orfão, Nathalia Halax; Crepaldi, Nathalia Yukie; Brunello, Maria Eugênia Firmino; Andrade, Rubia Laine de Paula; Monroe, Aline Aparecida; Ruffino-Netto, Antonio; Villa, Tereza Cristina Scatena

doi:10.1590/1413-81232017226.15352016

Brasil

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FREE THEMES • Ciênc. saúde colet. 22 (6) • June 2017 • https://doi.org/10.1590/1413-81232017226.15352016 linkcopy

Coordinated care for tuberculosis: data registration and implementation of a computerized system

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective to analyze sources of data for tuberculosis (TB) before and after the implementation of the Computerized System to Record Care for TB in Ribeirão Preto - SP.

Method Intervention, descriptive-analytical epidemiological study. Data was collected from secondary sources using a structured form, and analyzed using Chi-squared or Fisher’s Exact Test, with a significance level of 5%.

Results We found an association between the period before implementation of the system and placing the Directly Observed Treatment Card in the file, and registration of instructions for the return visit by the nursing team. The latter was associated with an increase in registered data regarding TB patient telephone number, address, end of treatment date, status at closing, sputum smear results for monthly control, HIV test, monthly checkups, tests ordered by physician, social worker visits, patient living conditions, contact control, social incentives and the use of drugs and alcohol.

Conclusion Implementing the system improved the registration of a number of variables, despite the fact that other sources of data other than the system continue to exist.

Health information systems; Assessment of tuberculosis healthcare systems

Sections	Variables
I - Data from the DOT follow-up file (yellow file) and the computerized SISTB system.	Records of DOTs performed The existence of the DOT card in the clinical file TB patient notifying party control data Contact data (address and telephone) for TB patients Location where the majority of the medication supervision was performed
II - Information in the TB patient registration and follow-up book (Green book).	TB patient i.d. records TB patient clinical information records Test results records (sputum test, X-Ray, HIV), including monthly control tests Status at closure records
III - Clinical File Data	Monthly physician, nurse and social worker visits Instructions given and procedures performed by the physician and nursing team Records of other Healthcare Services used by the TB patient Records of DOTs performed TB patient living conditions TB patient tests during treatment Records of notifying parties Social incentives offered to the TB patient Use of drugs and alcohol by the TB patient

Variables		Before System Implementation* (n = 23)		After System Implementation (n = 16)		p***

		Yes N (%)	No N (%)	Yes N (%)	No N (%)
Card stored in file		23 (100)	0	0	16 (100)	0.000
TB patient telephone contact		0	23 (100)	8 (50)	8 (50)	0.000
TB patient address		17 (73.9)	6 (26.1)	16 (100)	0	0.031
DOT		17 (73.9)	6 (26.1)	13 (81.3)	3 (18.7)	0.447
Medicinal supervision location	Home	16 (69.6)	7 (30.4)	13 (81.3)	3 (18.7)	0,331
Medicinal supervision location	Healthcare Service	1 (4.3)	22 (95.7)	0	16 (100)	0,590
Information on notifying party		0	23 (100)	2 (12.5)	14 (87.5)	0.162

Variables		Before SISTB implementation (n = 23)		After SISTB implementation (n = 16)		p

		Yes (%)	No (%)	Yes (%)	No (%)
TB patient data	Name	23 (100)	0	16 (100)	0
	Age	23 (100)	0	16 (100)	0
	Gender	23 (100)	0	16 (100)	0
	File number	23 (100)	0	16 (100)	0
	SINAN number	0	23 (100)	0	16 (100)
TB patient clinical information	Clinical Form	22 (95.7)	1 (4.3)	16 (100)	0	0.590**
	Type of Entry	23 (100)	0	16 (100)	0
	Treatment start date	23 (100)	0	16 (100)	0
	Treatment end date	7 (30.4)	16 (69.6)	13 (81.3)	3 (18.7)	0.001*
	Status at closing	7 (30.4)	16 (69.6)	14 (87.5)	2 (12.5)	0.000*
Results of the sputum test for diagnostic purposes		19 (82.6)	4 (17.4)	15 (93.7)	1 (6.3)	0.304**
Results of the sputum test for monthly control purposes		0	23 (100)	6 (37.5)	10 (62.5)	0.002**
Results of the X-Ray		23 (100)	0	16 (100)	0
Results of the HIV test		17 (73.9)	6 (26.1)	16 (100)	0	0.031**

Variables			Before SISTB implementation (n = 23)		After SISTB implementation (n = 16)		p

			Yes (%)	No (%)	Yes (%)	No (%)
Monthly physician visits (5 or more)			8 (34.8)	15 (65.2)	11 (68.7)	5 (31.3)	0.037*
Monthly visits to the nurse			4 (17.4)	19 (82.6)	4 (25)	12 (75)	0.425**
Social worker visits			2 (8.7)	21 (91.3)	15 (93.7)	1 (6.3)	0.000*
Physician instructions		General instructions***	1 (4.4)	22 (95.6)	2 (12.5)	14 (87.5)	0.363**
		Tests performed	4 (17.4)	19 (82.6)	0	16 (100)	0.108**
		Return visits	20 (87)	3 (13)	14 (87.5)	2 (12.5)	0.674**
Procedures performed by the physician		Clinical progress	20 (87)	3 (13)	15 (93.7)	1 (6.3)	0.452**
		Prescription	19 (82.6)	4 (17.4)	16 (100)	0	0.108**
		Referrals	4 (17.4)	19 (82.6)	0	16 (100)	0.108**
		Tests ordered	4 (17.4)	19 (82.6)	15 (93.7)	1 (6.3)	0.000*
Instructions performed by the nursing team		General instructions***	5 (21.7)	18 (78.3)	1 (6.3)	15 (93.7)	0.196**
		Tests performed	5 (21.7)	18 (78.3)	0	16 (100)	0.058**
		Return visits	11 (47.8)	12 (52.2)	1 (6.3)	15 (93.7)	0.005**
Procedures performed by nursing team		Nursing care	8 (34.8)	15 (65.2)	3 (18.7)	13 (81.3)	0.234**
Procedures performed by nursing team		Other***	1 (4.4)	22 (95.6)	4 (25)	12 (75)	0.803**
Use by other Healthcare Services to follow other comorbidities, perform tests, etc.			4 (17.4)	19 (82.6)	2 (12.5)	14 (87.5)	0.522**
DOT performed			4 (17.4)	19 (82.6)	5 (31.3)	11 (68.7)	0.265**
TB patient test conditions			1 (4.4)	22 (95.6)	13 (81.3)	3 (18.7)	0.000*
Tests performed during treatment	Sputum test		20 (87)	3 (13)	13 (81.3)	3 (8.7)	0.478**
	X-Ray		23 (100)	0	13 (81.3)	3 (8.7)	0.061**
	HIV test		21 (91.3)	2 (8.7)	8 (50)	8 (50)	0.006**
Notifying parties			8 (34.8)	15 (65.2)	11 (68.7)	5 (31.3)	0.037*
Social Incentives - Basic Basket of Food Items			2 (8.7)	21 (91.3)	15 (93.7)	1 (6.3)	0.000*
Drug and alcohol use			2 (8.7)	21 (91.3)	9 (56.3)	7 (43.7)	0.002**

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[TFN1001] *Data collected in the DOT card. Once the SISTB was in place, this card was generated by the system. ** Data collected by the SISTB system. ***Fisher’s Exact Test.