The access of the homeless persons with tuberculosis to the health care: an integrative review
Introduction: The Tuberculosis (TB) keeps being a big public health problem in the world, having the poverty, the bad life condition, the bad income distribution, the social iniquity and the disability on the health system as a substrate to its maintenance.
Objective: To identify the scientific knowledge produced under the access to the health service of the homeless person sick by TB.
Method: Integrative literature review conducted from April to June, 2016, having as inclusion criteria: publications written in Portuguese, English or Spanish, published from 1990 to 2015, indexed on the data basis: LILACS, SciELO, MEDLINE and Web of Science and portals Virtual Health Library (VHL) and MEDLINE/PubMed, that had the text completely available online. As searching strategy was used the Boolean operator AND, with the descriptors: Tuberculosis, health services accessibility; homeless persons. To obtain the information that answered the research guideline question was elaborated a form that contemplated the following items: identification, theme, descriptors or key-words, abstract, introduction, method, results, discussion, conclusions and references. The search resulted in 51 articles that, observed with the inclusion and exclusion criteria, resulted in 10 complete articles. The data analyzes was made in qualitative terms, summarized in three categories: I) Specific characteristics of the homeless people access to the health services to tuberculosis diagnostic and treatment; II) Access difficulty to the health care: factors related to homeless people and factors related to health services; III) Strategies to overcome the access difficulties of the homeless person (HLP) to the health care.
Results: pointed that the homeless people have a higher risk to get sick by TB, presenting TB incidence rate 10 to 20 times higher than the general population. Many obstacles that limited those people access to the health services were identified. Many times they presented difficulty to identify the appropriated place to search for assistance and not always this place had the opened doors to this social group. Another important finding treats about the low adhesion to the TB treatment, because treating about the search for health care, the homeless people are less inclined to search the health services, seen that living on the street implies in a daily fight for survival. To those people, the sickness treatment has a lower priority than the meal obtaining, the searching for shelter, or the search for a job.
Discussion: It was observed that by the fact to be exposed to many risk factors, such as: alcoholism, chemical dependence, environmental exposition, inadequate sleeping accommodations, crowed shelters, stress, psycho disturbs, poverty, HIV infection, weak nutrition, affected immunity through the pre-existent conditions, lack of access to health services, cognitive affection and the adverse effects to the health by the lack of home, the homeless people have high risk to get sick and the high TB mortality rate if compared to the general population. Thus it is evident the serious problem that this disease represents to this specific group, justifying urgently the necessity of specific actions to the TB control in this population. The most important element during the TB elimination will be a significant decreasing of the agglomerations, on the poverty and the barriers to the health care. To increase the access to the health care is essential on the homeless population TB control. It is necessary to highlight that when health services that attends their necessity are provided, the homeless individuals will access to the health care at the same rhythm as the general population.
Conclusion: It is necessary that the health actions break the strictly technical caring barriers and include the psychosocial and educative perspective in all the health care process to homeless people with different conformations due to the individuals’ singularities and their scenarios. Thus, the search by the more integral care and, therefore, more efficient possible, it is wait that be included on the health team daily work, routines and process to a systematic search for the health necessities, and developed abilities to recognize the adequacy of the offers to the specific context, in which is given the meeting from the individual and the team.
Keywords: Tuberculosis; health services accessibility; homeless persons.
2. World Health Organization [WHO]. Global tuberculosis report 2014. 2014. Available from:http://apps.who.int/iris/bitstream/10665/137094/1/9789241564809_eng.pdf
3. Starfield B. Atenção Primária: equilíbrio entre necessidades de saúde, serviços e tecnologia. 2002. Available from:http://bvsms.saude.gov.br/bvs/publicacoes/atencao_primaria_p1.pdf
4. Santos MLSG. et al. Pobreza: caracterização socioeconômica da tuberculose. Rev. Latino-Am. Enfermagem. 2007; 15(spe): 762-767.DOI: http://dx.doi.org/10.1590/S0104-11692007000700008
5. Hijjar MA et al. Epidemiologia da tuberculose: importância no mundo, no Brasil e no Rio de Janeiro. Pulmão. 2005; 14(4): 310-314. Available from:http://www.sopterj.com.br/profissionais/_revista/2005/n_04/08.pdf
6. Bertolli Filho C. História social da tuberculose e do tuberculoso: 1900-1950 2001. Antropologia & Saúde collection. Available from:http://static.scielo.org/scielobooks/4/pdf/bertolli-9788575412886.pdf
7. San Pedro A, Oliveira RM. Tuberculose e indicadores socioeconômicos: revisão sistemática da literatura. Rev Panam Salud Publica.2013;33(4):294-301.DOI: http://dx.doi.org/10.1590/S1020-49892013000400009
8. Ministério da Saúde(BR), Secretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Panorama da tuberculose no Brasil: indicadores epidemiológicos e operacionais. 2014. Available from:http://bvsms.saude.gov.br/bvs/publicacoes/panorama%20tuberculose%20brasil_2014.pdf
9. Aguiar MM. Iriart JAB. Significados e práticas de saúde e doença entre a população em situação de rua em Salvador, Bahia, Brasil. Cad. Saúde Pública.2012; 28(1): 115-124. DOI: http://dx.doi.org/10.1590/S0102-311X2012000100012
10. Varanda W, Adorno RCF. Descartáveis urbanos: discutindo a complexidade da população de rua e o desafio para políticas de saúde. Saude soc. 2004; 13(1): 56-69. DOI: http://dx.doi.org/10.1590/S0104-12902004000100007
11. Carneiro Junior N, et al . Serviços de saúde e população de rua: contribuição para um debate. Saude soc. 1998; 7(2): 47-62. DOI: http://dx.doi.org/10.1590/S0104-12901998000200005
12. Popescu-Hagen M, Tanasescu M, Traistaru R, Postolache P. Homeless People: A Real Challenge in TB Management in Romania. Chest Journal. 2016; 149(4_S): A75 Available from:http://journal.publications.chestnet.org/article.aspx?articleid=2511476
13. Ministério da Saúde(BR), Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Política Nacional de Atenção Básica. 2012. Available from:http://22.214.171.124/dab/docs/publicacoes/geral/pnab.pdf
14. Lavras C. Atenção primária à saúde e a organização de redes regionais de atenção à saúde no Brasil. Saúde soc. 2011 ; 20(4): 867-874. DOI: http://dx.doi.org/10.1590/S0104-12902011000400005
15. Mendes EV. A atenção primária à saúde no SUS. Fortaleza, Escola de Saúde Pública do Ceará, 2002.
16. Ministério da Saúde(BR), Secretaria de Vigilância em Saúde. Departamento de Vigilância Epidemiológica. Sistema de Informação de Agravos de Notificação - Sinan: normas e rotinas. 2 ed. Brasília. 67p. 2007.
17. Ministério da Saúde(BR), Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Manual sobre o cuidado à saúde junto a população em situação de rua. 2012. Available from: http://126.96.36.199/dab/docs/publicacoes/geral/manual_cuidado_populalcao_rua.pdf
18. Ranzani OT, Carvalho CRR, Waldman EA, Rodrigues LC. The impact of being homeless on the unsuccessful outcome of treatment of pulmonary TB in São Paulo state, Brazil. BMC Medicine. 2016; 14:41. Available from:https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0584-8
19. Polit DF, Beck CT. Using research in evidence-based nursing practice. In: Polit DF, Beck CT, editors. Essentials of nursing research. Methods, appraisal and utilization. Philadelphia: Lippincott Williams & Wilkins; 2006. 457-94.
20. Benefield LE. Implementing evidence-based practice in home care. Home Health Nurse. 2003;21(12): 804-11. Available from: https://www.ncbi.nlm.nih.gov/pubmed/14665967
21. Beyea SC, Nicoll ELH. Writing an integrative review. Aorn J. 1998; 67(4):877-80. Available from:https://www.ncbi.nlm.nih.gov/pubmed/9616108
22. Mendes KDS, Silveira RCCP, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto Contexto Enferm. 2008;17(4):758-64. DOI: http://dx.doi.org/10.1590/S0104-07072008000400018
23. Ganong LH. Integrative reviews of nursing research. Res Nurs Health. 1987;10(1):1-11. Available from:https://www.ncbi.nlm.nih.gov/pubmed/3644366
24. Bardin L. Análise de conteúdo. Lisboa: Edições 70; 2007.
25. Bamrah S, Yelk Woodruff RS, Powell K, Ghosh S, Kammerer JS, Haddad MB. Tuberculosis among the homeless, United States, 1994–2010. Int J Tuberc Lung Dis. 2013. 17(11):1414–1419. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5077150/
26. Brewer TF, Heymann J, Krumplitsch SM, Wilson ME, Colditz GA, Fineberg HV. Strategies to Decrease Tuberculosis in US Homeless Populations. A Computer Simulation Model. JAMA. . 2001;286(7):834-842. Available from:https://www.ncbi.nlm.nih.gov/pubmed/11497538
27. Hwang SW. Homelessness and health. CMAJ. 2001; 164(1): 229-33. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80688/
28. Craig GM, Joly LM, Zumla A. ‘Complex’ but coping: experience of symptoms of tuberculosis and health care seeking behaviours – a qualitative interview study of urban risk groups, London, UK. BMC Public Health. 2014; 14:618. Available from:http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-618
29. Lashley M. A Targeted Testing Program for Tuberculosis Control and Prevention Among Baltimore City’s Homeless Population. Public Health Nursing. 2006; 24(1): 34–39. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17214651
30. Brickner PW, et al. Proviing Health Services or the Homeless: A Stitch in Time. Bulletin Of The New York Academy Of Medicine. 1993; 70(3): 146-170. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2359236/
31. Brudney K. Homelessness and TB: A Study in Failure. The Journal of Law, Medicine & Ethics. 1993; 21(3-4): 360-367. Available from: http://onlinelibrary.wiley.com/wol1/doi/10.1111/j.1748-720X.1993.tb01261.x/abstract
32. Macerata I, Soares JGN, Ramos JFC. Apoio com o cuidado de territórios existenciais: Atenção Básica e a rua. Interface (Botucatu). 2014. 18(supl. 1): 919-930. Available from: http://www.scielo.br/pdf/icse/v18s1/1807-5762-icse-18-1-0919.pdf
33. Carneiro Junior N. et al. Organização de práticas de saúde equânimes em atenção primária em região metropolitana no contexto dos processos de inclusão e exclusão social. Saude soc., São Paulo. 2006; 15(3):30-39. DOI: http://dx.doi.org/10.1590/S0104-12902006000300004
34. Mfinanga SG. et al. The magnitude and factors as sociated with delays in management of smear positive tuberculosis in Dar es Salaam, Tanzânia. BMC Health Serv Res. 2008; 8(158). Available from: https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-8-158
35. Arcencio RA, Oliveira MF, Villa TCS. Internações por tuberculose pulmonar no Estado de São Paulo no ano de 2004. Ciênc. saúde coletiva. 2007; 12(2): 409-417. Available from: http://www.redalyc.org/pdf/630/63012214.pdf
36. Otálvaro AFT, Arango MEC. Accesibilidad de la poblaci ón habitante de calle a los programas de Promoción y Prevención esta blecidos por la Resolución 412 de 2000. Investigaciones Andina. 2009; 11(18): 23-35. Available from: http://www.redalyc.org/pdf/2390/239016503003.pdf
37. Gelberg L, Andersen RM, Leake BD. The Behavioral Model for Vulnerable Populations: Application to Medical Care Use and Outcomes for Homeless People. HSR: Health Services Research. 2000; 34:6. Available from: https://www.researchgate.net/publication/12659629_The_Behavioral_Model_for_Vulnerable_Populations_Application_to_Medical_Care_Use_and_Outcomes_for_Homeless_People
38. Demissie M, Lindtjorn B, Berhane Y. Patient and health service delay in the diagnosis of pulmonary tuberculosis in Ethiopia. BMC Public Health. 2002; 2:23. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC130033/
39. Romaszko J, Siemaszko A, Bodzioch M, Buciński A, Doboszyńska A. active case finding among homeless people as a means of reducing the incidence of pulmonary tuberculosis in general population. Advs Exp. Medicine, Biology - Neuroscience and Respiration. 2016. Available from: http://link.springer.com/bookseries/5584
40. Stevens A, Bickler G, Jarrett L, Bateman N. The public health management of tuberculosis among the single homeless: is mass miniature x ray screening effective? Journal of Epidemiology and Community Health. 1992; 46: 141-143. Available from:http://pubmedcentralcanada.ca/pmcc/articles/PMC1059522/pdf/jepicomh00209-0055.pdf
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