Created in November 2020, the remote monitoring service for tuberculosis patients has already served 1,276 people in the health network of the municipality of Manaus. Currently, 723 patients are followed in the service provided by the city of Manaus, through the Municipal Department of Health (Semsa).
According to Semsa secretary Shádia Fraxe, telemonitoring was instituted as a means of strengthening the follow-up of tuberculosis patients by telephone contact, even in times of the Covid-19 pandemic, when many people avoided seeking a health unit. by telephone. contamination of the new coronavirus.
“As the strategy has shown positive results, the City Council of Manaus has decided to maintain remote monitoring in the actions of the municipal program to combat tuberculosis. It is a means of reinforcing the guarantee of access to care, the adherence of the patient to treatment and the reduction of cases of abandonment, in addition to the work carried out by the team of the health unit where the patient is supported.“Says Shadia Fraxe.
To carry out the remote monitoring service, Semsa provides a team made up of two infectiologists, two pediatricians and a nurse, who contact the patient by telephone at least once a month, to follow the drug treatment, which lasts at least six months. month. .
A total of 5,382 successful calls were made through the service, 339 in 2020, 4,276 last year and 767 this year.
The head of the Tuberculosis Control Center of Semsa, nurse Daniel Sacramento, informs that after notification of a new case of tuberculosis, in any health service in Manaus (basic health units, reference services or units hospitals), the information is exported to the remote monitoring platform, allowing professionals to have the information necessary to establish the first contact by telephone.
“With each phone call, the healthcare professional reinforces information about the disease, the treatment and the importance of assessing the patient’s household contacts, since transmission of the disease can occur between people who live in close proximity. . The professionals also try to identify the barriers encountered by the patient during the treatment so that they can eliminate them, especially if there is some kind of difficulty in accessing or following the health services”, explains Sacramento.
For infectious disease specialist Silvana de Lima e Silva, who works in telemonitoring tuberculosis, the service has been important in overcoming geographical barriers, using technology in favor of patient health, even from a distance.
“We can access patients more quickly, assess their current health status and advise them on effective TB treatment and control measures. Many have doubts about the adverse effects of drugs and the transmission period of the disease. Thus, at that time, we can better guide on these aspects and on others, directing the service towards each reality found. The involvement of the team is also essential, strengthening the relationship with the patient, reinforcing adherence to treatment and providing greater reliability and safety so that they do not abandon the use of the drugs”, Silvana said.
The doctor also reports that the main difficulty in carrying out the service is the frequency with which patients change their phone number and that many do not answer calls because they think it is a scam or commercial offers.
“This makes contact with patients difficult, delays care and can compromise the health response. It’s not uncommon for us to get in touch a day and days later the phone number has been changed,” explains Silvana.
case of tuberculosis
As a strategy to change the epidemiological indicators of tuberculosis in Manaus, the Brazilian capital with the highest incidence rate of the disease, Semsa has worked to increase the detection of new cases.
“The earlier the case is diagnosed, the lower the risk of community transmission, hospitalization or death. Another line of action is to expand the assessment of patient contacts, increase the number of tests and diagnose people who are infected but do not have active disease at the moment. With this, it is possible to offer preventive treatment and avoid the disease,” explains Sacramento.
In 2019, Semsa carried out 11,515 examinations of symptomatic respiratory patients (person who has been coughing for two weeks or more). In 2020, when the Covid-19 pandemic started and there was a reduction in demand for exams at UBS, 7,991 exams were performed. Last year, the number of symptomatic respiratory examinations reached 9,872.
“There was a 23.5% increase in the number of respiratory symptoms examined in 2021, compared to 2020. For 2022, the objective is to exceed the year 2019, the pre-pandemic period of Covid-19, where there was the best evaluation indicator with 11,515 patients examined in primary care”, Sacramento said.
With more testing being done, there was also an increase in case detection last year, with a record 2,316 new TB cases in Manaus, representing an incidence rate of 102, 7/100,000 inhabitants. “Compared to 2020, there has been an 11.6% increase in reported cases, and an equivalence to the cases diagnosed in 2019. At the beginning of this year, Manaus already registers 279 new cases of the disease”, informs the nurse.
Tuberculosis is an infectious and communicable disease caused by the mycobacterium Mycobacterium tuberculosis or Koch’s bacillus (BK), which mainly affects the lungs. The main symptom is cough and therefore the recommendation is that people who have had a cough for two weeks or more should be examined, seeking one of the health units in the municipal network to carry out tests.
Tuberculosis transmission occurs when, by talking, sneezing and especially coughing, people with active tuberculosis release particles into the air in the form of aerosols containing bacilli, which can transmit the disease to others. people.