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Detención de pacientes persistentemente no adherentes con tuberculosis
T Oscherwitz1, J P Tulsky, S Roger
1Program in Medical Ethics, University of California, San Francisco, USA.
JAMA
|September 18, 1997
Resumen
La detención civil de pacientes con tuberculosis que no se adhieren al tratamiento es una medida de salud pública. Si bien muchos pacientes detenidos completaron el tratamiento, es posible que se necesiten detenciones más largas para garantizar su finalización.
Área de la Ciencia:
- Salud Pública La salud pública.
- Control y Control de Enfermedades Infecciosas
- La gestión de la tuberculosis.
Sus antecedentes:
- La no adherencia persistente al tratamiento de la tuberculosis (TB) plantea un riesgo significativo para la salud pública.
- California implementó un proceso de detención civil en 1993 para pacientes con TB no infecciosos pero persistentemente no adherentes.
Objetivo del estudio:
- Para identificar las características de los pacientes objeto de detención por parte de los controladores de TB.
- Para determinar la frecuencia y las ubicaciones de las detenciones de pacientes.
- Evaluar las tasas de finalización del tratamiento contra la TB entre los pacientes detenidos.
Principales métodos:
- Diseño de una serie de casos con comparación transversal con otros pacientes adultos con TB.
- Estudio realizado en doce condados de California con altos números de casos de tuberculosis en 1994.
- Datos obtenidos de registros de salud pública, entrevistas oficiales de TB y informes oficiales de casos de TB.
Principales resultados:
- Los controladores de tuberculosis llevaron a cabo la detención civil o el arresto de 67 pacientes (1,3% de los adultos elegibles).
- Los pacientes detenidos con frecuencia experimentaron falta de vivienda (46%), abuso de sustancias (81%) y enfermedades mentales (28%).
- De los 49 pacientes detenidos analizados, el 84% completó la terapia, aunque solo 17 fueron detenidos hasta su finalización; los pacientes detenidos tuvieron una mayor pérdida de seguimiento y tasas de finalización más bajas que los pacientes no detenidos.
Conclusiones:
- La mejora de la atención de los pacientes con tuberculosis persistentemente no adherentes puede requerir servicios psicosociales mejorados.
- Los centros de detención civil apropiados son cruciales para la gestión de las personas no adherentes.
- La duración de la detención debe ser suficiente para garantizar la finalización del tratamiento para la tuberculosis.
Palabras clave:
Enfoque empírico El enfoque empírico.Atención médica y salud pública.Enfoque jurídico El enfoque jurídico.Más Videos Relacionados
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