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DEGREE OF AFFILIATION (OPEN QUESTIONS)
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A1. In which health unit are your
registered? |
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A2. Which health unit is the most
responsible for your care? |
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A3. Which health unit do you normally visit
when you get sick? |
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A4. What was the first health service you
sought when you started having the symptoms of leprosy?
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A5. What was the health service that found
(diagnosed) you had leprosy? |
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A6. Which health service do/did you visit
for your leprosy treatment? |
| Do/Did you use prednisone or thalidomide? ( ) Yes ( )
No. If YES, answer question A.7 |
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A7. In which health service were you
served? |
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FIRST CONTACT
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B1. Was the primary health care unit the
first place you looked for when you presented the signs
and symptoms of leprosy? |
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B2. Do/Did you look for the primary health
care unit for the examination of your family and
guidance on caring for your eyes, hands and feet for
prevention of disabilities? |
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B3. When you need (or needed) an
appointment due to a new health problem related to
leprosy (such as the appearance of new spots, pain in
the peripheral nerves and others), do/did you look for
the primary health care unit? |
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B4. Did you need to attend a consultation
in the primary health care unit to be referred for an
evaluation with a leprosy specialist (Ex.:
dermatologist)? |
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ACCESS
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C1. Is the health unit open after 6PM at
least one day during the week? |
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C2. When the unit is open, is there a phone
number to call for information? |
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C3. Is reaching the health unit difficult
for you? |
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C4. Do you have to use the bus, car or bike
to get to the health unit? |
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C5. Do you miss your work shift to be
served at the health unit? |
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C6. When you looked for the health unit
with complaints of leprosy symptoms, did you manage to
see a doctor or a nurse within 24 hours? |
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C7. Do you schedule an appointment at the
health unit to receive the supervised dose? |
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C8. When you come to the health unit, do
you have to wait longer than 30 minutes to receive the
supervised dose? |
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C9. Did you manage to schedule an
appointment at the health unit within 24 hours when you
had a new health problem related to leprosy (Ex.: nerve
pain, medication reactions, leprosy reactions)? |
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CONTINUED CARE
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D1. When you go to the health unit for a
leprosy consultation, are you seen by the same doctor at
all times? |
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D2. When you go to the clinic for a leprosy
consultation, are you seen by the same nurse at all
times? |
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D3. Does the doctor or nurse have your
medical records available during your consultation?
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D4. During your consultation, does the
doctor or nurse make notes on the details of your
appointment in your medical record? |
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D5. Does the doctor or nurse know your
whole health history (Ex.: other diseases you have or
had or surgeries)? |
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D6. Does the doctor or nurse ask about all
medicines that you are taking? |
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D7. Does the doctor or nurse ask if you
have trouble paying for drugs not provided by the SUS
and other products that you need? |
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D8. If you have any questions about the
illness or doubts about the treatment, can you speak
with the doctor or nurse that works at the health unit?
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D9. Does the doctor or nurse answer your
questions in a way that you understand? |
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D10. Does the doctor or nurse give you
enough time to talk about your concerns and answer your
questions? |
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D11. Does the doctor or nurse ask if
leprosy makes it difficult to perform activities of your
daily life? |
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D12. Does the doctor or nurse know about
your work? |
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D13. Are you satisfied with the service of
the health unit? |
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COMPREHENSIVENESS OF AVAILABLE SERVICES
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Are the following services available at the
primary health care units?
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E1. Vaccines |
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E2. Care for children |
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E3. Care for adolescents |
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E4. Care for adults |
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E5. Care for the elderly |
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E6. Family planning or contraceptive
methods |
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E7. Prenatal care |
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E8. Screening test for cancer of the cervix
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E9. Care for sexually transmitted diseases,
including counseling and request for HIV testing |
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E10. Care for schistosomiasis, dengue and
tuberculosis |
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E11. Care for hypertension, diabetes and
asthma |
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E12. Care for mental health problems |
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E13. Dressings |
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E14. Counseling or treatment for harmful
use of tobacco |
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E15. Advice on healthy eating |
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E16. Evaluation of oral health and dental
treatment |
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E17. Home care |
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COMPREHENSIVENESS OF PROVIDED SERVICES
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In relation to leprosy, does/did the health unit
provide those services?
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E18. Guidance on what is leprosy and how to
catch the disease |
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E19. Skin assessment with the sensitivity
test (warm/cold) |
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E20. Skin assessment with the sensitivity
test with cotton |
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E21. Skin assessment by performing the
monofilament testing (esthesiometer) |
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E22. Palpation of peripheral nerves |
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E23. Test sensitivity of the hands and feet
with the use of monofilaments (esthesiometer) |
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E24. Test sensitivity of the eyes with the
use of dental unflavored floss |
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E25. Assessment of motor strength |
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E26. Assessment of visual acuity by
applying the Snellen chart |
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E27. Request for blood tests in the
beginning of leprosy treatment |
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E28. Smear testing in the city |
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E29. Assessment of people who live with you
(contacts examination) |
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E30. Application of the BCG vaccine in
people who live with you |
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E31. Monthly consultation to evaluate your
health when you go to the health unit to receive the
supervised dose |
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E32. Guidance on the proper use of
medication for leprosy and the major reactions caused by
them |
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E33. Guidance on the care of the eyes,
hands and feet |
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E34. Guidance on the signs and symptoms of
leprosy reactions: the appearance of new spots on the
skin, nerve pain and decreased motor strength |
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E35. Sensitivity testing of eyes, hands and
feet and evaluation of muscle strength every three
months |
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E36. Offering of other services available
at the health unit |
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Answer questions E37 and E38 only if patient was
discharged.
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Does not apply in other cases.
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E37. Perform sensitivity testing of eyes,
hands, feet and evaluation of muscle strength at the end
of treatment |
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E38. Guidance on care after discharge for
healing, such as the periodic monitoring by
professionals and maintaining care of the eyes, hand and
feet |
| If the respondent answered the question A7, answer the
questions E39 to E43. |
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E39. Palpation of peripheral nerves, muscle
strength testing, sensitivity testing of eyes, hands and
feet, fortnightly or monthly |
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E40. Guidance to place the affected limb at
rest |
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E41. Initiation of treatment with
prednisone at the health unit |
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E42. Referral to the reference service
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E43. Regular monitoring of fasting glucose
(blood glucose), body weight and blood pressure during
treatment with prednisone |
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COORDINATION
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Only respond if the patient has been referred to
a specialist.
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Does not apply in other cases.
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F1. After scheduling the appointment with a
specialist, have you received any receipt and/or proof
of consultation? |
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F2. Has the doctor or nurse of the health
unit written a report for the specialist about the
reason for the visit? |
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F3. Have you returned to the health unit
with the report on the results of the consultation with
the specialist? |
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F4. Has the doctor or nurse at your health
unit talked to you about the results of the consultation
with the specialist? |
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To which health service were you referred?
Answer: Y – yes; N – no
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F5. Reference center for leprosy |
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F6. Making of shoes and insoles |
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F7. Psychology |
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F8. Physiotherapy |
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F9. Occupational therapy |
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F10. Social service |
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F11. Ophthalmology |
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F12. Neurology |
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F13. Orthopedics |
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F14. Hospital service (Hospital Eduardo de
Menezes or Hospital das Clínicas) |
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FAMILY ORIENTATION
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G1. Do you receive home visits from
professionals (doctor, nurse, or CHA) of the health unit
because of leprosy? |
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G2. Does the doctor or nurse know who lives
with you? |
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G3. Does the doctor or nurse ask about
diseases of other people in your family, such as
hypertension, diabetes and cancer? |
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G4. Does the doctor or nurse ask you if
people in your family have spots or areas of the skin
with loss or decreased sensitivity? |
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G5. Do health professionals (doctor, nurse,
or CHA) guide you and your family about the examination
of the family? |
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G6. Do health professionals (doctor, nurse,
or CHA) talk to people in your family about leprosy?
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G7. Does the doctor or nurse ask a person
from your family to accompany you on the routine of your
treatment? |
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G8. Do health professionals (doctor, nurse,
or CHA) talk with people who live with you about the
care you need to have with your eyes, hands and feet?
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G9. Do health professionals (doctor, nurse,
or CHA) talk with people who live with you about the
possibility of appearance of new spots, lumps and nerve
pain during or after the treatment of leprosy? |
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Only answer the question G10 if you were
discharged for healing. Does not apply in other
cases.
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G10. Do health professionals (doctor,
nurse, or CHA) talk with people who live with you about
the care after discharge for healing? |
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COMMUNITY ORIENTATION
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H1. Have you seen stories on leprosy in
television, radio and newspapers? |
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H2. Does the health unit organize lectures
and give pamphlets to inform the community about
leprosy? |
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H3. Do schools and churches disseminate
information on leprosy to the community? |
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H4. Does the health unit carry out
activities in the community to identify people who have
spots (Ex: spot day)? |
