The adoption of a new diagnostic technology for tuberculosis in two Brazilian cities from the perspective of patients and healthcare workers: a qualitative study.

BACKGROUND: This article presents the qualitative component linked to a larger study of implementation of the Xpert™ MTB/Rif technology in two Brazilian cities. Despite intrinsic advantages of new health technologies, its introduction can be disruptive to existing routines, and it is thus important to understand how these innovations are perceived by the different groups involved in its regular use. METHODS: This study was based on semi-structured interviews with patients, lab technicians, health care workers and managers involved with diagnosis and care of Tuberculosis (TB). The interviews had their content analyzed in order to abstract the different perspectives for the various actors. RESULTS: For patients the changes were not perceived as significant, since their greatest concerns were related to treatment and the stigma associated with TB. The professionals in general welcomed the new technique, which dramatically decreases the workload, time and reliability of diagnosis, in their view. However, we noted difficulties with the concomitant implementation of new IT technology for recording and reporting test results, which negatively impacted the time necessary to get lab diagnosis to physicians. CONCLUSIONS: Through this analysis we detected some bottlenecks in the surrounding environment, not necessarily linked to the technology itself but which could hamper considerably its advantages.

[On haystacks, needles, doctors, and medical knowledge: the thought style of physicians]. / Sobre palheiros, agulhas, doutores e o conhecimento médico: o estilo de pensamento dos clínicos.

This paper, the second in a series, reports on a study designed to assess how physicians operate selective mechanisms to sort out relevant and/or reliable information from what is presented to them. Twenty-four professors of internal medicine from two leading medical schools in Rio de Janeiro, Brazil, answered open-ended interviews. The conceptual framework adopted is based on Ludwik Fleck's work (on thought style). The thought style that emerged from this set of interviews can be briefly characterized as a largely intuitive, pragmatic, results-oriented search for relevant (i.e., potentially useful in practice) information, selected from sources with sufficient academic credibility and submitted to a primacy of practical knowledge. However, despite this skepticism, doctors lack resources (i.e. time, as well as knowledge of technical aspects of research, particularly in terms of epidemiology and statistics) to effectively assess the knowledge that is constantly being force-fed to them.