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Almeida PFD, Santos AMD, Cabral LMDS, Fausto MCR. Context and organization of primary health care in remote rural communities in Northern Minas Gerais State, Brazil. CAD SAUDE PUBLICA 2021; 37:e00255020. [PMID: 34877992 DOI: 10.1590/0102-311x00255020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/17/2020] [Indexed: 11/22/2022] Open
Abstract
The study analyzes the structural characteristics of primary health care (PHC) in its contextual and organizational dimensions in remote rural municipalities (counties) in Northern Minas Gerais State, Brazil. This is a case study with a qualitative approach, using 21 semi-structured interviews with health system administrators and health care workers from the family health teams (EqSF), as well as secondary data. For the contextual dimension, the results show that socioeconomic factors in the remote rural municipalities condition the organization of PHC and leave the population vulnerable, especially in the rural areas of the remote municipalities. As for the organizational dimension, the principal characteristics are: coexistence of formal and informal assignment of the services' users, two modalities of first-contact services, namely basic health units (UBS) and 24-hour health centers; prioritization of response to the spontaneous demand; strong action by the Family Health Support Centers in the development of activities in promotion and prevention, expanded scope of practices by community health workers; partial guarantee of transportation for persons in treatment; partial computerization of the UBS with the implementation of the electronic patient record (e-SUS), telecardiology; and the More Doctors Program. The study found that remote rural municipalities are not a uniform unit, since the municipal (county) seat and the rural areas are unequal in terms of living conditions and lack specific organization, policies, and financing to guarantee access to PHC. With all the limitations, the observations show initiatives with major difficulties in maintenance and sustainability and sometimes without necessarily corresponding to the use of space and social life that define rural health itineraries.
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Affiliation(s)
| | - Adriano Maia Dos Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brasil
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Lui L, Schabbach LM, Nora CRD. Health regionalization and federative cooperation in Brazil: the role of inter-municipal consortium. CIENCIA & SAUDE COLETIVA 2020; 25:5065-5074. [PMID: 33295523 DOI: 10.1590/1413-812320202512.03752019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/15/2019] [Indexed: 11/21/2022] Open
Abstract
This paper aims to investigate public inter-municipal health consortium operation in Brazil. To this end, a qualitative documentary analysis was conducted on the content of the agreements between the consortia and the Federal Government, available at the Transparency Portal of the Federal Government, from 1996 to 2016. The results cover two categories: agreements concluded in Brazil and the content of the agreements signed by an inter-municipal public consortium (CIS). The agreements signed were concentrated mainly in the Southern and Southeastern regions and aimed to carry out regional actions, thus contributing to health regionalization. However, challenges related to the process of cooperation and coordination between the health management bodies persist, mainly related to the improvement of linkages between the consortium and the regional health coordination and in-depth social control of these organizations.
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Affiliation(s)
- Lizandro Lui
- Programa de Pós-Graduação em Sociologia, Universidade Federal do Rio Grande do Sul (UFRGS). Av. Bento Gonçalves 9500, Bairro Agronomia. 91501-970 Porto Alegre RS Brasil.
| | - Letícia Maria Schabbach
- Programa de Pós-Graduação em Sociologia, Universidade Federal do Rio Grande do Sul (UFRGS). Av. Bento Gonçalves 9500, Bairro Agronomia. 91501-970 Porto Alegre RS Brasil.
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Oliveira SB, Soares DA. Acesso ao cuidado do câncer de mama em um município baiano: perspectiva de usuárias, trabalhadores e gestores. SAÚDE EM DEBATE 2020. [DOI: 10.1590/0103-1104202012412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Este estudo teve como objetivo avaliar o acesso de mulheres com câncer de mama aos serviços de atenção à saúde em um município de médio porte no interior da Bahia, na perspectiva de usuárias, trabalhadores e gestores. Trata-se de um estudo de caso com abordagem qualitativa, realizado com mulheres com diagnóstico de câncer de mama, tanto da zona urbana quanto da rural. Além disso, participaram trabalhadores da atenção primária em saúde, da média e alta complexidade e gestores municipais. Os resultados foram apresentados em duas categorias: Organização da rede de atenção ao câncer de mama e Acesso à atenção ao câncer de mama na rede de atenção à saúde. Na primeira, destaca-se a inexistência da linha de cuidado ao câncer de mama, financiamento insuficiente da saúde e fragilidade nos mecanismos de integração da rede de atenção. Na segunda, rastreamento mamográfico ineficaz, focalização da atenção ao câncer de mama no Outubro Rosa e dificuldade de acesso aos exames e procedimentos especializados, como consulta com mastologista e punção/biópsia mamária. A pluralidade de perspectivas avaliadas proporcionou observar lacunas importantes na constituição da rede de atenção às mulheres com câncer de mama, em que problemas organizacionais se retroalimentam com aqueles relativos à atenção prestada.
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Rossetto V, Toso BRGDO, Rodrigues RM. Organizational flow chart of home care for children with special health care needs. Rev Bras Enferm 2020; 73:e20190310. [DOI: 10.1590/0034-7167-2019-0310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/13/2019] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To develop a workflow protocol for Home Care (HC) services in the HC2 modality for children with special health care needs (CSHCN) in the state of Parana. Method: Quantitative, descriptive, exploratory, multiple case studies. Data was collected with professionals from the eight home care services in Parana. Data were analyzed using the Strengths, Weaknesses, Opportunities and Threats (SWOT) methodology, from which a 5W2H method of action plan was developed, resulting in a flow chart. Results: Considering the strategies found in Home Care services, such as planned hospital discharge, caregiver training, organized transportation and singular therapeutic project, a flow organization protocol for children with special health care needs in Home Care services was developed. Conclusion: The protocol developed makes it possible to organize the care provided to children with special health care needs in home care.
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Almeida PFD, Giovanella L, Martins Filho MT, Lima LDD. Regionalized networks and guarantee of specialized health care: the experience of Ceará, Brazil. CIENCIA & SAUDE COLETIVA 2019; 24:4527-4540. [PMID: 31778503 DOI: 10.1590/1413-812320182412.25562019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/12/2019] [Indexed: 11/22/2022] Open
Abstract
This paper analyzes policies and management tools aimed at the regional organization of specialized care in Ceará. A case study was developed in a health region based on 18 interviews with regional and municipal managers and health professionals and visits to services. Several factors enabled advances in the organization of specialized care: the preponderant role of the State Health Secretariat in the regional health coordination of actions and services, providing infrastructure, financing with redistribution of resources and technical support to municipalities; implantation of regional Polyclinic and Specialized Dental Care Centers through the Public Health Consortium; and logistics support of transport system. The institutional framework of Municipal Health Secretaries Council and the participatory functioning of the Regional Interagency Committee provided adequate space for the regional governance. Challenges remain for the integration of the network, qualification of care regulation, and provision of hospital care in the region. The results reinforce the importance of public and universal arrangements for the provision of comprehensive health care that can reduce inequities.
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Affiliation(s)
- Patty Fidelis de Almeida
- Departamento de Planejamento em Saúde, Instituto de Saúde Coletiva, Universidade Federal Fluminense. R. Marquês de Paraná 303/3º/anexo HUAP, Centro. 24030-215 Niterói RJ Brasil.
| | - Ligia Giovanella
- Departamento de Administração e Planejamento em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fiocruz. Rio de Janeiro RJ Brasil
| | | | - Luciana Dias de Lima
- Departamento de Administração e Planejamento em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fiocruz. Rio de Janeiro RJ Brasil
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de Fátima Vasques Monteiro M, Barbosa CP, Vertamatti MAF, Tavares MNA, de Oliveira Carvalho AC, Alencar APA. Access to public health services and integral care for women during the puerperal gravid period period in Ceará, Brazil. BMC Health Serv Res 2019; 19:851. [PMID: 31747914 PMCID: PMC6868722 DOI: 10.1186/s12913-019-4566-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 09/27/2019] [Indexed: 11/28/2022] Open
Abstract
Background Over time, the Brazilian health system, a growing country, has been developing to ensure good accessibility to health goods and services. This development is focusing on the principle of universality of access and completeness of health care. In this context, we aimed to evaluate the completeness of care and universality of access for women in their pregnancy and puerperal period in Ceará, Brazil. Methods A descriptive, cross-sectional study based on a quantitative approach, using information collected from the database of the regulation system of the state of Ceará and data from the Prenatal Monitoring System. The research population comprised of 1701 women who delivered a baby in an obstetric reference unit in the Health Macro-Region of Cariri, Ceará, Brazil from January to December 2015. Results There was a high rate of cesarean delivery (49.7%) and a high waiting time for access to high-risk delivery (32.6%) and neonatal intensive care unit (72.9%). There was also a low percentage (41.1%) of pregnant women undergoing an adequate number of prenatal consultations, dental care (20%), educational activities (15%), visits to the maternity ward (0.1%), laboratory tests of the third trimester (29.2%) and puerperal consultation (37.9%). Conclusions It was concluded that the Maternal and Child Health Policy, especially the Rede Cegonha, which is still under development, does not ensure access and completeness of care for women during the prenatal, delivery, and puerperal periods, thus violating their reproductive rights. The results of this study allow a critical analysis by the academia and health managers in search of strategies to improve the services of Rede Cegonha in Brazil.
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Affiliation(s)
| | | | | | - Maria Nizete Alves Tavares
- Master in Nursing, Regional University of Cariri, Rua Coronel Antônio Luiz, 1161 - Pimenta, Crato, CE, 63105-010, Brazil
| | | | - Ana Paula Agostinho Alencar
- Master in Nursing, Regional University of Cariri, Rua Coronel Antônio Luiz, 1161 - Pimenta, Crato, CE, 63105-010, Brazil
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Dos Santos AM, de Almeida PF. [Specialized care in health regions: challenges to ensure comprehensive health care in Brazil]. ACTA ACUST UNITED AC 2019; 20:301-307. [PMID: 30844001 DOI: 10.15446/rsap.v20n3.61392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 02/22/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To analyze aspects of specialized health care provision in the context of incipient regional integration, as well as barriers to offering comprehensive health care. MATERIALS AND METHODS Case studies in tree municipal seats of health regions in the state of Bahia, Brazil. 31 semi-structured interviews were conducted with health managers and surveys were applied to 201 physicians and nurses of family health care teams and 1 590 users. RESULTS The participants agreed on the lack of the specialized health care, considering limitations in regional planning due to low public funding and difficulties to attract specialized physicians. A significant percentage of users seek specialized health care directly in private services. CONCLUSIONS The provision of comprehensive health care faces not only the challenge of strengthening the essential characteristics of primary health care (PHC), but also the lack of specialists, the fragmentation between different points of the network and communicational disarticulation between levels of the health system.
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Affiliation(s)
- Adriano Maia Dos Santos
- ADS: OD. Ph. D. Saúde Pública. Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia, Brasil.
| | - Patty Fidélis de Almeida
- PFA: Psicóloga. Ph. D. Saúde Pública. Departamento de Planejamento em Saúde, Instituto de Saúde Coletiva, Universidade Federal Fluminense. Niterói. RJ, Brasil.
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Pires DEPD, Vandresen L, Machado F, Machado RR, Amadigi FR. PRIMARY HEALTHCARE MANAGEMENT: WHAT IS DISCUSSED IN THE LITERATURE. TEXTO & CONTEXTO ENFERMAGEM 2019. [DOI: 10.1590/1980-265x-tce-2016-0426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to identify what is discussed in studies published in Brazilian and international literature in the last ten years on Primary Health Care management. Method: an integrative review with a search carried out from 2006 to 2016, in the SciELO®, LILACS®, Scopus®, PubMed® and CINAHL® databases in the Portuguese, English and Spanish languages. The review followed the steps: formulation of the research question, definition of the inclusion and exclusion criteria, identification and selection of the studies, and summary of the subjects found in the studies. Resources from The Atlas.ti® software was used for data organization and analysis. Results: the corpus include 90 studies which predominantly originated from LILACS® and were performed in Brazil. The themes covered in the publications were: health policy and management in Primary Health Care, material resources management, human resources management, financial management, quality management, planning, characterization of managers, management role/ activities, challenges/difficulties in management, potentialities/facilities in management. There was a prevalence of studies that dealt with Primary Health Care management in the context of reflections on health policies and those dealing with the challenges/difficulties faced in Primary Health Care management. These findings demonstrate that the Primary Health Care model is complex and challenging, both for policymakers and for those managing it. Conclusion: the number of studies on Primary Health Care management is significant in the current literature and the predominance of health policy and difficulties in performing management issues reinforce the recognition of the centrality of the management for effective Primary Health Care.
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Landim ELAS, Guimarães MDCL, Pereira APCDM. Rede de Atenção à Saúde: integração sistêmica sob a perspectiva da macrogestão. SAÚDE EM DEBATE 2019. [DOI: 10.1590/0103-11042019s514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Este artigo analisa a integração sistêmica da atenção à saúde da linha de cuidado do câncer de mama, no contexto da regionalização da saúde no estado da Bahia, sob a perspectiva da macrogestão. Estudo transversal retrospectivo, de natureza exploratória e descritiva, com uso da abordagem qualiquantitativa e referencial da rede de políticas públicas. Foram utilizadas as técnicas de análise documental, extração de dados dos sistemas de informação, entrevistas semiestruturadas com 141 participantes na coleta de dados. Elegeram-se como categorias analíticas: Desenho institucional da rede de oncologia; Atenção Primária à Saúde como porta de entrada e ordenadora da rede; Sistemas de apoio; e Sistemas logísticos. Os resultados sinalizaram que as normas, embora necessárias, não são per si suficientes para garantir a integração sistêmica; o desenho de redes de atenção à saúde tem seguido a lógica de estruturação por oferta, adensando-se nos grandes centros populacionais, gerando vazios assistenciais; predomina o acesso da população aos serviços não complementares ao Sistema único de Saúde (SUS) e/ou de alta densidade tecnológica, evidenciando a hegemonia do modelo médico-centrado e privatista; mecanismos de regulação do acesso e de gestão dos sistemas de informação ainda ocorrem de forma incipiente, com pouca e/ou esparsa interação entre si.
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Almeida PFD, Medina MG, Fausto MCR, Giovanella L, Bousquat A, Mendonça MHMD. Coordenação do cuidado e Atenção Primária à Saúde no Sistema Único de Saúde. SAÚDE EM DEBATE 2018. [DOI: 10.1590/0103-11042018s116] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Coordenação do cuidado significa estabelecer conexões de modo a alcançar o objetivo maior de prover/atender às necessidades e preferências dos usuários na oferta de cuidados em saúde, com elevado valor, qualidade e continuidade. O presente ensaio faz uma revisão dos estudos, teóricos e empíricos, sobre coordenação do cuidado, tendo como objetivo norteador a identificação de políticas, estratégias e instrumentos para alcance de melhor coordenação no Sistema Único de Saúde. A síntese é realizada a partir de três dimensões, consideradas centrais para análise desse atributo no contexto da Atenção Primária à Saúde (APS) brasileira: posição da Estratégia Saúde da Família na rede assistencial; integração entre níveis assistenciais e interfaces com a regulação assistencial; e integração horizontal com outros dispositivos de atenção e cuidado no território. Buscou-se identificar conceitos, evidências, resultados e desafios acerca da coordenação do cuidado no cenário nacional, assim como formular uma 'agenda estratégica pró-coordenação' que reconhece os avanços alcançados, mas também a incompletude dessas iniciativas. Na medida em que o fortalecimento da APS é uma das mais potentes medidas pró-coordenação, a diminuição de investimentos e de prioridade na Estratégia Saúde da Família representa o enfraquecimento da consolidação de arranjos sistêmicos, capazes de garantir a integralidade da atenção.
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Fabrizzio GC, Gonçalves Júnior E, Cunha KSD, Kahl C, Santos JLGD, Erdmann AL. Care management of a patient with Devic's Disease in Primary Health Care. Rev Esc Enferm USP 2018; 52:e03345. [PMID: 30088542 DOI: 10.1590/s1980-220x2017024603345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 01/31/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Describing the care management of a patient affected by Devic's Disease in the Primary Health Care setting. METHOD A clinical-qualitative case study based on the health status of a Devic's Disease patient in a Health Center of the municipality of Florianópolis, accompanied by the Family Health Team. Data collection was carried out by electronic medical records, documents of the patient's domain, as well as a semi-structured interview with the participant. Ethical aspects of research involving human beings were respected. RESULTS The categories were defined according to relevance criteria with the purpose of reporting the case study, presenting a unique implemented therapeutic project and describing the patient's perception of her situation. CONCLUSION Acupuncture and auriculotherapy were successfully performed, evidencing an improvement in the patient's pain, which may contribute to new possibilities of care. Despite this, not all the available care tools were implemented, considering the range of complementary care therapies that go beyond the medicinal approach.
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Affiliation(s)
- Greici Capellari Fabrizzio
- Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem, Florianópolis, SC, Brasil
| | | | - Kamylla Santos da Cunha
- Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem, Florianópolis, SC, Brasil
| | - Carolina Kahl
- Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem, Florianópolis, SC, Brasil
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Fernandes FMB. Regionalization in the Brazilian Healthcare System, SUS: a critical review. CIENCIA & SAUDE COLETIVA 2018; 22:1311-1320. [PMID: 28444054 DOI: 10.1590/1413-81232017224.26412016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/23/2016] [Indexed: 11/22/2022] Open
Abstract
Objective to review the output and the use of the data to support managers in making decisions on the healthcare system, and analyze academic output on the theme. Method An online search of the SciELO database for articles using 'regionalization' and 'health/healthcare' as the keywords, and all indices as the 'scope of the study'. We found a total of 102 references, and after analyzing the abstracts selected 70 articles that effectively discuss regionalization of health/healthcare in Brazil. We also found four articles in non-health related journals. Analysis the institutional criteria (journal, theme area, date of publication, scope and number of authors), and the analytical criteria created by author - Type 1 - "Exploratory Studies" (26), "Evaluation Studies" (6), "Comparison Studies" (3); and "Reports of Experience" (5), Type 2 - "Theoretical-Analytical" papers (20) and "Historical-Conceptual Reviews" (4), and Type 3 - "Editorials (3) and "Book Reviews" (3). Findings regionalization has become more important in journals published since 2010. Most of the articles fall in the Type 1 category.
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Chaves LA, Jorge ADO, Cherchiglia ML, Reis IA, Santos MADC, Santos ADF, Machado ATGDM, Andrade EIG. [Integration of primary care in the healthcare network: analysis of the components in the external evaluation of the PMAQ-AB]. CAD SAUDE PUBLICA 2018; 34:e00201515. [PMID: 29489952 DOI: 10.1590/0102-311x00201515] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 07/05/2017] [Indexed: 11/22/2022] Open
Abstract
This cross-sectional study examined the integration of primary care in the healthcare network of the Brazilian Unified National Health System (SUS), using the Gradual Response Model of Item Response Theory. Based on data from 17,202 teams that participated in the National Program for Access and Quality Improvement in Primary Care (PMAQ-AB, 2012), we measured gradients of integration to identify the teams' profile by level of integration. The results show that the items pertaining to matrix support measures (medical consultations, case discussions, shared clinical action, joint elaboration of therapeutic projects, permanent educational activities, work process discussions, interventions in the territory, and visits with primary care professionals) improved the performance of primary care teams. Communications devices between teams reinforced this understanding. Still, the approximately 50% of answers associated with the worst scenario for some study items evidenced the need to upgrade the integration between primary care activities and specialized care for the consolidation of comprehensive primary healthcare.
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Ribas EDN, Bernardino E, Larocca LM, Poli Neto P, Aued GK, Silva CPCD. Nurse liaison: a strategy for counter-referral. Rev Bras Enferm 2018; 71:546-553. [DOI: 10.1590/0034-7167-2017-0490] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 09/20/2017] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to identify the profile of the counter-referred patients by the “nurse liaison” and to describe the experience of the professionals who participated in the project. Method: intervention research, with twelve nursing nurses from a hospital and an Emergency Care Unit, and 26 nurses from Primary Health Care. Data were obtained through questionnaires and counter-referral forms. Results: Out of 43 counter-referred individuals, 62.8% are over sixty years, 53.5% are men with multi-pathologies. Among the positive aspects, the nurses highlighted the dialogue between health care services, agility in the acquisition of inputs for the continuity of care in primary care, benefiting patients after hospital discharge. The greatest challenge was the lack of time and the deficit of nurses to perform the function. Final considerations: the presence of the “nurse liaison” has proved to be an important strategy to improve integration between services and to promote continuity of care.
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Doricci GC, Guanaes-Lorenzi C, Pereira MJB. [The Articulator of Primary Health Care Program: an innovative proposal for qualification of Primary Health Care]. CIENCIA & SAUDE COLETIVA 2017; 22:2073-2082. [PMID: 28614525 DOI: 10.1590/1413-81232017226.17412016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 08/18/2016] [Indexed: 11/22/2022] Open
Abstract
In 2009, the Secretary of State for Health of Sao Paulo created a Program with a view to qualify the primary care in the state. This proposal includes a new job function, namely the articulator of primary care. Due to the scarcity of information about the practice of these new professionals in the scientific literature, this article seeks to analyze how articulators interpret their function and how they describe their daily routines. Thirteen articulators were interviewed. The interviews were duly analyzed by qualitative delineation. The results describe three themes: 1)Roles of the articulator: technical communicator and political advisor; 2) Activities performed to comply with the expected roles, examples being diagnosis of the municipalities, negotiation of proposals, participation in meetings, visits to municipalities; and 3) Challenges of the role, which are configured as challenges to the health reform process, examples being the lack of physical and human resources, activities of professionals in the medical-centered model, among others. The conclusion drawn is that the Program has great potential to provide input for the development and enhancement of Primary Care. Nevertheless, there are a series of challenges to be overcome, namely challenges to the context per se.
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Affiliation(s)
- Giovanna Cabral Doricci
- Departamento de Psicologia, Faculdade de Filosofia Ciências e Letras de Ribeirão Preto, Universidade de São Paulo (USP). Av. Bandeirantes 3900, Monte Alegre. 14040-901 Ribeirão Preto SP Brasil. psicologia.
| | - Carla Guanaes-Lorenzi
- Departamento de Psicologia, Faculdade de Filosofia Ciências e Letras de Ribeirão Preto, Universidade de São Paulo (USP). Av. Bandeirantes 3900, Monte Alegre. 14040-901 Ribeirão Preto SP Brasil. psicologia.
| | - Maria José Bistafa Pereira
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, USP. Ribeirão Preto SP Brasil
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