A integralidade da atenção à saúde na perspectiva da gestão no município

Oral cancer and dentists in Primary Care: difficulties, behavior and expectation in Brazil

BACKGROUND

Oral cancer affects thousands of people around the world, and the later the diagnosis is performed, the worse are prognosis and survival. In Brazil, primary care is the preferred gateway to the Unified Health System (Sistema Único de Saúde [SUS]) and has an important role in the coordination of and responsibility for user's care. The objective of this study is to evaluate the service flow of users with suspicion of oral cancer in Primary Care and also the dentist's perception regarding the diagnosis of oral cancer in the city of São Paulo.

METHODS

It is a quantitative-qualitative study, where 374 questionnaires were applied and 17 interviews were conducted with primary care dentists.

RESULTS

It was shown that professionals are aware of the role of Primary Care and also know their importance and need on referral network.

CONCLUSIONS

There are barriers that are imposed by the health network, that create difficulties to guarantee their fully professional exercises, with loss of health care tracking on the health care system.

Oral health care after the National Policy on Oral Health - "Smiling Brazil": a case study

In 2004, the National Oral Health Policy (PNSB) - Smiling Brazil was launched. Its guidelines seek to qualify Primary Health Care, ensure comprehensive actions, work on the basis of health surveillance, plan actions in accordance with the epidemiology and information available on the territory, financing and scheduling the research agenda so that the work can be based on scientific evidence. The purpose of this case study was to investigate the perspectives of health care professionals and managers on oral health care after launching the PNSB. For the gathering of information, an oral interview was conducted with health care professionals and managers and direct observation of oral health services. The interpretation of meaning method was used for analysis of the interviews. Approximately 10 years after launching the PNSB, even though the care and the oral health actions have been amplified and qualified, the cities still find it difficult to implement their basic premises.

[Brazilian scientific production on the Family Health Strategy and the change in the model of care]

The variety of existing studies addressing the Family Health Strategy (ESF) and its role in the reorientation of the model of care in the country has motivated the systematization of the advances and limitations described in these studies. Thus, this study, from a review of the scientific production on this theme, analyzed if the ESF has been able to modify the model of care. Forty-one articles from the Scielo database published between 2002 and 2010 that fulfilled the inclusion criteria were analyzed. They were fully analyzed in terms of political-institutional, organizational or technical-care dimensions. The results show that despite the improvement in the work process in primary care, its replacement aspect was not seen in the majority of the studies. Universal expansion of access to the health services, extension of coverage and focus were predominant. The changes are observed when analyzed in light of the demand, with better attendance and connectivity. The most evident limits are in the lack of focus on health needs, as in the territorial issue, community participation and the social determinants addressed in an intersectoral way. Different degrees of the implementation of strategy were identified, though they have not yet resulted in system reorganization at local level.

Primary health care in municipalities at high risk for malaria

This study aims to characterize aspects of Primary Health Care in the Amazon Region of Brazil, considered as the main endemic area for malaria in the country. The Ministry of Health recommends the expansion of Primary Health Care in endemic areas for malaria. A survey focusing on patients infected with malaria was conducted in 6 municipalities, in January and February 2007, to investigate specific aspects of Primary Health Care. Data was analyzed quantitatively and field records helped to give support to context and policy issues in the visited sites. Quality of access to health services and medicines, continuity of health care, system coordination and community orientation are still incipient in the visited areas. The study showed that there is little integration between Primary Health Care and malaria control in the region, which calls for development of joint strategies and for the strengthening of Primary Health Care per se, as a benefit to the population of this endemic area.

O trabalho gerencial do enfermeiro na Rede Básica de Saúde

Este estudo focaliza questões da gerência nos serviços públicos de saúde e têm como objetivo identificar elementos do trabalho gerencial do enfermeiro na Rede Básica de Saúde de Goiânia-GO. Pesquisa exploratória descritiva, de base quantitativa, realizada entre 2006/2007. Para a coleta de dados foi utilizada a entrevista estruturada com 44 enfermeiros gerentes de serviços. Foi construído um banco de dados, utilizando o Software Epi-Info versão 3.3.2. Os dados foram submetidos a um processo de codificação e analisados por medida de frequência simples e nas variáveis que o enfermeiro pode discorrer utilizamos a categorização por semelhança. Os resultados apontam aspectos que fortalecem e tornam mais visíveis as ações gerenciais dos enfermeiros, ao mesmo tempo que mostram as fragilidades do trabalho gerencial na Rede Básica de Saúde. A contribuição dos enfermeiros gerentes foi de grande significado para que a formação seja repensada pelas universidades e pelos gestores.

A prática da integralidade em modelos assistenciais distintos: estudo de caso a partir da saúde da criança

Avaliou-se a prática da integralidade, a partir da saúde da criança. Estudo de caso exploratório-descritivo (natureza transversal, abordagem quantitativa) que foi desenvolvido em duas unidades de saúde: uma, cujo eixo estruturante da assistência era o Programa de Saúde da Família e outra que organizava a assistência no modelo tradicional. Os dados foram levantados por entrevista com pais/responsáveis pelas crianças (n=195) e analisados com teste qui-quadrado e t-student. Constatou-se que o acesso era difícil em ambas às unidades, com média de 2-3 idas ao serviço para marcação de consulta. Acesso a medicamento e o sistema de referência/contra-referência foi mais bem garantido na unidade de saúde da família. O princípio da integralidade não se mostrou incorporado, mesmo na unidade de saúde da família. Assim, ainda permanecem como desafios, a busca de modelos assistenciais que contemplem o acesso aos serviços de saúde e a integralidade da atenção.