Restructuring of primary health care in Portugal and participation of health centers in the network of care

Introduction

We describe the restructuring that is taking place in primary health care (PHC) in Portugal and discuss how the new emerging organization and work practices reflect in care transitions and intra- and inter-organizational integration.

Theory and methods

PHC represents an essential support for the restructuring that is taking place in health care in Portugal. We conducted a case study on a health centre located in the Centre Region of Portugal. We identified and analyzed internal units and care transitions and conducted interviews.

Results

Health centres are reorganizing toward a new model characterized by an organizational structure based on functional units: Family Health Unit (FHU), Community Care Unit (CCU), and Personalized Healthcare Unit (PHU), which will be in place in all of them plus transversal units, common to a group of these arrangements. The overarch management body is the ACES (Agrupamento de Centros de Saúde), that reports to a Health Regional Administration (HRA). In Portugal, there are five HRA. An ACES may coordinate a number of FHU, CCU and PHU but has only one Public Health Unit and one Shared Resources Care Unit. Units are based on multidisciplinary teamwork, having: specific missions, although inter-cooperative and complementary, organized in a network; administrative autonomy; proper instruments of organizational management; well-defined leadership and clinical governance systems and mechanisms of representation and participation of the community and citizens.

Conclusions and discussion

It is too soon to assess the implications that the reorganization of PHC might have in the integration of care in Portugal.

Current status and developments in the care of stroke patients in Portugal

Introduction

We discuss current status and developments in the care of stroke patients in Portugal.

Theory and methods

Stroke is the main cause of death in Portugal and the main cause of disability on elderly people. This situation has raised great concern and several initiatives have been put in place to deal with the problem. The Unidades de Acidentes Vasculares Cerebrais – (UAVC) (Stroke Unit) were launched in 2001, aiming at reducing length of stay in acute care hospitals, functional incapacity and post-stroke complications, the number of patients in need of home nursing or specialized inpatient long-term care, as well as facilitating reintegration in family and society, namely return to workplace. The study is based on deep literature review and clinical experience in specialized care for stroke patients in Portugal.

Results

Until the launch of UAVCs, a patient suffering from stroke would be admitted to a Serviço de Neurologia (Neurology Service) or to a Serviço de Medicina Interna (Internal Medicine Service), probably in the hospital closest to the occurrence and care would be oriented to the acute phase. Nowadays, patients with a diagnosis of stroke are preferably directed to a UAVC. These units integrate health professionals especially trained for these situations and apply diagnostic and therapeutic procedures according to protocols that follow the most recent international recommendations. The multidisciplinary teams execute integrated care and rehabilitation plans based on the individual needs. Complementary exams are done systematically aiming at more complete understanding. After discharge, patients are followed up in outpatient specific consultation. One of the most relevant practices adopted is physiotherapy care that promotes early mobilization and get up.

Conclusions and discussion

There are about 30 UAVCS in Portugal, some of them still working under technical and human limitations. However, these units are but one of the links in the chain of care. Many attempts have been made to integrate care in Portugal. At least in some areas, much is still to be done in this regard.