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2020, Number 2

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Revista Cubana de Salud Pública 2020; 46 (2)

Experiences and challenges for the professional inclusion in Primary Health Care in Brazil

Costa MD, Bispo JJP

Language: Spanish
References: 35
Page: 1-18
PDF size: 384.16 Kb.


ABSTRACT

Introduction: In Brazil, experts in primary health care were included as a resource to increase cases resolution and the scope of actions.
Objective: To analyze the contributions of the groups for family health´s support in expanding the response capacity of primary health care.
Methods: Multiple cases study with a qualitative approach carried out in six municipalities in Bahia state, Brazil. It was used an analytics matrix developed from primary care attributes like: access, care longitudinality, coordination of care and guidance for the community. The data were obtained by means of semi-structured interviews with 83 primary health care professionals and field observations. The data were organized and categorized according to the technique of thematic analysis.
Results: The support groups did not contributed much to expand the cases resolution. The access to the professional experts´ services was limited and the groups rarely offered continuous attention. Performance in the coordination of care was also unsatisfactory. It was shown incipient reduction of demand for the other levels and fragile interaction with the care network. The community-oriented performance occurred partially.
Conclusions: The work of the support groups shows little contextualization with the attributes of primary care, hence the need to overcome structural and organizational obstacles that involve the work of the new professionals in this basic level of the health system.


REFERENCES

  1. Starfield B. Primary care: an increasingly important contributor to effectiveness, equity, and efficiency of health services. SESPAS report 2012. Gac Sanit. 2012;26 (Suppl 1):20-6.

  2. Elorza ME, Moscoso NS, Lago FP. Delimitación conceptual de la atención primaria de salud. Rev Cub Sal Públ. 2017 [acceso 07/04/2020];43:1-17. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-34662017000300011

  3. Acosta-Ramírez N, Giovanella L, Vega Romero R, Silva HT, Almeida PF, Ríos G, et al. Mapping primary health care renewal in South America. Fam Pract. 2016 [acceso 07/04/2020];33(3):261-7. Disponible en: https://academic.oup.com/fampra/article/33/3/261/1749542

  4. Atun R, Andrade LOM, Almeida G, Cotlear D, Dmytraczenko T, Frenz P, et al. Healthsystem reform and universal health coverage in Latin America. The Lancet. 2015 [acceso 07/04/2020];385(9974):1230-47. Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61646-9/fulltext

  5. Brasil. Ministério da Saúde. Portaria nº 2.436, de 21 de setembro de 2017. Aprova a Política Nacional de Atenção Básica, estabelecendo a revisão de diretrizes para a organização da Atenção Básica, no âmbito do Sistema Único de Saúde (SUS). Brasília: Ministério da Saúde; 2017. [acceso 07/04/2020]. Disponible en: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2017/prt2436_22_09_2017.html

  6. Macinko J, Harris MJ. Brazil's Family Health Strategy-Delivering Community-Based Primary Care in a Universal Health System. N Engl J Med. 2015 [acceso 07/04/2020];372(23):2177-81. Disponible en: https://www.nejm.org/doi/full/10.1056/NEJMp1501140?url_ver=Z39.88- 2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed

  7. Montekio VB, Medina G, Aquino R. Sistema de salud de Brasil. Salud Pública de México. 2011 [acceso 07/04/2020];53(Suppl 2):120-31. Disponible en: http://saludpublica.mx/index.php/spm/article/view/5034/10033

  8. Osorio AG, Álvarez CV. La Atención Primaria de Salud: desafíos para su implementación en América Latina. Aten Primaria. 2013 [acceso 07/04/2020];45(7):384-92. Disponible en: https://www.sciencedirect.com/science/article/pii/S0212656713000413

  9. Fausto MC, Bousquat A, Lima JG, Giovanella L, Almeida PF, Mendonça MH, et al. Evaluation of Brazilian Primary Health Care From the Perspective of the Users: Accessible, Continuous, and Acceptable? J Ambul Care Manage. 2017 [acceso 07/04/2020];40(Suppl 2):60-70. Disponible en: https://journals.lww.com/ambulatorycaremanagement/Fulltext/2017/04001/Evaluation_of_ Brazilian_Primary_Health_Care_From.7.aspx

  10. Aleluia IRS, Medina MG, Almeida PF, Vilasbôas ALQ. Coordenação do cuidado na atenção primária à saúde: estudo avaliativo em município sede de macrorregião do nordeste brasileiro. Cien Saude Colet. 2017 [acceso 07/04/2020];22(6):1845-56. Disponible en: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413- 81232017002601845&lng=en&nrm=iso&tlng=pt

  11. Garcia-Subirats I, Lorenzo IV, Mogollón-Pérez AS, Paepe P, Silva MR, Unger JP, et al. Determinantes del uso de distintos niveles asistenciales en el Sistema General de Seguridad Social en Salud y Sistema Único de Salud en Colombia y Brasil. Gac Sanit. 2014 [acceso 07/04/2020];28(6):480-8. Disponible en: https://www.sciencedirect.com/science/article/pii/S0213911114001629

  12. Brasil. Ministério da Saúde. Núcleos de Apoio à Saúde da Família (Cadernos da Atenção Básica, 39). Brasília: Ministério da Saúde; 2014. [acceso 07/04/2020]. Disponible en: http://bvsms.saude.gov.br/bvs/publicacoes/nucleo_apoio_saude_familia_cab39.pdf

  13. Cunha GT, Campos GWS. Apoio Matricial e Atenção Primária em Saúde. Saúde Soc. 2011 [acceso 07/04/2020];20(4):961-70. Disponible en: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104- 12902011000400013&lng=en&nrm=iso&tlng=pt

  14. Campos GWS, Figueiredo MD, Pereira Júnior N, Castro CP. A aplicação da metodologia Paideia no apoio institucional, no apoio matricial e na clínica ampliada. Interface (Botucatu). 2014 [acceso 07/04/2020];18(Sup l1):983-95. Disponible en: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1414- 32832014000500983&lng=en&nrm=iso&tlng=pt

  15. Yin RK. Estudo de Caso: planejamento e Métodos. 5ª ed. Porto Alegre: Bookman; 2015.

  16. Brasil. Ministério da Saúde. Sala de Apoio à Gestão Estratégica (SAGE); 2017 [acceso: 29/05/2018]. Disponible en: http://sage.saude.gov.br/

  17. Starfield B. Atenção Primária: equilíbrio entre necessidades de saúde, serviços e tecnologia. Brasília: UNESCO, Ministério da Saúde; 2002.

  18. Giovanella L, Mendonça MHM. Atenção Primária à Saúde. En: Giovanella L, Escorel S, Lobato LVC, Noronha JC, Carvalho AI, editores. Políticas e Sistemas de Saúde no Brasil. 2ª ed. Rio de Janeiro: Fiocruz; 2012. p 493-546.

  19. Oliveira MM, Campos GWS. Apoios matricial e institucional: analisando suas construções. Cien Saude Colet. 2015 [acceso 07/04/2020];20(1):229-38. Disponible en: http://www.scielo.br/scielo.php?pid=S1413- 81232015000100229&script=sci_arttext&tlng=pt

  20. Gibbs G. Análise de Dados Qualitativos. Porto Alegre: Artmed; 2009.

  21. OPS. Organización Panamericana de la Salud. La Renovación de la Atención Primaria de Salud en las Américas: Documento de Posición de la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS). Washington, D.C.: OPS; 2007. [acceso 07/04/2020]. Disponible en: https://www.paho.org/bra/index.php?option=com_docman&view=document&layout=defa ult&alias=533-la-renovacion-atencion-primaria-salud-las-americas- 3&category_slug=atencao-primaria-em-saude-944&Itemid=965

  22. Reverón SF. El acceso a los servicios de salud: consideraciones teóricas generales y reflexiones para Cuba. Rev Cub Sal Públ. 2017 [acceso 07/04/2020];43(2):272-286 Disponible en: http://www.revsaludpublica.sld.cu/index.php/spu/article/view/761/869

  23. Garcia-Subirats I, Vargas I, Mogollón-Pérez AS, Paepe P, Silva MR, Unger JP, et al. Barriers in access to healthcare in countries with different health systems. A cross-sectional study in municipalities of central Colombia and north-eastern Brazil. Soc Sci Med. 2014 [acceso 07/04/2020];106:204-13. Disponible en: https://www.sciencedirect.com/science/article/pii/S0277953614000951?via%3Dihub

  24. Campos RTO, Ferrer AL, Gama CAP, Campos GWS, Trapé TL, Dantas DV. Avaliação da qualidade do acesso na atenção primária de uma grande cidade brasileira na perspectiva dos usuários. Saúde debate. 2014 [acceso 07/04/2020];38:252-64. Disponible en: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103- 11042014000600252&lng=en&nrm=iso&tlng=pt

  25. Norman AH, Tesser CD. Acesso ao cuidado na Estratégia Saúde da Família: equilíbrio entre demanda espontânea e prevenção/promoção da saúde. Saúde Soc. 2015 [acceso 07/04/2020];24:165-79. Disponible en: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104- 12902015000100165&lng=en&nrm=iso&tlng=pt

  26. Waibel S, Henao D, Aller MB, Vargas I, Vázquez ML. What do we know about patients' perceptions of continuity of care? A meta-synthesis of qualitative studies. Int J Qual Health Care. 2012 [acceso 07/04/2020];24(1):39-48. Disponible en: https://academic.oup.com/intqhc/article/24/1/39/1803960

  27. Busse R, Stahl J. Integrated care experiences and outcomes in Germany, the Netherlands, and England. Health Aff (Millwood). 2014 [acceso 07/04/2020];33(9):1549-58. Disponible en: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2014.0419?url_ver=Z39.88- 2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&

  28. Souza MB, Rocha PM, Sá AB, Uchoa SAC. Trabalho em equipe na atenção primária: a experiência de Portugal. Rev Panam Salud Publica. 2013 [acceso 07/04/2020];33(3):190-5. Disponible en: https://www.scielosp.org/pdf/rpsp/2013.v33n3/190-195/pt

  29. Zlateva I, Anderson D, Coman E, Khatri K, Tian T, Fifield J. Development and validation of the Medical Home Care Coordination Survey for assessing care coordination in the primary care setting from the patient and provider perspectives. BMC Health Serv Res. 2015 [acceso 07/04/2020];15:226. Disponible en: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015-0893-1

  30. Santos APL, Lacaz FAC. Apoio matricial em saúde do trabalhador: tecendo redes na atenção básica do SUS, o caso de Amparo/ SP. Cien Saude Colet. 2012 [acceso 07/04/2020];17(5):1143-50. Disponible en: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413- 81232012000500008&lng=en&nrm=iso&tlng=pt

  31. Almeida PF, Fausto MCR, Giovanella L. Fortalecimento da atenção primária à saúde: estratégia para potencializar a coordenação dos cuidados. Rev Panam Salud Publica. 2011;29(2):84-95. [acceso 07/04/2020]. Disponible en: https://scielosp.org/article/rpsp/2011.v29n2/84-95/

  32. Bethencourt JAB, Ramis Andalia RM, Nápoles MM. Investigación traslacional y transdisciplinaria en salud pública. Rev Cub Sal Públ. 2014 [acceso 07/04/2020];40(2):236- 45. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864- 34662014000200008

  33. López-Dicastillo O, Canga-Armayor N, Mujika A, Pardavila-Belio MI, Belintxon M, Serrano-Monzó I, et al. Cinco paradojas de la promoción de la salud. Gac Sanit. 2017 [acceso 07/04/2020];31(3):269-72. Disponible en: https://www.scielosp.org/article/gs/2017.v31n3/269-272/pt/

  34. March S, Martín MJ, Gomis IM, Azagra CBB, Elizalde L, Ramos R. ¿Qué hacemos en el barrio? Descripción de las actividades comunitarias de promoción de la salud en atención primaria: Proyecto frAC. Gac Sanit. 2014 [acceso 07/04/2020];28(4):267-73. Disponible en: https://www.scielosp.org/article/gs/2014.v28n4/267-273/es/

  35. Bispo Júnior JP, Gerschman S. Potencial participativo e função deliberativa: um debate sobre a ampliação da democracia por meio dos conselhos de saúde. Cien Saude Colet. 2013 [acceso 07/04/2020];18(1):7-16. Disponible en: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232013000100002&lng=en&nrm=iso&tlng=pt




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