Issue/problem Covid-19 pandemic requires rapid responses. The reconfiguration of the psychosocial care network was needed to ensure access to all patients during this period. Description of the problem Psychosocial Care Centers (PCC) are strategic equipment for strengthening the mental health policy in Brazil. These services work with a multi and interdisciplinary team, aiming to assist crisis and rehabilitation processes of people with severe and persistent mental disorders or those with impairments due to the use of psychoactive substances. This work shares the experience of two PCC over the COVID-19 pandemic in São Paulo, Brazil. In April 2020, in front of the increasing Covid-19 cases and hospitalization, lack of hospital beds for mental health care, suspension of PCC group activities, and restriction of face-to-face assistance, it was necessary to adjust the PCC work process and physical structure. Results Telemedicine was implemented to assure assistance and monitoring. An internal flow was implemented to identify and assess patients seeking the service with respiratory symptoms and proceed with case notification if confirmed. A station for respiratory symptoms screening was settled outside the PCC, an isolation room to symptomatic respiratory patients was defined to medical assessment, and referral criteria to the emergency care established. To reinforce beds for hospitals in the region, inpatient beds were created in the PCC to attend hospitalization of acute crisis cases. Further, professionals from Primary Health Care were relocated and trained to support PCC assistance. Lessons This experience reaffirms the role of PCC as an articulator of the psychosocial network. Reorganization of PCC work process enabled the continuity of mental health outpatient care as well as rearguard from inpatient beds. Key messages The COVID-19 pandemic reinforce the necessity of integrated healthcare networks to provide care access and continuity of care. This experience reaffirms the role of PCC as an articulator of the psychosocial network.
Problem/Issue The Specialized Outpatient Care (SOC) organization is a worldwide concern, aiming to ensure integrality and equity of health care. Description of the problem Implantation of SOC services regionalized and integrated in a healthcare network coordinated by Primary Care (PC) seems to be a potential strategy to restore balance between demand and supply by SOC. The “Health Care Planning” (HCP) method, proposes a population-based management SOC model with horizontal and collaborative relation between SOC and PC, different from the conventional model focused on medical specialties. Thus, SOC assumes three functions besides assistance: educational, research and supervisory. In 2018, the PlanificaSUS project started the implantation of this model in 25 regions of 19 Brazilian states. Each region chose one SOC service and one priority line of care, based on local epidemiological indicators. Workshops and tutoring activities were conducted and SOC teams were trained based on the continuous care cycle, in an inter-professional and collaborative way. Results Priority lines of care were chosen as follows: maternal and child (n = 17); elderly health (n = 1); mental health (n = 1); and hypertension and diabetes (n = 6). Each SOC service mapped PC services in region, defined evidence-based clinical guidelines in the healthcare network and organized SOC portfolio, composed of multi-professional team, equipment and physical structure. Team training was concluded in 19 SOC services, in which educational function was introduced with PC through a risk stratification course. This course was based on common clinical guideline between PC and SOC, contributing to shared and resolutive care. Lessons The proposed model for SOC organization could be a potential strategy to integrate SOC with PC in different settings, in spite of important challenges, such as: covid-19 pandemic, necessity local health managers' protagonism and politics to support SOC integration in healthcare network. Key messages Organization of SOC integrated in healthcare networks must be promoted to ensure integrality, equity and longitudinally of shared and resolutive care. Population-based management and a horizontal and collaborative relation between SOC and PC should be encouraged to improve quality and effectiveness of care in the healthcare network.
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