Objective To understand and evaluate the work of intersectoral assistance on the insertion and the flow of people in situation of street with severe mental illness in public services of Mental Health. Method A case study developed from ten visits to a night shelter between March and April 2012. For data collection, the participant observation and semi-structured interviews were carried out with four sheltered individuals, as well as non-directive group interviews with five technicians of the social-assistance services. Results Were analyzed using Content Analysis and developing a Logic Model validated with the professionals involved. Conclusion The social assistance services are the main entry of this clientele in the public network of assistance services, and the Mental Health services have difficulty in responding to the specificities of the same clientele and in establishing intersectoral work.

Neste artigo, abordamos o acesso de pessoas em situação de rua com transtorno mental grave aos serviços públicos de saúde mental. Para tanto, realizamos revisão narrativa sobre o tema. Concluímos que os serviços de Assistência Social têm frequente contato com essa parcela da população, oferecendo respostas às suas necessidades, como moradia e resgate de direitos civis. Os serviços de saúde mental ainda apresentam dificuldades em estabelecer estratégias para o atendimento às pessoas em sofrimento mental na própria rua e em inseri-las em CAPS e UBS. Desse modo, a rede socioassistencial tem sido frequentemente a porta de entrada dessa população aos serviços de saúde mental, indicando que o trabalho intersetorial precisa ser mais bem desenvolvido para a efetividade do acesso à rede pública de saúde.

The term "territory" and its correlates have become commonplace in the field of Mental Health since the psychiatric reform, a potentially emancipatory milestone in non-hospital-centered ideals. However, in a previous empirical study, we found a lack of consistent concepts and practices (corresponding to the use of this term) in the territorial reinsertion of persons with mental illness. To clarify the term's various uses and its possible correlations in practice, we have conducted a systematic survey of scientific articles and official documents, comparing them to each other and with the concept of territory from Critical Geography. We conclude that in the Mental Health field in Brazil, despite numerous and repeated critical efforts, a functional notion of territory has prevailed, overlooking power relations and symbolic appropriations, increasing the tendency of subjecting the reinsertion of persons with mental illness to a given territory rather than favoring socio-spatial transformations for the coexistence of differences.

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic led to the suspension or postponement of care for nonurgent conditions worldwide. Regula Mais Brasil is an initiative of the Unified Health System (SUS) in Brazil to optimize the management of referrals to specialized care by using telehealth. Objectives: To report the expansion of telehealth activities of Regula Mais Brasil in response to COVID-19 and to assess qualification of referrals in primary health care (PHC) units as well as the added value of teleconsultation in qualifying referral cases. Methods: Descriptive study of the teleconsultations carried out as an additional strategy to the remotely operated referral management system, responsible for navigating cases from PHC units to specialized care in Recife, Brazil, between May 6, 2020 and September 30, 2020. Teleconsultation was implemented as a tool for reducing delays in the access to health care due to COVID-19 and ultimately allowed for reclassification of the referral ade-quacy and priority. Changes in referral priority ratings and referral decisions after teleconsultation were analyzed. Results: A total of 622 referral cases were analyzed. Approved referrals represented 51.9% of cases. The main reason for approved referrals was the need for diagnostic resources. There was a reduction in priority ratings in 449 cases (72.2%) after teleconsultation. There was a statistically significant association between the change of priority ratings and the decision on referral (Pearson's v 2 , p-value <0.0001). Results show that telemedicine had an impact on the prioritization and qualification of cases referred to specialized services. Conclusions: A need was detected to rapidly adapt tools available for telemedicine in Brazil. Our results demonstrate that teleconsultation as an additional strategy to the remotely operated referral management system has contributed toward improving equitable access to specialized services.

Chronic non-communicable diseases (NCD) account for 72% of the causes of death in Brazil. In 2013, 54 million Brazilians reported having at least one NCD. The implementation of e-Health in the Unified Health System (SUS) could fill gaps in access to health in primary health care (PHC). Objective: to demonstrate telehealth strategies carried out within the scope of the Institutional Development Support Program of the Unified Health System (PROADI-SUS) and developed by Hospital Alemão Oswaldo Cruz, between 2018 and 2021, on evaluation, supply, and problem-solving capacity for patients with NCDs. Methodology: a prospective and descriptive study of three projects in the telehealth areas, using document analysis. The Brasil Redes project used availability, implementation, and cost-effectiveness analysis, TELEconsulta Diabetes is a randomized clinical trial, and Regula Mais Brasil is focused on the waiting list for regulation of specialties. All those strategies were developed within the scope of the SUS. Results: 161 patients were attended by endocrinology teleconsultation in one project and another two research projects, one evaluating Brazil’s Telehealth Network Program, and another evaluating effectiveness and safety of teleconsultation in patients with diabetes mellitus referred from primary care to specialized care in SUS. Despite the discrepancy in the provision of telehealth services in the country, there was an increase in access to specialized care on the three projects and especially on the Regula Mais Brasil Collaborative project; we observed a reduction on waiting time and favored distance education processes. Conclusion: the three projects offered subsidies for decision-making by the Ministry of Health in e-Health and two developed technologies that could be incorporated into SUS.

(Nichols, 2001, p.20-21) v AGRADECIMENTOSAo meu orientador Juarez, que desde o mestrado vem me mostrando o "caminho das pedras" da escrita científica e do complexo campo acadêmico. Seu cuidado em balancear rigor teórico-metodológico e liberdade criativa foram essenciais nesse trajeto.Às agências de fomento CNPq (processo 167767/2014-3) e Fapesp (processo número 2014/19616-4) pela concessão de bolsa de estudo, que permitiram com que eu realizasse com dedicação exclusiva este doutorado.Ao meu companheiro Renato Pavon, pelo amor, parceria e paciência ao longo dos anos. Agradeço aos momentos em que ele me tirou do trabalho para que eu pudesse olhar o mundo, retomar o fôlego e seguir em frente.Agradeço às pessoas em situação de rua, que por diversas maneiras contribuíram para a realização desta tese: na disposição para relatarem suas vidas, na sinceridade em exporem seus conflitos, nos inesperados cumprimentos em calçadas e rodoviárias, e na inspiração proveniente da beleza e insistência em manterem suas vidas mesmo com tantas privações. Espero que esta tese contribuía de alguma forma para a melhoria de suas condições de vida.À minha família, pela compreensão nos momentos de afastamento e pelo apoio ao longo de toda esta jornada. Em especial ao Vitor Borysow por ter acompanhado mais de perto o trabalho e contribuído com a melhoria do texto final.Aos trabalhadores e gestores da equipe de Consultório na Rua que fizeram parte desta pesquisa, pela receptividade, generosidade e por terem permitido com que eu participasse de seu cotidiano. Agradeço também aos entrevistados que colaboraram de maneira solícita com suas histórias de vida.Ao supervisor do estágio, Prof. Dr. Virgílio Borges Pereira, pelo acolhimento e disponibilidade em Portugal, e pelas contribuições valiosas à tese.E aos colegas do Laboratório de Avaliação em Saúde, pelo companheirismo e pelas contribuições oferecidas em diversos momentos. Os sujeitos que, apesar da precariedade, buscam manter sua higiene reconhecem, nesse ato, tanto um caminho para manter sua dignidade como estratégia para se misturar às "massas", serem invisíveis na multidão, e para serem recebidos em entrevistas e mesmo serviços de apoio. Apesar disso, percebem que a melhora da aparência física não é o único ingrediente para a integração social, pois mesmo limpos, sentem o peso do preconceito e os olhares implacáveis da sociedade (Dequiré, 2010).Iniciar a vida nas ruas exige o desenvolvimento de estratégias compensatórias diante das perdas e o uso de recursos de sobrevivência. As PSRs desenvolvem novas formas de organização para a superação de dificuldades e para a satisfação de 7 necessidades, e, ao mesmo tempo, incorporam as privações que a rua impõe (Varanda, et al., 2004). Elas carregam em seus corpos e nas suas maneiras de ser as marcas da miséria e da luta cotidiana pela sobrevivência, fatores que se sobrepõem a seus habitus, ou seja, às suas disposições constituídas ao longo de suas vidas e que podem ganhar novas configurações quando os agentes são inseridos em espaços sociais ...

Aims: Cost-minimization analysis (CMA) comparing the teledermatology service of the State of Santa Catarina, Brazil with the provision of conventional care, from the societal perspective. Patients & methods: All costs related to direct patient care were considered in calculation of outpatient costs. The evaluation was performed using the parameters avoided referrals and profile of hospitalizations. The economic analysis was developed through a decision tree. Results: Totally, 40% of 79,411 tests performed could be managed in primary care, avoiding commuting and expanding the patients’ access. The CMA showed the teledermatology service had a cost per patient of US$196.04, and the conventional care of US$245.66. Conclusion: In this scenario, teledermatology proved to be a cost-saving alternative to conventional care, reducing commuting costs.