A implementação do Programa Mais Médicos e a integralidade nas práticas da Estratégia Saúde da Família

Comes, Yamila; Trindade, Josélia de Souza; Pessoa, Vanira Matos; Barreto, Ivana Cristina de Holanda Cunha; Shimizu, Helena Eri; Dewes, Diego; Arruda, Carlos André Moura; Santos, Leonor Maria Pacheco

doi:10.1590/1413-81232015219.15472016

Cited by 24 publications

(36 citation statements)

References 13 publications

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“…Strong territorial integration and community interaction are consistent with findings from other studies on practices in the PMM 21,22,23 . Cuban medical training, targeted to the provision of community-oriented services 24 , may have been a facilitating factor.…”

Section: Discussionsupporting

confidence: 90%

“…Corroborating previous studies, we found a receptiveness to the spontaneous and scheduled demand based on strategies for its absorption 21,23,26 . Follow-up of various population groups is another positive aspect of the practices by physicians in the PMM.…”

Section: Boxsupporting

confidence: 90%

“…Although not highly systematized, the six steps to the person-centered approach 25 were present in practices by physicians in the PMM. Other studies have also identified the presence of elements of the person's centrality and autonomy in the work by physicians in the PMM 21,23,26 . The assessments by the supervisors on this point appear to identify a certain tension and the defense of a Brazilian Divergence in adequate adherence to clinical guidelines.…”

Section: Discussionmentioning

confidence: 99%

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A integralidade das práticas dos médicos cubanos no Programa Mais Médicos na cidade do Rio de Janeiro, Brasil

2018

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The shortage of physicians in remote and underprivileged areas poses an obstacle to universal access and quality of health care. Through the More Doctors Program (PMM), as of 2015, 18 thousand physicians had been incorporated into Brazil's Unified National Health System (SUS) to work in basic care, 79% of whom were Cubans. This article analyzed the comprehensiveness of practices by Cuban physicians in the PMM using a qualitative study in the city of Rio de Janeiro, Brazil, based on interviews with Cuban physicians (24) and a focus group with supervisors of the PMM (4). Comprehensiveness was analyzed in two dimensions: the community-oriented biopsychosocial approach to care and the range of activities in health promotion, prevention, and care. The work by Cuban physicians presents elements that are consistent with the comprehensiveness of practices in primary care, providing a wide range of care and services, in keeping with the health problems' complexity and the plurality of settings. These health workers show outstanding capacity for community interaction, a preventive focus, planning of activities, and positive interpersonal team relations. The study identified attitudes and techniques of solidarity, physician-patient bonding, and community accountability. Challenges were identified in the promotion of participatory practices with communities, the expansion of users' autonomy in clinical decisions, management of psychological problems, systematization of approach tools, and performance of invasive procedures. The study furnishes strong evidence that the PMM, in addition to medical consultations, provides comprehensive health care and contributes to strengthening basic care in Brazil.

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Section: Discussionsupporting

confidence: 90%

Section: Boxsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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A integralidade das práticas dos médicos cubanos no Programa Mais Médicos na cidade do Rio de Janeiro, Brasil

2018

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“…It is important to analyze the contributions and challenges of RAS everyday programs and practices to promote comprehensive health care [40,41]. On the other hand, the nutritional care provided by the SUS services should be more effectively incorporated in the network, and comprehensive health care should be the aim of the practices adopted [32].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of nutritional care of overweight adults from the perspective of comprehensive health care

2017

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Objective: Describe and evaluate the nutritional care provided for overweight adults by the Primary and Secondary Health Care services of Santos, São Paulo, Brazil. Methods: This study was carried out between 2013 and 2015 integrating quantitative and qualitative approaches; it was divided into two phases: (1) characterization and (2) evaluation. In phase 1, a census of Primary Health Care Units (n=28) and Secondary Health Care Units (n=4) was conducted using interviews with health service managers and/or health professionals. Data were analyzed using exploratory data analysis. In phase 2, in-depth interviews were conducted with health service managers and/or health professionals investigating a sample of the Primary Health Care services and the totality of Secondary Health Care services provided. Thematic analysis was carried out using the theoretical framework for comprehensive health care proposed by Pinheiro & Mattos. Results: A total of 40 professionals were interviewed: 36 in the primary health care services and 4 in the secondary health care services. Nutritional care in the Primary Care services is focused on individual care and referrals to other services; nutrition diagnosis and health promotion occur only when overweight is associated with another disease. It was observed that the referral and counter-referral system and intersectorial collaborations were ineffective. In Secondary Care services, nutritional care is focused on clinical care using traditional approaches to nutrition education. Limiting factors for promoting comprehensive care were identified at the two levels of care: unproductive actions, lack of actions for health promotion and protection, and little dialogue between the Primary and Secondary care services. Conclusion: Overweight is not an outcome based on Primary and Secondary Care, but rather on prescriptive practices, which are not very effective in promoting users’ autonomy. It is necessary to guide the actions taken in these two levels of care to ensure the promotion of effective nutritional care.

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“…Studies already report benefits, including fewer doctor shortages, more satisfied users, fewer avoidable hospital admissions, and service improvements such as better patient-doctor relationships, continuity of care, and multidisciplinary team coordination 391314…”

Section: Tackling Inequitymentioning

confidence: 99%

The end of Brazil’s More Doctors programme?

Santos

Millett

Rasella

et al. 2018

BMJ

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A implementação do Programa Mais Médicos e a integralidade nas práticas da Estratégia Saúde da Família

Cited by 24 publications

References 13 publications

A integralidade das práticas dos médicos cubanos no Programa Mais Médicos na cidade do Rio de Janeiro, Brasil

A integralidade das práticas dos médicos cubanos no Programa Mais Médicos na cidade do Rio de Janeiro, Brasil

Evaluation of nutritional care of overweight adults from the perspective of comprehensive health care

The end of Brazil’s More Doctors programme?

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