Myocardial revascularization: factors intervening in the reference and counter-reference in Primary Health Care

Abstract

Objective: Understanding the factors that influence the reference and counter-reference process of people indicated/submitted to Myocardial Revascularization surgery in the Primary Health Care scenario. Method: A qualitative research anchored in the Grounded Theory, totaling 41 participants subdivided into three groups (patients, health professionals and managers) in the Metropolitan and West Region of Santa Catarina. Results: Two categories elucidate the intervening factors found, contrasting the potentialities and obstacles in (creating) the bond between people affected by cardiovascular diseases and primary health care for the reference process, highlighting weaknesses in the primary health care services provided, with failures in the counter-reference for people submitted to myocardial revascularization surgery. Conclusion: Strengthening the potentialities presented in this study is essential for the reference process of people affected by Cardiovascular Disease, as well as strategic actions focused on solving the evidenced obstacles which contribute to deficiencies in the referral and counter-referral process, thus impeding integral care in the health care network.

Revascularização Miocárdica: Referência E Contrarreferência Do Paciente Em Uma Instituição Hospitalar

“…Despite this, it should be emphasized that, in order to promote health, treatment of diseases and rehabilitation, the treatment of a person with coronary artery disease and submitted to MRS requires the integration of all the services in the health care network, articulated by the referral and counter-referral process, to ensure comprehensive and continuous care. 10 However, as in this study, counter-referral is a condition that is not or little verified in other Brazilian realities and in the American countries, as recommended by the World Health Organization, despite its need for continuity of care and health control. 28 It is noted that the definition of guidelines and clinical protocols for flows and counter-flows of care and mapping of the health services network, by health professionals and managers, can establish the basis for the referral system 17,28 and also of counterreferral to the users of the health services and to the professionals who work in these services.…”

“…6 However, even with the development of public policies to adapt the provision of care services to the users' demands, in an orderly, timely and rational manner, fundamentally based on the principles of universality and equity, 7 the process of referral and counter-referral is still in deployment and points to the need for improvement. [8][9] In particular, in the cardiovascular care line, it is considered fragile the regulation of access to care for patients with coronary diseases and submitted to MRS among the health services from the perspective of patients, professionals and managers who work in Primary Health Care (PHC), 10 considering the waiting time for performing the surgical procedure as well as the absence of a formal counterreferral. Considering this scenario, we ask ourselves: how does thereferral and counter-referral process of the patient with coronary artery disease submitted to MRS with an emphasis on the hospital context occur?…”

Nurse liaison: a strategy for counter-referral

“…However, there are still weaknesses in the communication between professionals from different health care services, especially between primary and high complexity care, a barrier in the dialogue of professionals with patients, as well as disarticulation of the service network caused by the absence of counter-referral (4)(5)(6)(7) , which may impair continuity of care. From the perspective of the hospitalized patient, continuity of care can be enabled by the practice of responsible discharge, which happens through the orientation of the patient and his/ her relatives about the need to proceed with treatment elsewhere, through the articulation between the different points of RAS, especially with Primary Health Care (PHC) (8) .…”

Referral and counter-referral: repercussions of coronary artery bypass graft in the perspective of Primary Care

“…Descriptores: Revascularización Miocárdica; Integralidad en Salud; Referencia y Consulta; Enfermería en Salud Pública; Atención Primaria a la Salud. and coordination of care, such as the absence of an integrated and regionalized network of referral and counter-referral of the patient with indication/submitted to the CABGS, which can have repercussions in the health-disease, interfering with their care and sometimes even aggravating their clinical condition (8) .…”