Regulação do cuidado em redes de atenção: importância de novos arranjos tecnológicos

Abstract

Resumo Um dos maiores desafios para os sistemas de saúde é a garantia de acesso integral. Os processos regulatórios em saúde no Brasil priorizam a organização de listas de espera e fluxos assistenciais com caráter normativo, mas se distanciam das necessidades dos usuários no sentido de uma produção de cuidado integral. No presente estudo, de caráter qualitativo, analisou-se as implicações da regulação em saúde na produção do cuidado no município de São Bernardo do Campo, utilizando-se as técnicas observação participante, grupo focal e usuário-guia, construídas a partir de um processo cartográfico. Foram identificados arranjos tecnológicos em três cenários: Complexo Regulador, Observatório de Redes e Apoio de Redes, que puderam ser apreendidos em conjunto com gestores, trabalhadores e usuários. Os arranjos tecnológicos relacionados ao matriciamento da pneumologia e à linha de cuidado da dor osteomuscular permitiram a análise da relação entre as ações de regulação e a produção do cuidado em redes. O estudo concluiu que as ações de regulação foram capazes de produzir cuidado centrado no usuário, que o Complexo Regulador atuou de forma coadjuvante na garantia do acesso e que os mecanismos regulatórios nos serviços de saúde potencializaram uma regulação produtora do cuidado em redes de atenção.

Factors associated with the waiting time for access to specialized oral healthcare services in Brazil

“…This could produce a vertical, normative and centralized regulation that does not consider complementary actions of dialogues and agreements within the healthcare network. 14 Here, our findings indicated that when the search for specialized care in surgery, endodontics and periodontology was led by the user, the waiting time for consultation was significantly reduced. This can be understood as a 'lay regulation', in which the user, relatives, friends and other users with the same needs make use of cognitive, relational and economic resources to make government regulations more flexible and streamline their access to specialized care.…”

“…Here, our findings indicated that when the search for specialized care in surgery, endodontics and periodontology was led by the user, the waiting time for consultation was significantly reduced. This can be understood as a ‘lay regulation’, in which the user, relatives, friends and other users with the same needs make use of cognitive, relational and economic resources to make government regulations more flexible and streamline their access to specialized care 14 . About the first phase of the PMAQ ‐ CEO , 4 these findings demonstrate that the regulation of access based on a State action (‘governmental regulation’) made little progress in the organization of user flow.…”

“…However, we note that the contact between professionals should not imply the flexibilization of formal regulation nor should it be seen as an independent initiative, which could negatively open room for personal networking between the services. As it stands, this type of initiative may cause inequity of access to care and favour specific groups of users 14 …”

“…As it stands, this type of initiative may cause inequity of access to care and favour specific groups of users. 14 The regulation of access through computerized appointment scheduling via the primary care team, and/or the operationalization of CEO based exclusively on referrals, may create barriers and additional bureaucracy in the flow of users. This could produce a vertical, normative and centralized regulation that does not consider complementary actions of dialogues and agreements within the healthcare network.…”

“…In Brazil, the regulation of access is often limited to organizing waiting lists and assistance flows 14 . Given the negative consequences of waiting times on health outcomes, 15 this study aimed to analyse the factors associated with the waiting time for access to specialized care at CEO in the Brazilian healthcare system by specialty (Stomatology, Surgery, Endodontics, Patients with Special Needs and Periodontology).…”