Da fragmentação à integralidade: construindo e (des)construindo a prática de saúde bucal no Programa de Saúde da Família (PSF) de Alagoinhas, BA

Abstract

Estudo sobre a prática de saúde bucal no PSF de Alagoinhas BA (2001-2004), com o objetivo de analisar os dispositivos que orientam a atenção integral à saúde bucal: vínculo, acolhimento, autonomia, responsabilização e resolubilidade. A metodologia é de natureza qualitativa, numa perspectiva histórico-social. Os materiais empíricos foram entrevistas com trabalhadores, gestores e usuários, observação da prática e fontes documentais. Os resultados revelam que a prática é organizada através de ações individuais e coletivas, construídas por uma demanda reprimida. O atendimento é fragmentado com a valorização excessiva da técnica e da especialidade, cujo eixo é ordenado pelo modelo médico-centrado, com resolubilidade limitada. O acolhimento é manifestado através de uma relação tensa e conflitante, porém com potencialidade para construir alternativas de mudança. Vínculo e autonomia entrecruzam-se no resgate da relação trabalhador-usuário e no encontro de suas potencialidades, possibilitando horizontalizar saberes, estreitar laços e consolidar afetos. Enfim, a prática da saúde bucal é plena de conflitos e contradições e se constitui em potencial ferramenta de mudança nos processos de trabalho, convivendo com o velho (fragmentação) e o novo (integralidade), num processo inacabado, em construção.

Perception of ‘Comprehensiveness of Care’: a qualitative study amongst dentists in the Brazilian Health System

“…In addition to introducing communicative and teamwork skills, these disciplines should adequately prepare new dentists who will work in the public sector. 4 Our results might be useful in further understanding how to evaluate the process of care, as well as how the perceptions of dentists could contribute to References improvements in primary oral health care. In future studies, the perceptions of dentists from different parts of Brazil, as well as of other nationalities, should be researched to enrich and strengthen the data obtained and to broaden the discussion into the private sector.…”

“…9,10 Nevertheless, this study did raise important issues that support policy literature on this issue, suggesting that these findings could contribute to the debate on primary dental care in Brazil; additionally, these findings address gaps in the Brazilian literature. 1,4,22 Furthermore, although one would expect a self-selecting group to be more interested in these concepts, it was clear from the findings that they did not believe they were adequately delivering them, partly due to the volume of patient care. The high volume of patients every day for patient welcoming, the lack of adequate infrastructure to address this number of patients and the lack of better teamwork skills all represent problems in the clinical settings that might hinder the application of concepts and tools to improve and optimise clinical care.…”

“…4,5 Thus, comprehensiveness exists in act and can be sought in the organisation of services and renewal of health practices. In this sense, it must be recognised in strategies to improve the access to and development of integrated practices.…”

“…In this sense, it must be recognised in strategies to improve the access to and development of integrated practices. 1,4,5 General concepts of 'patient welcoming,' 'bonding' and 'quality of care' have been applied and used to evaluate the comprehensiveness approach. 1,2,5,6,7 It is important for the comprehensiveness element to be reinforced in the critical awareness of health professionals and the community to enable the realisation of transformative actions.…”

Comprehensiveness and programmatic vulnerability to stds/hiv/aids in primary care

“…Health comprehensiveness is thought of as a light beam (15), subject to the same physical phenomena, such as properties of reflection, refraction or absorption, suggesting that the bringers return to their starting place if they are reflected when trying to pass through an obstacle. Therefore, the second time, they break barriers and cross spaces, even if they suffer a coefficient of refraction and deflection.…”