Access Versus Care Continuity in Health Network Services: Experiencing Possibilities and Contradictions

Abstract

Objective: to understand the meaning of access to health services with a view to care continuity in the care network for users and professionals. Method: qualitative research, which used the methodological steps of Grounded Theory, carried out from November 2015 to April 2017. The theoretical sampling was obtained with 33 participants from a hospital institution and a Family Health Strategy unit. The participants were organized into three sample groups according to circular and continuous orientation of data collection and Grounded Theory analysis. The analysis was conducted according to the guidelines of the methodological framework which was composed of the open, axial and integrative coding phases. Results: four central concepts emerged from the data that demonstrate how participants experience access with a view to care continuity. These range from the first contact with the health network, through limitations and alternatives found to achieve perspectives to the care continuity in health actions and services. Conclusion: possibilities and contradictions were identified in the experience of care, with regard to access to health services and actions for the continuity of care, understanding them as feasible in health services, but divergent from the ideal advocated by the literature on the theme, as well as by the norms and prerogatives in force in the Unified Health System.

Continuity of care for patients recovering from Covid-19 under the angle of clinical management principles

“…The lack of integration between the hospital and primary care is a negative aspect in the studied context, diverging from the ideal model recommended in the literature (23) , but it cannot be said that continuity of care does not exist. The lack of counter-referrals in Brazilian health services is still commonplace in health care settings (20) .…”

“…Professionals working in this care setting must be able to provide comprehensive primary care, disseminating resources for decision-making when possible complications and/or new cases are detected, preventing new hospital breakdowns (25) , as well as ensuring continuity of care according to the user's needs after hospital discharge. However, when it comes to continuity of care, PHC is usually seen as responsible for supplying health materials and devices, rarely as an aspect of care in counter-referrals, and is more likely to seek support from home-based services (23) .…”

Continuidade do cuidado a pacientes recuperados da Covid-19 à luz dos princípios da gestão da clínica

“…A falta de integração entre o hospital e a atenção primária é um aspecto negativo no contexto estudado, sendo divergente ao modelo ideal preconizado pela literatura (23) , todavia, não se pode dizer que a continuidade do cuidado não existe. A inexistência de contra referência nos serviços de saúde brasileiros ainda é trivial entre os cenários de atenção à saúde (20) .…”

“…Os profissionais inseridos neste cenário de atenção devem ser capazes de prestar cuidados primários abrangentes disseminando recursos para a tomada de decisão diante a detecção de possíveis complicações e/ou novos casos, prevenindo novos colapsos hospitalares (25) , além de assegurar a continuidade do cuidado conforme a necessidade do usuário depois da alta hospitalar. Entretanto, no que tange a continuidade do cuidado, habitualmente a APS é vista como responsável pelo fornecimento de materiais e dispositivos em saúde, raramente, como um aspecto de cuidado na contrarreferência, sendo mais recorrente buscar apoio nos serviços domiciliares (23) .…”

Percepção de idosos que vivenciaram situação de rua e a relação com a qualidade de vida

“…O IS é direcionado ao entendimento da forma pela qual os indivíduos interpretam os objetos e as pessoas com os quais interage e como a interpretação direciona as ações em determinadas situações. Esses significados são construídos durante a interação social e plausíveis de serem manipulados ou modificados por um processo de interpretação utilizado pela pessoa para entender e significar as coisas/pessoas que ela encontra (Utzumi et al, 2018). Portanto, a utilização desse referencial teórico se justifica, haja vista a mudança de vida dos idosos perpassar por muitas ressignificações.…”