Care of Children With a Chronic Condition in Primary Care: Challenges to the Healthcare Model

Abstract

This is a qualitative study aiming to analyze the healthcare model for children with chronic conditions in Primary Health Care. The study subjects were nurses, nurse technicians and auxiliary nurses working in 16 basic health units in the city of Belo Horizonte, Minas Gerais. Data were collected through semi-structured interviews and later analyzed from the critical perspective, seeking to identify the common themes in the empirical material. Data revealed how primary health care professionals identified and reached children with chronic conditions, as well as how they presented the care actions performed. However, the development of a model of care for children with chronic conditions in primary health that considers their specific health needs constitutes a challenge.

Chronic disease in childhood and adolescence: continuity of care in the Health Care Network

“…The SpeNK project presents the hospital discharge procedures and integrated clinical procedures for child follow-up and guidelines to evaluate the continuity of attention by the family and the role of the family pediatrician (5) . In Brazil, the care actions for children with chronic conditions do not differ from program actions established by the MHD for other assisted children (6) . Therefore, our results indicate that health professionals do not address the individual needs of this population and that they are www.ee.usp.br/reeusp Rev Esc Enferm USP · 2017;51:e03226 unproductive and wait for requests from the management team to implement actions for the affected population.…”

“…In this context, the Family Health Strategy (FHS) aims to reorganize Primary Health Care (PHC) and coordinate care (6) to ensure its continuity from the perspective of longitudinality. However, it has not adequately addressed the demands of children and adolescents with chronic illness and their families, resulting in dissatisfaction and disregard of that service as a trusted source of care (7) .…”

“…However, it has not adequately addressed the demands of children and adolescents with chronic illness and their families, resulting in dissatisfaction and disregard of that service as a trusted source of care (7) . Studies (6,8) indicate that limitations in the continuity of care include gaps in the system of reference and counter reference and the limited coordination of Unified Health System (Sistema Único de Saúde -SUS) as a whole because of the inefficient communication between services and network professionals. Moreover, in the Brazilian states, there is limited access and an unequal distribution of skilled services for the care of children with chronic diseases (9) , which causes the permanent migration of families within the Health Care Network (HCN), often leading to an unsuccessful search for care (10) .…”

Social rights of children with chronic conditions: a critical analysis of brazilian public policies

“…22 The adoption of an approach based on the consequences of chronic conditions on children's social participation, regardless of categories of diagnosis, such as that developed in the Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF -International Classification of Functioning, Disability and Health), may favor the recognition of their needs and their families' and the proposition of actions to meet their specificities, aiming at their quality of life and social inclusion. 23 With regard to the strategies proposed in the legislation, the PNAISC defined seven strategic axes to guide and qualify the actions and services of children's health in the country. The policy was built due to the need to strengthen the proposed axes to promote Integrality of child care, articulating health actions at all levels of care and in all SUS management spheres.…”

“…15,21 The adoption of the CIF guidelines in the instruments for the evaluation of the disabled persons requesting BPC made it possible to incorporate the biopsychosocial perspective. 23 However, considering the determination that social assistance will be provided to those who need it according to the Federal Constitution and the definition of disability of the Convention on the Rights of Persons with Disabilities, the organic law of 2011 restricts the scope of social protection by linking long-term impediments to a minimum of two years and by reaffirming the text of the 1993 law, according to which social assistance must provide social minimums to meet basic needs. Social minimums, understood as minimum conditions of life or guarantee of survival, being adopted as a parameter for the provision of social assistance, instead of guaranteeing adequate standards of living, disrespect the principles of equality and universality of the Federal Constitution, aiming at reducing the budget impact of BPC.…”