Coordenação do cuidado e Atenção Primária à Saúde no Sistema Único de Saúde

Abstract

RESUMO Coordenação do cuidado significa estabelecer conexões de modo a alcançar o objetivo maior de prover/atender às necessidades e preferências dos usuários na oferta de cuidados em saúde, com elevado valor, qualidade e continuidade. O presente ensaio faz uma revisão dos estudos, teóricos e empíricos, sobre coordenação do cuidado, tendo como objetivo norteador a identificação de políticas, estratégias e instrumentos para alcance de melhor coordenação no Sistema Único de Saúde. A síntese é realizada a partir de três dimensões, consideradas centrais para análise desse atributo no contexto da Atenção Primária à Saúde (APS) brasileira: posição da Estratégia Saúde da Família na rede assistencial; integração entre níveis assistenciais e interfaces com a regulação assistencial; e integração horizontal com outros dispositivos de atenção e cuidado no território. Buscou-se identificar conceitos, evidências, resultados e desafios acerca da coordenação do cuidado no cenário nacional, assim como formular uma 'agenda estratégica pró-coordenação' que reconhece os avanços alcançados, mas também a incompletude dessas iniciativas. Na medida em que o fortalecimento da APS é uma das mais potentes medidas pró-coordenação, a diminuição de investimentos e de prioridade na Estratégia Saúde da Família representa o enfraquecimento da consolidação de arranjos sistêmicos, capazes de garantir a integralidade da atenção.

Use of health services by elderly people post-stroke: a randomized controlled trial

“…The program consisted of educational interventions for family caregivers by nurses and physiotherapists addressing individual training on home care before discharge, available support network (outpatient service and support groups), and seminars on the disease. In addition, they received orientation through phone calls improvements in the quality of the services offered and expanding access to different levels of care (17) . For the transition from hospital care to the home of dependent elderly patients post-stroke, the services need to be articulated and should continue care, according to the complexity of the case.…”

Care handover to chronic conditions to regionalized planning

“…Although these debates are still restricted to specific demands, one can see an attempt by the municipalities to share experiences and obstacles to the inter-municipal and regional coordination of care, thus providing solidary exchanges regarding different levels of care in the Health Region (6) . This finding should be discussed considering the complexity of chronic illness, the need to centralize primary care in the coordination of care, and the power of establishing strategies that favor the transition of care (1,9) , such as those mentioned above. The demands of chronic conditions require health care services and networks to structure mechanisms based on the user's perception of their health status and reinforce the family's participation to achieve greater visibility on the subject (16) .…”

“…This causes the planning of municipalities to be deprecated in the name of punctual, albeit indispensable demands, from the point of view of the right to health care. Consequently, it is necessary to address regionalization and provide spaces to discuss information on municipal, regional, and state planning and the organization of referral flow among health care services (1) . Furthermore, care for users with chronic diseases must be linked and longitudinal in order to include the different levels of care and referred municipalities for effective case management.…”

“…In Brazil, the discussion on coordinated and organized health care models has gained space in the academic literature and legislation, mainly due to chronic illnesses and the necessary sustainability of the health system (1)(2) .…”

“…The perspective of care coordination proposes that community, assistance, and managerial resources be interconnected to enable intervention in complex situations, as in the case of chronic conditions, in which users require the simultaneous and prolonged use of different health care resources (1) . However, in view of the economic conjuncture of fiscal austerity, the role and intervention of the State in health care have progressively diminished.…”