Estratégias Para Consolidação Da Coordenação Do Cuidado Pela Atenção Básica

Abstract

Re su mo O estudo aqui apresentado analisou a coordenação do cuidado por meio de dados do Programa Nacional para a Melhoria da Qualidade e do Acesso da Atenção Básica. Tratou-se de estudo descritivo com base em questionários aplicados a 1.313 usuários e 324 equipes de atenção básica no município do Rio de Janeiro em 2012. Avaliaram-se dimensões como organização da porta de entrada, resolutividade e continuidade do cuidado, integração horizontal, organização dos fluxos e acesso à rede de referência, continuidade informacional e comunicação entre profissionais. Os resultados indicaram que a atenção primária em saúde se consolidou como porta de entrada preferencial. Os usuários relataram que as equipes de atenção básica buscavam resolver seus problemas de saúde, o prontuário eletrônico estava disponível, embora não fosse integrado aos demais níveis, e os profissionais indicaram realizar reuniões semanais e receber apoio matricial. Entretanto, o tempo de espera para atendimento especializado era alto e a comunicação entre os profissionais insuficiente, o que dificultava o percurso do usuário na busca pelo cuidado e desvelava as fragilidades do trabalho em rede. Foram identificados avanços no fortalecimento da atenção primária e desafios para a constituição da Rede de Atenção à Saúde que minimizavam as possibilidades de coordenação do cuidado pelas equipes de atenção básica. Pa la vras-cha ve avaliação de serviços de saúde; atenção primária à saúde; estratégia saúde da família; coordenação do cuidado. Abs tractThis study examined the coordination of care based on data from the National Program for the Improvement of Quality and Access to Primary Care. It was a descriptive study based on questionnaires answered by 1,313 users and 324 primary care teams in the city of Rio de Janeiro (Brazil), in 2012. Dimensions such as the organization of the gateway, resolution and continuity of care, horizontal integration, organization of flows and access to the referral network, informational continuity, and communication among professionals were analyzed. The results indicated that primary health care has established itself as the preferred gateway. Users reported that primary care teams sought to solve their health issues, the electronic medical record was available, although it had not been integrated into the other levels, and the professionals stated they held weekly meetings and got matrix support. However, there was a long waiting time for specialized care and a lack of communication among professionals, a fact that not only hindered the users in their pursuit for care, but also revealed networking weaknesses. There was progress in the process of strengthening primary care and challenges to the establishment of the Health Care Network that minimized the possibilities for care coordination by the primary care teams.

Therapeutic itineraries for patients with cerebrovascular accident: fragmentation of care in a regionalized health network

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