Integração assistencial em região de saúde: paradoxo entre necessidades regionais e interesses locais

Abstract

Resumo Este estudo tem como objetivo identificar e analisar o desenvolvimento de estratégias regionais para a integração assistencial no contexto das regiões de saúde, com especial foco no papel da Atenção Primária à Saúde (APS). Foi realizada análise das atas e observação das reuniões de uma Comissão Intergestores Regional (CIR) no período de um ano e também onze entrevistas com gestores/gerentes municipais, regionais e estaduais do estado da Bahia. Os resultados indicam que a APS é um tema pouco frequente nas discussões da CIR, embora a região de saúde enfrente problemas em comum a outras regiões da Bahia e do Brasil como a disputa predatória por médicos e fraca coordenação do cuidado. A meta de conformação de Redes de Atenção à Saúde, coordenadas pela APS, ainda é um objetivo distante diante da premência de garantir acesso à atenção especializada e de urgência/emergência hospitalar na região de saúde, tema que dominou as discussões da CIR, ficando a APS circunscrita aos limites municipais.

Integration between Primary Health Care and Emergency Services in Brazil: Barriers and Facilitators

“…In addition, there were some disagreements among the interviewees with the reading of summaries. Other studies in different regions of Brazil revealed the same characteristics as the Regional Interagency Committee which we analysed [3334], however, this forum acts as an important indicator of the effectiveness of regionalization [3536]. …”

Atenção primária à saúde e coordenação do cuidado nas regiões de saúde: perspectiva de gestores e usuários

“…It is worth remembering that these expenses added to the purchase of drugs were an economic burden for the families. The supply profile, coupled with the lack of therapeutic back-up, especially in the provision of specialized services, weakens the coordination capacity of PHC, a nodal point for the organization of networks, in several aspects 23 . This setting is common to other health regions, heavily dependent on the private sector 23 .…”

“…The supply profile, coupled with the lack of therapeutic back-up, especially in the provision of specialized services, weakens the coordination capacity of PHC, a nodal point for the organization of networks, in several aspects 23 . This setting is common to other health regions, heavily dependent on the private sector 23 . In these, insufficient supply and public underfunding, coupled with the sometimes-inadequate use of existing resources and disarticulation among providers are factors that make it difficult for PHC to be a robust and resolutive practice 23 .…”

“…This setting is common to other health regions, heavily dependent on the private sector 23 . In these, insufficient supply and public underfunding, coupled with the sometimes-inadequate use of existing resources and disarticulation among providers are factors that make it difficult for PHC to be a robust and resolutive practice 23 . In contrast to the user's perspective, managers and professionals have a restricted view of the public-private relationship, as they are not active stakeholders in the process of obtaining the necessary care.…”

“…In the perspective of an integrated system, the construction of a regionalized network implies planning and management strategies shared by the federated entities to confront the set of health problems that transcend the managerial capacity of only one subnational sphere 22 . Hence, there is a need for further studies to analyze in the scope of health networks and regions the potentialities of PHC teams to assume coordination both at the local level and beyond the municipal boundaries, in the regional space 23 . This paper aims to analyze the coordination of care by PHC, especially for users with chronic conditions, in the perception of managers and users with a backdrop of the RAS construction process in a region of the State of São Paulo.…”