Primary Health Care: care coordinator in regionalized networks?

Abstract

RESUMO OBJECTIVE:To analyze the breadth of care coordination by Primary Health Care in three health regions. METHODS:This is a quantitative and qualitative case study. Thirty-one semi-structured interviews with municipal, regional and state managers were carried out, besides a cross-sectional survey with the administration of questionnaires to physicians (74), nurses (127), and a representative sample of users (1,590) of Estratégia Saúde da Família (Family Health Strategy) in three municipal centers of health regions in the state of Bahia. RESULTS:Primary Health Care as first contact of preference faced strong competition from hospital outpatient and emergency services outside the network. Issues related to access to and provision of specialized care were aggravated by dependence on the private sector in the regions, despite progress observed in institutionalizing flows starting out from Primary Health Care. The counter-referral system was deficient and interprofessional communication was scarce, especially concerning services provided by the contracted network. CONCLUSIONS:Coordination capacity is affected both by the fragmentation of the regional network and intrinsic problems in Primary Health Care, which poorly supported in its essential attributes. Although the health regions have common problems, Primary Health Care remains a subject confined to municipal boundaries.

Care coordination and longitudinality in primary health care in the Brazilian Amazon

“…Care coordination in PHC reflects the capacity to coordinate the actions within PHC itself, at other care levels or in institutions corresponding to other public policies involved in the care process. It is related to the continuity of care between professionals and services involved in the follow-up of clinic cases through informational and communication tools, and to the existence of referrals/flows between services (10)(11) .…”

A atenção primária em regiões de saúde: política, estrutura e organização

“…Ampliar o escopo da APS, no sentido de torná-la mais efetiva/resolutiva, também é essencial para a garantia de cuidados coordenados, contínuos, integrados e integrais. Experiências relacionadas ao fortalecimento do trabalho em equipe, ampliação e valorização das ações clínicas do enfermeiro e do Núcleo de Apoio à Saúde da Família (NASF), da cobertura por equipes de saúde bucal, ampliação do leque de serviços e adensamento do arsenal tecnológico das UBS, por exemplo, poderiam contribuir para que a população reconhecesse a atenção básica como local de prestação de cuidados resolutivos e de qualidade 32 .…”

Movimentos de reforma do sistema de saúde do Distrito Federal: a conversão do modelo assistencial da Atenção Primária à Saúde

“…There is abundant evidence on the association of PHC-organized systems with a more equitable distribution in access to health care, lower costs, better control of chronic and infectious diseases, and lower infant mortality when compared to the care provided by specialists 7,9,[12][13][14][15][16] . The FHS brought a new organization to PHC, adding several improvements to the previously predominant model, commonly called the traditional model 4,11,17 , in which primary care was centered on the physician and fragmented among the Internal Medicine, Pediatrics and Gynecology and Obstetrics specialties.…”

“…The increase in FHS coverage was accompanied by important gains in health for the Brazilian population. Studies have shown large and sustainable decreases in infant mortality 2,7,8,11,[18][19][20] , with an average reduction of 4.5% in the infant mortality rate for every 10% increase in FHTcoverage 15 , with higher rates in less developed municipalities 2 . There was a significant increase in the diagnosis of hypertension and diabetes, suggesting improved access to health care 2,11 , leading to reductions in morbidity and mortality associated with cardiovascular 2,8,11,18,21 and cerebrovascular diseases 11. It has been shown that the risk of death from secondary stroke and myocardial infarction are lower in patients followed at theFHS compared to those followed in units without a FHT 22 .…”