UM OBSERVATÓRIO DE ATENÇÃO INTEGRANDO SAÚDE DA FAMÍLIA E SERVIÇOS DE URGÊNCIAS E EMERGÊNCIAS A PARTIR DE UM ESTUDO DE CASOS MÚLTIPLOS

Abstract

Brazil has been facing several structural changes over the years, mainly in the area of health. Among them, the creation and implementation of the Unified Health System, universal, decentralized, favorable to comprehensiveness and with social participation, in accordance with constitutional registration, which has triggered the implementation of various strategies for organizing services and care to health. The research aimed to organize information to serve as a care observatory in the territories, aiming to enhance the articulation between these two levels of care, promoting comprehensive and continuous care for the user. It is worth highlighting the idea that this is not about evaluative research, which concludes “rights” and “wrongs” in relation to one service or another, but about accumulating information about the functioning of health systems and, in particular, primary care/ primary. Given the complexity of health production in territories and the restriction of the current scientific thinking model to solve problems of this nature, the research is associated with the idea that, for a health service embedded in a complex territory, in addition to better care for the health of people, the ability to observe, produce and systematize data and support decision-making processes with the best current science and local knowledge is necessary. The objective of this analysis was to produce a device to analyze the profile of care provided in two spontaneous demand care units, as an observatory of primary care and territorial actions and to observe the living networks woven by users in the micropolitics of health and the existing cartography molded extramurals. Through a study of multiple cases in different regions, the work examines how the implementation of a device with the function of an observatory, which can identify gaps in the care network, improve the flow of patients between services and increase the resolution of situations urgency and emergency. Producing a care observatory in the territory is a technology that can shift practices and forms of articulation to a broader plateau of comprehensiveness, making visible situations that everyday practice often does not make visible. The research also investigates the challenges and good practices found in the integration of these services, considering aspects such as communication between health teams, information sharing and care coordination. For the study, two emergency services were analyzed, in a multiple case study research design, with the services selected as follows: one in the city of Paraíso das Águas/MS, the Pronto Atendimento Médico Laurentina Correa Leite and one in city of São Gabriel do Oeste/MS, the Hospital Municipal José Valdir Antunes de Oliveira, both under municipal management and with spontaneous demand service and referenced in the National Health Establishment Registry. The analyzes developed in this study demonstrated the reality of the living network in action from the perspective of conditions sensitive to primary care that are using health care units. spontaneous demand as a “gateway” to the health network system. The study provides evidence on how to improve integration between Primary Care and emergency services, based on concrete situations, often on different bases than those assumed by protocols and standardized classifications. By understanding the care flows and the difficulties faced, it was possible to propose articulation strategies so that the patient is treated at the most appropriate level and with greater resolution. This integration helps avoid overloading emergency services, ensuring that patients receive preventive care or early treatment, avoiding complications that require emergency care. Finally, it did not seek to investigate mistakes and successes, power or not, dictate rules or define them, this study only demonstrated the reality of the living network in action. Future studies are recommended in order to delve deeper into this universe of health that is constantly changes. Descriptors: Family Health Strategy, Health Care, Social Determinants of Health.