Processo de trabalho do NASF: o que mudou para o enfrentamento da pandemia da COVID-19?

Abstract

The objective of this study was to analyze the care practices developed by multidisciplinary teams of Primary Health Care (APS) and the Expanded Nuclei of Family Health and Primary Care (NASF-AP) before and during the COVID-19 pandemic. A cross-sectional quantitative research was carried out using the online survey method by websurvey for data collection. Workers from NASF teams and PHC multiprofessional teams across the country were invited to participate in the research. Those who accepted the invitation answered a form with structured and semi-structured questions about the profile of the participants and the teams, and the execution of several practices developed in the daily work of the NASF teams. 733 workers responded to the websurvey. Based on the inclusion and exclusion criteria, the final sample consisted of 646 professionals from multidisciplinary teams or NASF-AP from 24 Brazilian states and the Federal District, with a mean age of 35.9 years, ranging from 22 to 67 years. . Most professionals in the sample were female (83.4%). Workers from 21 different professions participated in the study, the most frequent being Physiotherapists (20.4%), Psychologists (20.1%), Nutritionists (17.3%), Social Workers (13.6%) and Physical Education Professionals (9.9%). Most respondents work in urban centers (76.6%) and had been in the position for more than two years (78%). As for the percentage of professionals who participated in training, training or permanent education actions on COVID-19, it was 70.3%. Of the participants, 76% have a postgraduate course, 65.9% in the form of specialization, followed by 9.6% with a master's degree and 0.5% with a doctorate. The main area of postgraduate knowledge was Public Health (38.4%). Before the pandemic, the activities performed most frequently were individual consultations, health promotion and prevention groups, home visits, team meetings with the Family Health Strategy, and therapeutic groups. The least carried out activities before the pandemic were tele calls, integrative and complementary practices and health project in the territory. During the pandemic, the most performed practices were individual consultations, screening or user reception in general, technical support from a professional nucleus, care actions related to the pandemic and social isolation related to the prevention of contagion, and the use of social networks, videos, audios , texts, newspapers and applications for guidance, dissemination and approximation with the population. The least performed practices during the pandemic were home visits to symptomatic users of COVID-19, networking and surveillance of hospitalized patients and the execution of therapeutic groups. In general, the findings of this research identified that the COVID-19 pandemic produced changes in the work processes of multidisciplinary PHC and NASF teams, in contrast to the reduction in the performance of practices when compared in the periods studied, there was also the emergence of new practices to meet the needs of the territory and the population. It is recommended that each territory, based on its needs, define the practices that need to be prioritized by their teams. The pandemic has emerged new health practices within the PHC, investing in continuing health education and in the training of professionals in the area of Public Health has the potential to reorganize the direction of NASF health practices, reinforcing the importance of the work of these professionals to the expansion of care and strengthening of integrality in the FHS. It is urgent that each territory, each team, based on its needs, define the practices to be carried out, using the tools already developed by the APS and NASF teams. A major challenge is to incorporate the new demands imposed by COVID-19, without abdicating or abandoning care for users who need other health actions, improving the harmony between clinical-assistance and technical-pedagogical practices.