Meu Deus, lá vem ele de novo! O cuidado à saúde aos usuários frequentes nas Unidades Básicas de Saúde
Data
2021-02-25
Autores
Tureck, Fernando [UNIFESP]
Orientadores
Andreazza, Rosemarie [UNIFESP]
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: Embora não haja na literatura consenso para a definição de quem seria um hiperutilizador na atenção básica, esses usuários são conhecidos das equipes e representam um grande desafio para os trabalhadores desses serviços por dois motivos pelo menos. Primeiro, porque apesar de representar um pequeno número, os hiperutilizadores consomem uma grande quantidade de consultas médicas e demais serviços oferecidos na UBS. E segundo, mais de 36% dos hiperutilizadores são considerados pacientes difíceis pelos profissionais. Objetivo: Analisar as diferentes dimensões da gestão do cuidado em saúde, em particular a organizacional, a profissional e a familiar, na definição e no cuidado aos “hiperutilizadores” na Atenção Básica à Saúde. Métodos: Foi realizada uma pesquisa qualitativa de caráter exploratório, do tipo estudo de caso, que fez uso de múltiplas técnicas para a produção dos dados. Foram entrevistadas 14 pessoas, sendo seis usuários considerados hiperutilizadores pelos profissionais, dois familiares e 6 profissionais das UBS. Após as entrevistas, foram realizados 2 seminários compartilhados com a participação dos profissionais de cada UBS estudada. Os achados foram divididos em dois planos de coorte e posteriormente analisados através dos “diálogos” formados pelos planos de visibilidade que emergiram dos planos de coorte. Resultado: Fica muito claro, desde o início das entrevistas, que as racionalidades que comandam a ação dos profissionais de saúde e os usuários sobre a frequência e a real necessidade com que as pessoas indicadas por eles como grande utilizadores buscam atendimento nas UBS são distintas. Surge com grande destaque, nas falas dos profissionais a responsabilização do usuário pela maior demanda de serviços das unidades, decorrentes principalmente da não adesão às “normas” ditadas pelas equipes: encaminhamentos, tratamentos, modificações dos hábitos de vida. As necessidades em saúde que fogem do modelo biomédico preponderante muitas vezes não são reconhecidas ou consideradas legítimas pelos profissionais. As estratégias utilizadas pelos profissionais para ofertar cuidado aos pacientes muito frequentadores são principalmente voltadas para atender apenas às necessidades que são percebidas pelos profissionais, vinculadas ao saber operatório da biomedicina e pouco, ou quase não contemplam uma série de outras necessidades relatadas pelos usuários. Considerações finais: A maneira como os profissionais que atuam na ABS definem quem é um usuário hiperutilizador é mais complexa do que o número de consultas realizadas em determinado momento e passa pela identificação das necessidades em saúde que motivam a busca por atendimento de cada um dos usuários. O estudo dos usuários considerados hiperutilizadores pelas equipes serviu como um analisador da ABS, pois demonstra que estamos ainda aquém do que pretendemos com a ABS, mantemos um modelo ainda centrado na racionalidade biomédica.
Introduction: Although there is no consensus in the literature to define who would be a frequent attender in primary care, these users are known to the workers and represent a great challenge for them for at least two reasons. First, because despite representing a small number, frequent attenders use a large amount of medical consultations and other services offered at primary care. And second, more than 36% of frequent attenders are considered difficult patients by professionals. Objective: To analyze the different dimensions of health care management, in particular organizational, professional and family, in the definition and care of frequent attenders in primary care. Methods: A qualitative research of an exploratory nature was carried out, of a case study type, which used multiple techniques for the production of data. Fourteen people were interviewed, six users considered frequent attenders by the professionals, two family members and 6 professionals from the primary care. After the interviews, 2 shared seminars were held with the participation of professionals from each unit studied. The findings were divided into two plans and subsequently analyzed through “dialogues” formed by the visibility plans that emerged from the plans. Result: It is very clear, since the beginning of the interviews, that the rationales that command the action of health professionals and users on the frequency and the real need with which the people indicated by them as great users seek care in the primary care are different. It appears with great prominence, in the speeches of the professionals, the user's responsibility for the greater demand for services from the units, mainly due to the nonadherence to the “norms” dictated by the teams: referrals, treatments, changes in life habits. Health needs that differ from the prevailing biomedical model are often not recognized or considered legitimate by professionals. The strategies used by professionals to offer care to patients who are very frequent are mainly aimed at meeting only the needs that are perceived by professionals, linked to the operational knowledge of biomedicine and little, or almost do not address a series of other needs reported by users. Final considerations: The way that professionals working at primary care define who is a frequent attender is more complex than the number of consultations carried out at a given moment and involves identifying the health needs that motivate the seek for care for each of the users. The study of users considered frequent attenders by the professionals served as an primary care analyzer, as it demonstrates that we are still below what we intend with primary care, we maintain a model still centered on biomedical rationality.
Introduction: Although there is no consensus in the literature to define who would be a frequent attender in primary care, these users are known to the workers and represent a great challenge for them for at least two reasons. First, because despite representing a small number, frequent attenders use a large amount of medical consultations and other services offered at primary care. And second, more than 36% of frequent attenders are considered difficult patients by professionals. Objective: To analyze the different dimensions of health care management, in particular organizational, professional and family, in the definition and care of frequent attenders in primary care. Methods: A qualitative research of an exploratory nature was carried out, of a case study type, which used multiple techniques for the production of data. Fourteen people were interviewed, six users considered frequent attenders by the professionals, two family members and 6 professionals from the primary care. After the interviews, 2 shared seminars were held with the participation of professionals from each unit studied. The findings were divided into two plans and subsequently analyzed through “dialogues” formed by the visibility plans that emerged from the plans. Result: It is very clear, since the beginning of the interviews, that the rationales that command the action of health professionals and users on the frequency and the real need with which the people indicated by them as great users seek care in the primary care are different. It appears with great prominence, in the speeches of the professionals, the user's responsibility for the greater demand for services from the units, mainly due to the nonadherence to the “norms” dictated by the teams: referrals, treatments, changes in life habits. Health needs that differ from the prevailing biomedical model are often not recognized or considered legitimate by professionals. The strategies used by professionals to offer care to patients who are very frequent are mainly aimed at meeting only the needs that are perceived by professionals, linked to the operational knowledge of biomedicine and little, or almost do not address a series of other needs reported by users. Final considerations: The way that professionals working at primary care define who is a frequent attender is more complex than the number of consultations carried out at a given moment and involves identifying the health needs that motivate the seek for care for each of the users. The study of users considered frequent attenders by the professionals served as an primary care analyzer, as it demonstrates that we are still below what we intend with primary care, we maintain a model still centered on biomedical rationality.
Descrição
Citação
TURECK, F. Meu Deus, lá vem ele de novo! O cuidado à saúde aos usuários frequentes nas Unidades Básicas de Saúde. São Paulo, 2021. 103 p. Dissertação (Mestrado em Saúde coletiva) - Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, 2021.