Tratamento Fora de Domicílio-TFD: trajetórias de cuidado de usuários: um estudo no município de Santos
Data
2023-09-27
Autores
Verdugo, Carolina Paredes 
Orientadores
Capozzolo, Angela Aparecida
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Esta pesquisa foi desenvolvida com a perspectiva de estudar trajetórias de cuidado dos pacientes que utilizam o Tratamento Fora de Domicílio - TFD no município de Santos. O TFD foi instituído por meio da Portaria SAS/MS n.º 55/1999 e consiste em agendar consultas na rede referenciada, fornecer transporte e uma ajuda de custo, aos pacientes da rede pública ou conveniada/contratada do SUS, que pela complexidade dos seus casos, necessitam utilizar serviços localizados fora do município onde residem.
Apesar dos avanços em relação à situação anterior a essa portaria, observamos diversas dificuldades nesse processo desde o momento de definição diagnóstica até o acesso e o início do tratamento, que impactam de diferentes maneiras o cuidado e resultam em sofrimentos desnecessários aos usuários e seus familiares.
Partindo do pressuposto que é fundamental qualificar o TFD para garantir a integralidade do cuidado, esta pesquisa investigou, a partir de narrativas de usuários, a trajetória para o acesso ao TFD no município de Santos: buscou mapear os serviços utilizados, identificar e analisar a problemática envolvida nesse processo. Foram selecionados três usuários e/ou familiares atendidos há mais de um ano pelo TFD, com diagnósticos que demandam serviços de alta complexidade e o uso contínuo e sistemático do transporte. As narrativas foram produzidas através de encontros presenciais com o pesquisador que contou com um roteiro norteador. Esses encontros foram gravados e depois transcritos sendo feita a análise a partir da leitura de cada material individualmente e depois do conjunto. A análise apontou falhas nas informações das equipes sobre o TFD, problemas na articulação entre as equipes e os serviços da rede e normas e protocolos institucionais que resultam em dificuldades no acolhimento, acesso, acompanhamento e cuidado desses usuários.
A partir da investigação foi proposto como produto um material educativo denominado: Pitadas de saberes: sementes de reflexão, onde através de rodas de conversa, poderemos fomentar a abertura de diálogos, dar mais visibilidade às questões e problemáticas identificadas com os usuários e dessa forma contribuir para qualificar os serviços e os profissionais envolvidos nesse processo.
Palavras chaves: Tratamento Fora de Domicílio, narrativa, integralidade, cuidado, rede de serviços.
This research was developed with the perspective of studying care trajectories of patients who use Out-of-Home Treatment - PDT in the city of Santos. The TFD was instituted through Ordinance SAS/MS n. º 55/1999 and consists of scheduling consultations in the referenced network, providing transportation and a cost allowance, to patients in the public network or partnered/contracted by the SUS, who on average and high complexity of their cases, need to use services located outside the municipality where they live. Despite advances in relation to the situation prior to this ordinance, we observed several difficulties in this process from the moment of diagnostic definition to access and initiation of treatment, which impact care in different ways and result in unnecessary suffering for users and their families. Based on the assumption that it is essential to qualify the GT to guarantee comprehensive care, this research investigated, based on users' narratives, the path to access the GT in the municipality of Santos: it sought to map the services used, identify and analyze the problem involved in that process. Three users and/or family members assisted for more than a year by the GT were selected, with diagnoses that demand highly complex services and the continuous and systematic use of transport. The narratives were produced through face-to-face meetings with the researcher who had a guiding script. These meetings were recorded and later transcribed, with the analysis being carried out from reading each material individually and then as a whole. The analysis pointed out flaws in the teams' information about the flow of the GT, problems in the articulation between the teams and the network services and in the institutional norms and protocols that resulted in difficulties in the reception, access, follow-up and care of these users. Based on the investigation, an educational material called: Bites of knowledge: seeds of reflection was proposed as a product, where through conversation circles, we can encourage the opening of dialogues, give more visibility to the issues and problems identified with users and thus contribute to qualify the services and professionals involved in this process.
This research was developed with the perspective of studying care trajectories of patients who use Out-of-Home Treatment - PDT in the city of Santos. The TFD was instituted through Ordinance SAS/MS n. º 55/1999 and consists of scheduling consultations in the referenced network, providing transportation and a cost allowance, to patients in the public network or partnered/contracted by the SUS, who on average and high complexity of their cases, need to use services located outside the municipality where they live. Despite advances in relation to the situation prior to this ordinance, we observed several difficulties in this process from the moment of diagnostic definition to access and initiation of treatment, which impact care in different ways and result in unnecessary suffering for users and their families. Based on the assumption that it is essential to qualify the GT to guarantee comprehensive care, this research investigated, based on users' narratives, the path to access the GT in the municipality of Santos: it sought to map the services used, identify and analyze the problem involved in that process. Three users and/or family members assisted for more than a year by the GT were selected, with diagnoses that demand highly complex services and the continuous and systematic use of transport. The narratives were produced through face-to-face meetings with the researcher who had a guiding script. These meetings were recorded and later transcribed, with the analysis being carried out from reading each material individually and then as a whole. The analysis pointed out flaws in the teams' information about the flow of the GT, problems in the articulation between the teams and the network services and in the institutional norms and protocols that resulted in difficulties in the reception, access, follow-up and care of these users. Based on the investigation, an educational material called: Bites of knowledge: seeds of reflection was proposed as a product, where through conversation circles, we can encourage the opening of dialogues, give more visibility to the issues and problems identified with users and thus contribute to qualify the services and professionals involved in this process.
Descrição
Citação
VERDUGO, Carolina Paredes. Tratamento Fora do Domicílio (TFD): trajetórias de cuidados dos usuários: Um estudo no Município de Santos – SP . 2023. 97 f. Dissertação (Mestrado Profissional em Ensino em Ciências da Saúde) - Instituto de Saúde e Sociedade, Escola Paulista de Enfermagem, Universidade Federal de São Paulo. Santos, 2023.