Arranjos organizacionais para o cuidado da pessoa com doença renal crônica não dialítica no Brasil: realidade, barreiras e oportunidades
Data
2024-06-04
Autores
Albuquerque, Patrícia Maria Pereira de 
Orientadores
Kirsztajn, Gianna Mastroianni
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A doença renal crônica (DRC) está em expansão em todo mundo. Diante do cenário atual da DRC, que desponta como um grave problema de saúde pública, e grande impacto humano, clínico, econômico e social, numa conjuntura de múltiplos adoecimentos crônicos; ações legais do Ministério da Saúde por meio da coordenadoria-geral da Secretária de Atenção à Saúde, como órgão gestor do Sistema Único de Saúde no nível federal, que coloca o cuidado do regime de responsabilidade compartilhada com os demais e diferentes níveis do Sistema, estado e municípios, e informa que de acordo com o princípio da descentralização o processo de credenciamento e solicitação de habilitação dos serviços de nefrologia deve ser realizado pelo gestor Estadual o qual deve estabelecer os fluxos assistenciais locais, respeitando as competências das três esferas de gestão. Objetivo: Identificar fragilidades, barreiras e oportunidades frente aos arranjos organizacionais pactuados e operacionalizados no cuidado da pessoa portadora de DRC não dialítica no Brasil. Método: A pesquisa é classificada quanto aos seus objetivos como descritiva. Em relação ao método, caracteriza-se como uma pesquisa avaliativa com abordagem tipo quantitativa e qualitativa, método misto em saúde para o modelo de cuidado da pessoa portadora de DRC em estágio não dialítico. Resultado: Observou-se que 55% dos nefrologistas com atuação assistencial exclusiva (n=20 desconhecem a Portaria n°1675, de junho de 2018, responsável pela organização e financiamento da linha de cuidado da pessoa com DRC. Dos que conheciam essa normativa (45%), 20% deles tinham conhecimento sobre o termo “apoio matricial” e 15% confirmaram experiência na atuação do matriciamento. Por sua vez, entre os gestores entrevistados, todos conheciam a Portaria e o termo “apoio matricial”, apesar de apenas um deles referir experiência na atuação do apoio matricial junto à atenção primária à saúde APS. Discussão e Conclusão: A oportunidade idenificada pelos entrevistados para melhoria do modelo de cuidado da DRC, refere-se à implementação de um modelo híbrido de cuidado (presencial e digital). O cuidado compartilhado (apoio matricial), elo fundamental da linha de cuidado da DRC, não está implantado em nosso meio. Parcela significativa dos profissionais assistentes não conheciam ou não realizavam matriciamento da APS. Os gestores públicos da Linha de Cuidado da DRC, embora conhecessem as principais normas vigentes, nunca tiveram experiência com cuidado compartilhado.
Chronic kidney disease (CKD) is increasing worldwide. Given the current scenario of CKD, which has emerged as a serious public health problem and a major human, clinical, economic and social impact, in a context of multiple chronic illnesses; legal actions of the Ministry of Health through the general coordination of the Health Care Secretariat, as the managing body of the Unified Health System at the federal level, which places the care of the shared responsibility regime with the other and different levels of the System, state and municipalities, and informs that according to the principle of decentralization the process of accreditation and request for qualification of nephrology services must be carried out by the State manager who must establish the local care flows, respecting the competences of the three spheres of management. Objective: To identify weaknesses, barriers and opportunities in relation to the organizational arrangements agreed and operationalized in the care of people with nondialysis CKD in Brazil. Method: The research is classified as descriptive in terms of its objectives. Regarding the method, it is characterized as an evaluative research with a quantitative and qualitative approach, mixed method in health for the care model of the person with CKD in non-dialysis stage. Results: It was observed that 55% of nephrologists with exclusive care (n=20) were unaware of Ordinance No. 1675, of June 2018, which is responsible for organizing and financing the line of care for people with CKD. Of those who were aware of this regulation (45%), 20% were aware of the term "matrix support" and 15% confirmed experience in matrix support. In turn, all the managers interviewed were aware of the Ordinance and the term "matrix support", although only one of them reported experience in providing matrix support in primary health care. Discussion and Conclusion: The opportunity identified by the interviewees for improving the CKD care model refers to the implementation of a hybrid care model (face-to-face and digital). Shared care (matrix support), a fundamental link in the line of care for CKD, has not been implemented in our country. A significant proportion of professional assistants did not know or did not provide matrix support for PHC. Although the public managers of the CKD care line were aware of the main rules in force, they had never had any experience with shared care.
Chronic kidney disease (CKD) is increasing worldwide. Given the current scenario of CKD, which has emerged as a serious public health problem and a major human, clinical, economic and social impact, in a context of multiple chronic illnesses; legal actions of the Ministry of Health through the general coordination of the Health Care Secretariat, as the managing body of the Unified Health System at the federal level, which places the care of the shared responsibility regime with the other and different levels of the System, state and municipalities, and informs that according to the principle of decentralization the process of accreditation and request for qualification of nephrology services must be carried out by the State manager who must establish the local care flows, respecting the competences of the three spheres of management. Objective: To identify weaknesses, barriers and opportunities in relation to the organizational arrangements agreed and operationalized in the care of people with nondialysis CKD in Brazil. Method: The research is classified as descriptive in terms of its objectives. Regarding the method, it is characterized as an evaluative research with a quantitative and qualitative approach, mixed method in health for the care model of the person with CKD in non-dialysis stage. Results: It was observed that 55% of nephrologists with exclusive care (n=20) were unaware of Ordinance No. 1675, of June 2018, which is responsible for organizing and financing the line of care for people with CKD. Of those who were aware of this regulation (45%), 20% were aware of the term "matrix support" and 15% confirmed experience in matrix support. In turn, all the managers interviewed were aware of the Ordinance and the term "matrix support", although only one of them reported experience in providing matrix support in primary health care. Discussion and Conclusion: The opportunity identified by the interviewees for improving the CKD care model refers to the implementation of a hybrid care model (face-to-face and digital). Shared care (matrix support), a fundamental link in the line of care for CKD, has not been implemented in our country. A significant proportion of professional assistants did not know or did not provide matrix support for PHC. Although the public managers of the CKD care line were aware of the main rules in force, they had never had any experience with shared care.
Descrição
Citação
ALBUQUERQUE, Patricia Maria Pereira de. Arranjos organizacionais para o cuidado da pessoa com doença renal crônica não dialítica no Brasil: realidade, barreiras e oportunidades. 2024. 144 f. Tese (Doutorado em Nefrologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2024.