Avanços e desafios do acolhimento na reabilitação: um estudo dos centros de referência em reabilitação da rede do sistema único de saúde do munícipio de Belo Horizonte (MG)

Abstract

Introduction: In Brazil, the change in the epidemiological, demographic, urbanization and industrialization with the emergence of new problems and increased morbidity due to external causes, coupled with the technological developments in care have put in evidence the rehabilitation in the context of public health. Historically, rehabilitation services in Brazil, were characterized by low coverage and resolution. The light of the innovations proposed by the Brazilian Health Reform began the reconstruction of health care to the disabled person, with the consequent establishment of a territorial network of assistance in the Unified Health System (SUS), since the medium and high complexity to primary care. The SUS proposes the creation and strengthening of a line of care that can be responsive to the demands of different patients, user embracement them and providing answers and resolving effective. The user embracement operating guideline for the National Policy of Humanization of SUS (PNH), is to reorganize the work process in health services to provide access to all that seek to strengthen the principles of universality, fairness and the pursuit of completeness. The Centers for Excellence in Rehabilitation (CRR) became responsible for actions and procedures of medium and high complexity and increased demand for its services have put in check how their actions are produced to meet the needs of the population. The municipality of Belo Horizonte (BH) seeks to guarantee access to health services humanized their network / SUS, implemented user embracement the primary in 1995, and 2005 in their CRR. Objectives: To describe and analyze how the user embracement is given to patients who require care in the CRR Network BH SUS (SUS / BH). Methods: We performed a literature review on the theme of user embracement the different levels of complexity of the SUS, and on rehabilitation in Brazil. A field survey on the user embracement in three CRR - SUS / BH was also held, which elected a qualitative approach as a means of understanding this phenomenon studied in its complexity and uniqueness. For data collection were used: participant observation, document analysis, semi-structured interviews and with patients and focus groups with professionals in CRR-SUS / BH. Data analysis was carried out through the Analysis of Content, which comprised three stages: pre-analysis, material investigation and processing of results, inference and interpretation. The project was approved by the Ethics Committee of the Municipal Health Secretariat of Belo Horizonte - CEP / SMSA / BH, and the Federal University of Minas Gerais - UFMG / COEP, No 0017.0.410.203-10. Results: CRR SUS / BH studied the implementation the user embracement caused reflections and questions, raising the need for changes to extend the vision and governance teams. Thus, innovative actions based on comprehensive rehabilitation care have been devised to the patient, but some elements have hindered the user embracement in the CRR such as the biomedical model adopted, the impossibility of reconciling the geographical factors, economic and functional access for continuing the line of care in rehabilitation by excess demand and shortage of services to meet the more complex cases, the absence of a work in integrated networks, both for the user who is wandering the services, and for the professionals with the difficulties of routing and flow / or the absence of clear definitions of responsibilities and possibilities of each specific health equipment comprising the network SUS / BH. Moreover, the user perspective and practitioners, it was found that the dimension of care has been absorbed in the daily practices of the user embracement in CRR, both for its operation on a full time, as the information promptly given, and the ability to listen human posture and the professionals involved in the host. The concerns raised by professionals in the CRR, as with inadequate physical space to perform the reception, attention focused on procedure and not on the patient‟s workload at the time of user embracement - like having to computerize the data collected at the same time that becomes the user embracement, associated with excess demand and need for a unified medical record and cross-disciplinary, evidence that the user embracement undergoes significant changes, no longer just a good reception and / or screening, to become an expression of commitment and search of a practice of solidarity, and efficient. Conclusion: The results of this study indicate the importance to equip the teams in the CRR for innovative interventions for Continuing Education, as well as by the need to create protected spaces of the staff for reflection, discussion and analysis of the impasses, limits and surpassing the biomedical model light completeness in rehabilitation. There is need to rethink and reconstruct the flow of patient at different levels of complexity of the SUS BH, thus facilitating the integration and intersectoral actions for resolving the user embracement in rehabilitation.