Grau de integração da atenção primária à saúde na rede de serviços de saúde em município de pequeno porte

Abstract

Several studies show that fragmented health systems do not ensure a timely attention or quality. Even in universal basic health systems and guided by territorial and coordination of actions, such as in Brazil, this situation has been observed, with a fragile integration of the Health Care Network. In this context, integration becomes a priority and a challenge for health systems, with some experience in large municipalities in the literature. However, we must recognize that they cannot be generalized for all the Brazilian cities, especially in cases of small distant districts of large cities, sometimes located in true assistance empty. This study aimed to assess the degree of integration of the Primary Health Care (PHC) in RAS in a small town, far from major urban center and located in economically developed region bit of Minas Gerais. It is a case study with a quantitative approach, based on the perspective of the organization of integrated networks of health care, focusing on attention to ensuring the different levels. To assess the degree of integration has been developed an analysis matrix consisting of four types of analysis criteria 15 and 62 indicators. Predefined parameters allowed the issue of value judgments: the analyzed indicator received a score ranging from zero to three points. To meet the parameters of the indicators, data were collected using structured questionnaires applied to professionals and managers of municipal health system and also document analysis. To determine the degree of integration, it was considered the calculation obtained by the ratio between the sum of the observed score and the sum of the expected maximum score multiplied by 100. From the score achieved, the degree of integration could be classified as: integrated system (76-100), advanced integration (51-75), incipient (26-50) and very fragmented system (25). As a result, of the 186 anticipated points, municipal indicators reached 74 (score 39.8), indicating a degree of incipient integration between its APS and other Network services, highlighting problems that reflected directly in access to medium and high complexity. None of the categories of analysis proved to be well incorporated into the municipal reality. The best was incorporated First Strengthening Warning level for Care Coordination which obtained 61.1% of the points in question. What had the worst performance was access Specialized Care and Hospital, with only 30.2% of the distributed points. Finally, the elaborate analysis matrix proved to be an instrument capable of signaling the municipal situation regarding the fulfillment of integration between different health care levels and can guide managers to adopt strategies that encourage corrective actions towards integration.