Itinerários terapêuticos: compreendendo a trajetória de pessoas em hemodiálise no Sistema Único de Saúde de Belo Horizonte

Abstract

Introduction: Therapeutic itineraries involve all the movements trigged by individuals looking for preservation or recovery of their health and are influenced by individual or collective subjective constructs. Furthermore, they express the available health resources and the use of them by those in need. Studies on itineraries can provide the basis for health services organization and management, but are scarcely utilized in Brazil. Chronic renal disease (CRD), derived from hypertension and diabetes may be prevented or delayed by adequate follow-up of diseases condition by primary and secondary attention. In Belo Horizonte, 70% of the patients in hemodialysis began the procedure in emergencies, suggesting inadequate attention. Objective: To learn about the national scientific production on therapeutic itineraries in the last 20 years, describing and analyzing the approaches that were carried out. In addition, by utilizing this study and the narratives of people with CRD derived from hypertension or diabetes to learn about their trajectories in hemodialysis at the National Health System in Belo Horizonte. Methods: Two studies were carried out. In the first an extensive revision of the scientific production in Brazil on therapeutic itineraries in the last 20 years was conducted. Data were collected through scientific data base (www.bireme.br) and categorized by the content thematic analysis of Bardin. In the second study, narratives of thirty people with CRD derived from hypertension or diabetes taken during hemodialysis procedure were analyzed based on Grounded Theory to provide interpretative qualitative data. Results: The first study yielded 11 articles. It was observed that studies on therapeutic itineraries are recent and sub-utilized by researchers and managers. The socio-anthropological approach offers theoretical grounds to the majority of the studies. The main focus of interest is the patients perception of the disease and treatment. Only few studies associate aspects of access and services utilization and factors related to the patients context. In the second study, analysis of the interviews allowed the identification of five phenomena that characterize the therapeutic itinerary of the interviewees: perception that something is wrong, reception of the news about CRD and hemodialysis, attempt to explain CRD, via crucis through the health system and surviving on hemodialysis. The main problems identified were: lack of information about CRD as consequence of hypertension and diabetes, late discovery of the renal problem and lack of association with primary attention. From the integrated analysis of the phenomena a central category has emerged by qualifying the care management, through commitment and responsibility in primary attention, aiming at securing dialogue and information, generators of autonomous care. Conclusion: The literature about therapeutic itineraries is limited regarding the possibility that these studies could offer. Studies about therapeutic itineraries could be a complementary strategy to quantitative studies and constitute an important tool to qualify medical assistance. The study on therapeutic itineraries using the methodological reference of the Grounded Theory reached the objectives that were to learn about the trajectory of CRD patients subsequent to hypertension and diabetes, according to their perspective. The results of this study showed that knowledgement about therapeutic itineraries offer the possibility to provide better insight on the user behavior in relation to the process of health-disease-care