Análise da atenção domiciliar no âmbito da reabilitação no Sistema Único de Saúde/ Belo Horizonte (SUS/BH) a partir de casos traçadores

Abstract

The objective of the present study is to analyze the organization of Homecare Assistance (HA) within rehabilitation and users access to this type of practice as well as to the Healthcare network system, from the act of caring. With this purpose, a qualitative study using tracer methodology was conducted to investigate the paths of five users though the health systembased on the demand of the HA in primary care. This methodology concerns retrospective and prospective cases that allowed the knowledge of the ways in which work processes such as HA materialize in practice. Data collection occurred in three healthcare centers of the Northeast District in Belo Horizonte- Minas Gerais, and included documentary analysis, participant observation and interviews with centers managers, physiotherapists, health care users, caregivers and others involved in users care. In data analyses, case descriptions and the categories that came up during data collection were no longer the focus and became an entanglement of relations. This context, instigated by the joining of secondary sources, narratives and experiences, allowed the rebuilding of the subject of study, enhancing the singularity of tracer cases experiences and paths. The results allowed reflection about concepts, structures and dynamics that constitute the care system. There are obstacles that make the work of caretakers and professionals harder, especially when the focus of actions is turned to the infrastructure available. These obstructions frequently generate a feeling of shared frustration and impotence in all those involved, preventing users access to the care system and the continuity of care. On the other hand, it is noticeable that these protagonists of the development of the Healthcare network System, specifically Brazil´s Unified Public Health System (SUS), are motivated to cooperate and assist on its enhancing. Despite the difficulties to exercise good healthcare practice, HA unpredictably concerns the recruitment of various sectors and actors of the community. HA solidifies itself as a powerful network activator. In the search of solutions for the identified problems, HA generates the desire and effort of those involved, allowing the construction of formal and informal networks, beyond patient care. Results suggest that real change is related to the understanding that interrelations created by users and their needs are what allow network recruitment. The appointment of a coordinating center in the network might not be enough to put an end to fragmentation of care and to allow a continuous and integral flux. The pace of political transformations is different from those of epidemiologic, demographic and technologic transformations; therefore, it would be an exaggeration to focus only in the enhancement on health policies. Rehabilitation and HA are relatively new in this process, thus more studies are needed to contribute to the systems organization without generating artifice and policies that stifle it, but that allow new forms of practice.