Internações hospitalares por condições sensíveis à atenção ambulatorial: um estudo de caso com gestores e equipes da Estratégia Saúde da Família em uma microrregião de saúde.

Abstract

To offer an enlarged and resolutely attendance in the health area it is necessary to rethink and modify the attention practices existent in the services in order to find solutions to grievances that has harmed the communities, providing transformations in peoples health state that assures them the necessary care and life quality. Through this perspective, the objective of this study was to identify and evaluate the relation between the basic care services organization and operation structured in the Family Heath logic, attending the cases of hospitalizations by sensible conditions to ambulatory attention in a health micro region. As users offered attendance evaluation tool the hospitalizations by sensible conditions to ambulatory attention (CSAA) indicator was used. This indicator allows to evaluate the primary attention to health effectiveness and verify if unnecessary hospitalizations by grievances that should be attended in the basic health units occurred. The study of qualitative nature that used as strategy the study of cases was first developed with the survey of CSAA causes and indexes in the State of Minas Gerais and Coronel Fabriciano health micro region. In the sequence, the managers, job professionals and members of the micro region cities family health strategy teams were interviewed aiming at the identification of the health attention context in attendance of people that need hospitalization by CSAA. During this stage the services organization and functioning considering the access and flow for users attendance, the actions developed by the professionals in attendance to this users, the evaluations mechanisms of CSAA causes used in the services and the organizational aspects that interfered in the people attendance that need hospitalization were analyzed. For the primary data collection an identification sheet plus a semi structured interview routine were used, applied to managers and professionals of the Family Health Strategy (ESF) teams. For the secondary data collection the data about hospitalizations by CSAA of the Secretaria de Estado da Saúde de Minas Gerais and Gerência Regional de Saúde de Coronel Fabriciano that are available through the Primary Attention to Health State Superintendence were used. Data was analyzed by the content analyses technique proposed by Bardin. Results have showed that despite the Health Ministry investments, as the maximum institution for the health system organization all over the country as well as the States and cities interest in qualify the health attention, this process still needs more investments. This should be preferentially directed towards the assistance practices and to the professionals and net managers for the health attention. In the searching services reality, several problems related to the assistance and management fields have been observed, causing limitations in the definition and introduction of health promotion and grievance prevention among those related to CSAA hospitalizations. By the results found, it was verified that the hospitalization culture is settled in the people who use the services, as well as in the professionals, characterizing a great difficult with the health attention traditional model rupture determining the offer of a fragmented and not related with the necessity and social reality of people care. The existing deficiencies in the services structure, attendance process, net attention hierarchy and permanent professionals and managers education were noticed, that makes high quality assistance difficult and compromised. Referring to the understanding of the CSAA hospitalization determinants and the relationship with the relation with the basic attention function, structured in the health family strategy logic, it was stated the ignorance about the management mechanisms, services organization, monitoring instruments, and offered attention evaluation, the health indicators among them. Looking at this scenario, therefore, the Coronel Fabriciano micro region health services (re)structure is placed and should be referred to the Health Unique System principles with priorities to total health, net of health attendance effective hierarchy and regionalization, professionals permanent education investment, even with all the management practices, organization and care mistakes existed in the micro region health services.