Continuidade do cuidado ao portador de doença crônica em uma unidade de atendimento imediato

Abstract

This studys goal was to understand the continuity of care provided to the carrier of non-communicable chronic disease (NCCD) within the system of health care, through the perspective of managers, employees and users of an Immediate Care Center (ICC) located in Betim - Minas Gerais State, which was selected as the setting of this research under the criterion of accessibility. The present research is descriptive and qualitative in its nature. 22 individuals were part of it, according to the following division: three managers - one of the center as a whole, another of the medical body, and the last one of the nursing department; 12 employees - two social assistants, five nurses and five doctors; and seven users who are carriers of NCCD. The NCCDs were chosen for they can be classified as diseases of great magnitude, increasing morbidity, and because of the pressing need to think of policies concerned with assisting their carriers. The data were collected in the format of individual interviews with a semi-structured guide. Content analysis was the technique employed in examining the data, and it generated the emergence of three categories: Continuity of care: an analysis under the light of the concept of informational continuity, Management Continuity: from managing chronic conditions to management complexity and The Home Care Program as an expression of continuity of care. For the first category, it was revealed that there were gaps in communication inside the ICC, such as problems related to the records of patients, and poor communication among the members of the same team, which minimized the potential to take proper measures to enhance continuity of care. Interaction between the ICC and other health services appeared to be troublesome, though it was verified that the social assistant is an important key in making this interaction work. Moreover, there was evidence that the reference of users is more solid than the counter-reference, which is at a highly initial stage. In the second category it was found that the management of the NCCDs conveyed weaknesses that may interfere in the continuity of care, making it paramount to carry out interventions in such management. When talking about managerial aspects of continuity of care, it was observed that some characteristics in the work provided by the ICC, the management of people and material resources and political matters strongly influence the actions taken that are supposed to support continuity of care. Turning to the third category, it was possible to notice that the Home Care Program (HCP), which is linked to the ICC, was considered as one of the numerous possibilities of ensuring continuity of care. Besides this, the HCP was interpreted as an instrument to solve problems of overcrowdings and shortage of hospital beds. It is concluded that in order to guarantee continuity of care to the carriers of NCCDs, a greater integration and coordination of the health care system as a whole is necessary, accompanied by the development of strategies to improve communication among the professionals involved, in such a way thatenables interaction aimed at the continuity of care. Despite the several deficiencies that were pointed out, it was possible to timidly witness continuity of care, which was at times incipient. Nonetheless, we believe the field being studied is a fertile one to stimulate the development of strategic measures that would allow an improvement in the continuity of care and, hence, in assistential quality.