Micropolítica do cuidado farmacêutico na atenção primária: uma análise do discurso

Abstract

This study aims to analyze the discursive formation of primary care pharmacists, seeking to understand how these professionals are constituted to do or not do it. Over time, the pharmaceutical profession has been transformed to meet the needs of society. The growth of morbidity and mortality related to medicines has demanded that pharmaceuticals get involved in the clinic and health care. The performance of the pharmacist in Primary Health Care (PHC), as a member of the Family Health and Primary Health Care Expanded Support Center (NASF-AB), is an important contribution to increase the resolution of health care actions, as it is an opportunity to provide the responsible and shared provision of pharmacotherapy, through pharmaceutical care. However, despite the advances achieved and the efforts made in the Unified Health System (SUS), as well as the positive results with such practice, pharmaceutical care has still proved to be incipient. Several challenges for its implementation have been observed. The practice develops between daily tensions and, therefore, understanding how micropolitics influences pharmaceutical exercise is crucial. The methodological route was constructed through Discourse Analysis based on Foucault and the results were discussed from the perspective of knowledge and power relations. The corpus was formed by interviews of pharmacists active in the Nasf of Belo Horizonte, and other pertinent documents, leading to the definition of the discursive object pharmaceutical care. The results show that although the increase in drug-related morbidity and mortality may be a condition for pharmaceutical care, it has been constituted in the context analyzed through the knowledge-power relationships of academic-professional education; management of access to medicines; and the doctor-pharmacist relationship. The study made it possible to visualize dispersion points between practice and the instituted, depending on the different positions occupied by individuals in the discourse in their subjectivation. Although pharmaceutical care appears in different discursive domains, in the daily analysis its construction is still fragile. The subject in the constitution has been crossed by several discursive practices that keep him from this care. Relationships are generally tense and exhausting and unfold in practices centered on relationships and not on the patient, leading to a circulation of knowledge-power that does not promote the increase in the resolution of integral actions. To transform reality, it is necessary to appropriate knowledge and move the machinery of power. The understanding of the social role from the discourse, in its founding character, leads to important reflections for the strengthening of philosophical professional bases. Therefore, understanding how we are produced enables transformations so that the practice of pharmaceutical care is possible.