Reconstrução da trajetória assistencial de vítimas de trauma com exigências de cuidados após alta hospitalar, a partir da perspectiva dos trabalhadores da saúde e da formação de redes vivas

Abstract

The Federal Constitution of 1988 recognized the right to health as a State´s Duty and created the Unified Health System (SUS). Integrality is one of the principles of the SUS and represents the recognition of the complexity and needs of each individual. It is based on the logic of access and articulation of all actions and levels of health care. For its effectiveness, Attention Networks and Care Lines were instituted, among them, the Urgencies and Emergencies Care Network and the Trauma Care Line that are part of this study. The various operating logics of the SUS also enable the construction of “living networks” of care, considered as a way of producing connections that creates opportunities for the patients. Workers and users of the SUS produce movements and knowledge capable of building and sharing care. This work intends to add elements to the discussion on this system´s integrality and also be a strategy for health work in the search for overcoming the obstacles that interfere in the effectiveness of comprehensive care. To this end, we worked with the user-guide methodology to reconstruct the care trajectory of two users which were victms of trauma with care requirements after hospital discharge. This is a qualitative, descriptive and exploratory research whose main objective is to analyze the path of users in search of the construction of living networks under the vision and perspective of the primary health care worker (PHC), through the user strategy guide. For data collection, we carried out in-depth open interviews with users and workers, in addition to documentary research. We noticed that PHC workers produced living networks while meeting with the patients to overcome care deficiencies and logistical support of the municipal system. We found PHC weaknesses in ensuring continuity of care, establishing bonds, accountability and coordination of care for trauma victims with high care complexity. These weaknesses were related to deficiencies in the organization of services, in the infrastructure of human resources and in logistics, as well as deficiencies related to teamwork and multidisciplinary work, both generating a reduction in the system's capacity to provide comprehensive health care. This study demonstrates the necessity to improve the network for trauma victims who are discharged from the hospital with complex care demands, in order to ensure its continuity after hospital discharge.