Avaliação da abordagem assistencial ambulatorial na atenção especializada às condições crônicas em saúde do Hospital Regional de Santa Maria (HRSM)

Abstract

The predominance of aggravating factors of chronic conditions, constituted by the inconsistency between health problems and the social response of a segmented system, which acts episodic and reactively, has produced disordered clinical outcomes. In face of the complexity of health demands, this study verified whether the management of specialized ambulatory care at the Regional Hospital of Santa Maria is adequate for the new Model of Care for Chronic Conditions (MACC), from the perspective of health professionals. The research is characterized as descriptive with a quali-quantitative approach, based on a single case study. We carried out a structured questionnaire with health professionals, document analysis, clinical records analysis for data collection. The research instruments identified characteristics of the specialized care service, the profile of users and the assessment of institutional capacity for the care of chronic conditions. The data exploration technique to assess the professionals' perception was based on the Assessment of Chronic Illness Care (ACIC) instrument and its dimensions based on the MACC. We used a mean score scale ranging from 1 to 5 divided by analysis categories. Results pointed out important characteristics of the use of clinical management tools inserted according to the model of care for chronic conditions and based on the term of reference and technical notes that guide the execution of the actions of the Specialty Clinic for Hypertension and Diabetes Mellitus of HRSM. The socioeconomic and clinical profile of users is similar to a population with characteristics inherent to the aging process, with a low socioeconomic profile and a high risk of worsening existing chronic conditions. The ability to care for chronic conditions was fair to good, with an average variation of 3.040 to 4.004, for the dimensions related to the community articulation and Organization of Health Care, respectively. The component related to Chronic Condition Monitoring represents the greatest potential, with an average of 4.405. The components represented by community programs and users registration were the main weaknesses of the study, with an average of 2.432 and 2.459, respectively. Given the weaknesses found, the study proposed, due to the weakness reported, actions to improve care management based on the 5W2H methodology, a strategic planning tool that makes it possible to direct and qualify work processes.