Coordenação do cuidado na visão de enfermeiros da atenção primária à saúde: estudo de método misto

Abstract

Coordination of health care is an attribution of primary health care, assuming continuity and completeness of care and follow-up over time. For care coordination to be effective, it is necessary to analyze the conditions, understandings, facilitators or barriers to its implementation. This study aimed to analyze the coordination of care in primary health care, from the perspective of nurses in health region 20 of Rio Grande do Sul. It is characterized as an explanatory sequential mixed method study with data collection in two stages, the first quantitative and the second qualitative. In the quantitative stage, the PCATool - Brazil instrument was applied to PHC health professionals, subsequently the data was subjected to descriptive and analytical analysis, the qualitative stage started from the analysis of these data generated from the score of the PCATool instrument, when the municipalities that presented the highest and lowest scores for the attribute. In the exploration of qualitative data, the focus group technique was used, conducted through a semi-structured script. In the qualitative analysis, thematic analysis was used. Quantitative and qualitative data were analyzed and integrated to make the study results meaningful. The results of the quantitative stage identified a positive score for the attribute coordination – care integration for the municipalities of Health Region 20. The qualitative data resulted in four categories, which emerged from the empirical material produced, being: Understandings about care coordination – aligned team, user and flows; reference and counter-reference – a practice or a goal to achieve for care coordination?; The power and overload of nurses in coordinating care and; Traditional care and management models maintain the ways of being of users, health professionals and managers. The challenges encountered were significant, such as the inefficient dialogue for coordination between teams in primary care and the lack of information from users and its impacts on referral and counter-referral. Based on the results found, it is possible to evaluate the coordination of care with greater attention to strategic actions, through effective methodologies and the strengthening of identified facilitators. Thus, it was concluded that care coordination goes beyond universal/common/generalized and rapid care, in addition, it requires prioritizing its essential characteristics and, thus, promoting effectiveness in the user's care process within the network, which needs to be articulated, with established and continuous flows, multidisciplinary teams and collaborative work. Aiming to look at management models and behaviors that culminate in quality results and promise for the health system.