Integration strategies for caring for chronic noncommunicable diseases: a case study

OBJECTIVES

to identify the strategies for integrated care used regarding Chronic Noncommunicable Diseases in a Health District.

METHODS

a case study developed in a district of a municipality in southern Brazil, with 34 participants (coordinators and nursing assistants). Data were collected between August 2016 and June 2017, through interviews, documents and computerized files. To organize the data, the MAXQDA® software was used. Analysis took place using the Integrated Care Network model.

RESULTS

integration strategies were highlighted in the systemic, normative and functional dimensions, such as coordination, district organization, Annual Operating Plan, information system, and user management service.

FINAL CONSIDERATIONS

the district comprises a structure that enables interactions through various tools; among these, coordination represents an effective strategy to enhance care, boost cooperation among professionals and support and manage the district.

ACCESS VERSUS CARE CONTINUITY IN HEALTH NETWORK SERVICES: EXPERIENCING POSSIBILITIES AND CONTRADICTIONS

ABSTRACT Objective: to understand the meaning of access to health services with a view to care continuity in the care network for users and professionals. Method: qualitative research, which used the methodological steps of Grounded Theory, carried out from November 2015 to April 2017. The theoretical sampling was obtained with 33 participants from a hospital institution and a Family Health Strategy unit. The participants were organized into three sample groups according to circular and continuous orientation of data collection and Grounded Theory analysis. The analysis was conducted according to the guidelines of the methodological framework which was composed of the open, axial and integrative coding phases. Results: four central concepts emerged from the data that demonstrate how participants experience access with a view to care continuity. These range from the first contact with the health network, through limitations and alternatives found to achieve perspectives to the care continuity in health actions and services. Conclusion: possibilities and contradictions were identified in the experience of care, with regard to access to health services and actions for the continuity of care, understanding them as feasible in health services, but divergent from the ideal advocated by the literature on the theme, as well as by the norms and prerogatives in force in the Unified Health System.

CONTINUIDADE DO CUIDADO E O INTERACIONISMO SIMBÓLICO: UM ENTENDIMENTO POSSÍVEL

RESUMO Objetivo: buscar um entendimento pela consubstanciação entre o conceito de continuidade do cuidado ao referencial teórico do interacionismo simbólico, no sentido de agregar uma possibilidade de fortalecê-lo como conceito indispensável ao cuidado prestado aos usuários do sistema de saúde e provocar uma necessária reflexão sobre este. Método: estudo teórico-reflexivo, organizado em quatro seções, sobre a continuidade do Cuidado analisado sob a luz do referencial do interacionismo simbólico. Resultados: o interacionismo simbólico busca compreender a ação humana em grupo e acredita que os indivíduos ajam tendo como base os significados que as coisas têm para eles. Esta é uma construção social que se desenvolve na medida em que as pessoas agem e interagem consigo mesmas e com os outros. A continuidade do cuidado, trabalhada a partir das dimensões relacional, informacional e de gestão, coaduna com o proposto, por representar um produto social resultante das interações entre os envolvidos no cuidado, que se expressa segundo sua ação e reação, como uma constante para um conjunto de práticas de diferentes profissionais que buscam garantir o cuidado integral e coerente ao usuário. Conclusão: este trabalho possibilitou apresentar a continuidade do cuidado, dentro do contexto das interações sociais, não como algo concreto, mas como um objeto social decorrente do agir de cada um dos envolvidos com o cuidado, embora, ainda assim, se perceba a necessidade de sensibilizar profissionais e usuários a respeito de seu significado e intencionalidade no agir da cada um.