Departamento de Enfermagem Aplicada, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
Rev Saude Publica. 2010 Feb;44(1):166-76. doi: 10.1590/s0034-89102010000100018.
To analyze home care practices of outpatient and hospital services and their constitution as a substitute healthcare network.
A qualitative study was carried out using tracer methodology to analyze four outpatient home care services from the Municipal Health Department and one service from a philanthropic hospital in the municipality of Belo Horizonte, Southeastern Brazil, between 2005 and 2007. The following procedures were carried out: interviews with the home care services' managers and teams, analysis of documents and follow-up of cases, holding interviews with patients and caregivers. The analysis was guided by the analytical categories home care integration into the healthcare network and technical-assistance model.
Home care implementation was preceded by a political-institutional decision, both with a rationalizing orientation, intending to promote cost reduction, and also with the aim of carrying out the technical-assistance rearrangement of the healthcare networks. These two types of orientation were found to be in conflict, which implies difficulties for conciliating interests of the different players involved in the network, and also the creation of shared management spaces. It was possible to identify technological innovation and families' autonomy in the implementation of the healthcare projects. The teams proved to be cohesive, constructing, in the daily routine, new forms of integrating different perspectives so as to transform the healthcare practices. Challenges were observed in the proposal of integrating the different substitutive healthcare services, as the home care services' capacity to change the technical-assistance model is limited.
Home care has potential for constituting a substitutive network by producing new care modalities that cross the projects of users, family members, social network, and home care professionals. Home care as a substitute healthcare modality requires political, conceptual and operational sustainability, as well as recognition of the new arrangements and articulation of ongoing proposals.
分析门诊和医院服务的家庭护理实践及其作为替代医疗保健网络的构成。
本研究采用示踪剂方法进行了一项定性研究，以分析来自巴西东南部贝洛奥里藏特市市立卫生部门的四个门诊家庭护理服务机构和一个慈善医院的一个服务机构，时间为 2005 年至 2007 年。进行了以下程序：与家庭护理服务机构的管理人员和团队进行访谈，分析文件并对案例进行跟踪，对患者和护理人员进行访谈。分析由家庭护理整合到医疗保健网络和技术援助模式的分析类别指导。
家庭护理的实施是基于一项政治-制度决策，具有合理化的倾向，旨在降低成本，同时也旨在重新安排医疗保健网络的技术援助。发现这两种取向存在冲突，这意味着协调网络中不同参与者的利益以及创建共享管理空间存在困难。在医疗保健项目的实施中，可以发现技术创新和家庭的自主权。团队表现出凝聚力，在日常工作中构建了整合不同观点的新形式，以改变医疗实践。在提出整合不同替代医疗保健服务方面存在挑战，因为家庭护理服务改变技术援助模式的能力有限。
家庭护理具有构成替代网络的潜力，可以产生新的护理模式，跨越用户、家庭成员、社会网络和家庭护理专业人员的项目。作为替代医疗保健模式的家庭护理需要政治、概念和运营上的可持续性，以及对新安排的认可和对正在进行的提案的协调。
