Bousquat Aylene, Giovanella Ligia, Campos Estela Márcia Saraiva, Almeida Patty Fidelis de, Martins Cleide Lavieri, Mota Paulo Henrique Dos Santos, Mendonça Maria Helena Magalhães de, Medina Maria Guadalupe, Viana Ana Luiza d'Ávila, Fausto Márcia Cristina Rodrigues, Paula Daniel Baffini de
Faculdade de Saúde Pública, Universidade de São Paulo. Av. Dr. Arnaldo 715, Cerqueira César. 01246-904 São Paulo SP Brasil.
Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil.
Cien Saude Colet. 2017 Apr;22(4):1141-1154. doi: 10.1590/1413-81232017224.28632016.
This paper aims to analyze the healthcare coordination by Primary Health Care (PHC), with the backdrop of building a Health Care Network (RAS) in a region in the state of São Paulo, Brazil. We conducted a case study with qualitative and quantitative approaches, proceeding to the triangulation of data between the perception of managers and experience of users. We drew analysis realms and variables from the three pillars of healthcare coordination - informational, clinical and administrative/organizational. Stroke was the tracer event chosen and therapeutic itineraries were conducted with users and questionnaires applied to the managers. The central feature of the construction of the Health Care Network in the studied area is the prominence of a philanthropic organization. The results suggest fragility of PHC in healthcare coordination in all analyzed realms. Furthermore, we identified a public-private mix, in addition to services contracted from the Unified Health System (SUS), with out-of-pocket payments for specialist consultation, tests and rehabilitation. Much in the same way that there is no RAS without a robust PHC capable of coordinating care, PHC is unable to play its role without a solid regional arrangement and a virtuous articulation between the three federative levels.
本文旨在分析初级卫生保健（PHC）在医疗协调方面的情况，背景是在巴西圣保罗州的一个地区建立医疗保健网络（RAS）。我们采用定性和定量方法进行了一项案例研究，对管理人员的认知和用户的体验进行数据三角验证。我们从医疗协调的三个支柱——信息、临床和行政/组织方面提取了分析领域和变量。中风是选定的追踪事件，对用户进行了治疗流程跟踪，并向管理人员发放了问卷。研究区域内医疗保健网络建设的核心特点是一个慈善组织的突出作用。结果表明，在所有分析领域中，初级卫生保健在医疗协调方面存在脆弱性。此外，我们还发现了公私混合的情况，除了从统一卫生系统（SUS）签约的服务外，专科咨询、检查和康复还需自掏腰包付费。正如没有强大的能够协调护理的初级卫生保健就没有RAS一样，没有稳固的区域安排以及三个联邦层面之间的良性衔接，初级卫生保健就无法发挥其作用。
