O'Dwyer Gisele, Konder Mariana Teixeira, Reciputti Luciano Pereira, Lopes Mônica Guimarães Macau, Agostinho Danielle Fernandes, Alves Gabriel Farias
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Departamento de Administração e Planejamento em Saúde. Rio de Janeiro, RJ, Brasil.
Universidade Estadual do Rio de Janeiro. Faculdade de Ciências Médicas. Departamento de Clínica Médica. Rio de Janeiro, RJ, Brasil.
Rev Saude Publica. 2017 Dec 11;51:125. doi: 10.11606/S1518-8787.2017051000072.
To analyze the process of implementation of emergency care units in Brazil.
We have carried out a documentary analysis, with interviews with twenty-four state urgency coordinators and a panel of experts. We have analyzed issues related to policy background and trajectory, players involved in the implementation, expansion process, advances, limits, and implementation difficulties, and state coordination capacity. We have used the theoretical framework of the analysis of the strategic conduct of the Giddens theory of structuration.
Emergency care units have been implemented after 2007, initially in the Southeast region, and 446 emergency care units were present in all Brazilian regions in 2016. Currently, 620 emergency care units are under construction, which indicates expectation of expansion. Federal funding was a strong driver for the implementation. The states have planned their emergency care units, but the existence of direct negotiation between municipalities and the Union has contributed with the significant number of emergency care units that have been built but that do not work. In relation to the urgency network, there is tension with the hospital because of the lack of beds in the country, which generates hospitalizations in the emergency care unit. The management of emergency care units is predominantly municipal, and most of the emergency care units are located outside the capitals and classified as Size III. The main challenges identified were: under-funding and difficulty in recruiting physicians.
The emergency care unit has the merit of having technological resources and being architecturally differentiated, but it will only succeed within an urgency network. Federal induction has generated contradictory responses, since not all states consider the emergency care unit a priority. The strengthening of the state management has been identified as a challenge for the implementation of the urgency network.
分析巴西急救单元的实施过程。
我们进行了文献分析，并采访了24位州急救协调员和一个专家小组。我们分析了与政策背景和轨迹、实施过程中的相关方、扩张过程、进展、局限和实施困难以及州协调能力相关的问题。我们运用了吉登斯结构化理论战略行为分析的理论框架。
急救单元于2007年后开始实施，最初在东南部地区，2016年巴西所有地区共有446个急救单元。目前，有620个急救单元正在建设中，这表明有扩张的预期。联邦资金是实施的强大推动力。各州已规划了他们的急救单元，但市政当局与联邦之间的直接谈判导致了大量已建成但无法运作的急救单元。在急救网络方面，由于该国床位短缺，与医院存在紧张关系，这导致在急救单元住院治疗。急救单元的管理主要由市政当局负责，大多数急救单元位于首府以外，属于III类规模。确定的主要挑战包括：资金不足和招聘医生困难。
急救单元具有拥有技术资源和建筑特色的优点，但只有在急救网络内才能取得成功。联邦引导产生了矛盾的反应，因为并非所有州都将急救单元视为优先事项。加强州管理被确定为实施急救网络的一项挑战。
