Almeida Hylany Bezerra de, Vanderlei Lygia Carmen de Moraes, Mendes Marina Ferreira de Medeiros, Frias Paulo Germano de
Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brasil.
Universidade Federal Rural de Pernambuco, Recife, Brasil.
Cad Saude Publica. 2021 Feb 22;37(2):e00022020. doi: 10.1590/0102-311X00022020. eCollection 2021.
The study aims to understand the influence of communicational relations among healthcare professionals in the coordination of care between levels. This is a qualitative study with data from the international multicenter study Equity-LA II, with dialectic hermeneutics as the theoretical reference. The authors listened to the audios from 15 interviews with professionals (7 physicians from primary care and 5 from specialized care, and 3 institutional supporters from primary care) in a municipal network in the Agreste region of the state of Pernambuco, Brazil, in 2016. The mixed categories were submitted to content analysis. The analysis revealed a lack of recognition, by nearly all of the professionals, of primary care as the organizational backbone for care, and the perception of coordination revealed obstacles related to disconnects in establishing dialogical relations. Knowledge of the physician's role in primary care is incomplete, and its praxis is viewed with distrust by specialists, while the reciprocal is not true. There was a visibly non-dialogical interpersonal relationship, based on asymmetric relations reflected in the specialist's authoritarian stance and that of inferiority of primary care physicians. The basis for the communicative action relates to pretensions of validity rather than of power, which is external to language, and impedes the discussion of reasons and arguments. There was little disposition for dialogue and reciprocal recognition between the parties involved, with interdiction of a communicative situation in which there is symmetry of participation. The results revealed communicational weaknesses, thus requiring strategies that allow achieving communicative understanding among the professionals and promoting satisfactory patient follow-up between levels of care.
该研究旨在了解医疗保健专业人员之间的沟通关系对不同级别医疗协调的影响。这是一项定性研究，数据来自国际多中心研究Equity-LA II，以辩证诠释学为理论参考。作者听取了2016年在巴西伯南布哥州阿格雷斯特地区一个市立医疗网络中对15名专业人员（7名初级保健医生、5名专科护理医生和3名初级保健机构支持者）进行访谈的音频。对混合类别进行了内容分析。分析显示，几乎所有专业人员都未将初级保健视为医疗组织的核心支柱，并且协调方面的认知揭示了在建立对话关系中存在脱节相关的障碍。对医生在初级保健中角色的了解不完整，专科医生对其实际操作持怀疑态度，而反之则不然。基于专家的专制立场和初级保健医生的自卑立场所反映的不对称关系，存在明显的非对话式人际关系。交际行动的基础与有效性主张相关，而非与语言之外的权力相关，这阻碍了对理由和论据的讨论。参与各方之间几乎没有对话和相互认可的意愿，禁止出现参与对称的交际情境。结果揭示了沟通方面的弱点，因此需要采取策略，以实现专业人员之间的交际理解，并促进不同级别医疗之间令人满意的患者随访。
