Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, Vitória da Conquista, Brasil.
Instituto de Saúde Coletiva, Universidade Federal Fluminense, Niterói, Brasil.
Cad Saude Publica. 2021 May 17;37(5):e00149520. doi: 10.1590/0102-311X00149520. eCollection 2021.
The article analyzes the coordination of information and clinical management between levels of care in physicians' experience and explores related labor and organizational factors and attitudes towards the work and interaction. This is a cross-sectional study with application of the COORDENA-BR questionnaire to a sample of 64 primary health care (PHC) physicians and 56 specialized care (SC) from the public system in a medium-sized Brazilian city. The results show limited linkage of care in the Healthcare Network (RAS), with differences between PHC and SC. There is no exchange of information on diagnosis, treatment, or tests. Physicians in PHC agree more on the treatments prescribed by the specialists than vice versa, but repetition of tests is not frequent. PHC physicians refer patients to SC when necessary. Most medical specialists do not refer patients for follow-up consultations in PHC when necessary and do not give orientation to PHC physicians, who in turn fail to resolve their doubts with SC. Both PHC and specialties report long waiting times for specialist consultations. Temporary employment contracts are more common in PHC. Consultation time was considered too short for coordination between the two. Most physicians do not plan to change jobs, despite their heavy dissatisfaction with wages and work. Physicians do not know each other personally, and specialists do not identify physicians in PHC as the coordinators of care. Policies and measures to guarantee structural conditions to improve access, working conditions, and more favorable mutual adaptation need to be implemented systemically to the set of services in the Brazilian Unified National Health System (SUS).
本文分析了医护人员经验层面的各级照护之间的信息和临床管理协调情况，并探讨了相关劳动和组织因素，以及对工作和互动的态度。这是一项横断面研究，应用 COORDENA-BR 问卷对巴西一中等城市公立系统的 64 名初级保健医生和 56 名专科医生进行了抽样调查。结果显示，医疗保健网络（RAS）的照护衔接有限，初级保健和专科之间存在差异。在诊断、治疗或检查方面没有信息交流。初级保健医生对专家开出的治疗方案的认同度高于专家对初级保健医生开出的治疗方案的认同度，但重复检查并不常见。当需要时，初级保健医生会将患者转诊至专科。大多数医学专家在需要时不会将患者转介到初级保健进行后续咨询，也不会为初级保健医生提供指导，而初级保健医生则无法解决与专科的疑虑。初级保健和专科都报告说，专科咨询的等待时间很长。初级保健中临时雇佣合同更为常见。咨询时间被认为太短，无法进行两者之间的协调。尽管对工资和工作非常不满，但大多数医生并不打算换工作。医生之间彼此并不熟悉，专家也不认为初级保健医生是照护的协调者。需要系统地实施政策和措施，以保障结构性条件，改善获得服务的机会、工作条件，并促进更有利的相互适应，这是巴西全民健康体系（SUS）中一系列服务所必需的。
