Instituto de Medicina Integral Prof. Fernando Figueira. R. dos Coelhos 300, Boa Vista. 50070-550 Recife PE Brasil.
Cien Saude Colet. 2021 Aug;26(8):3359-3370. doi: 10.1590/1413-81232021268.04032020. Epub 2020 Jun 25.
The study aims to understand the thinking and acting of health professionals about the coordination between levels of care. Qualitative research from an international multicenter study Equity-LA II. Audios were retrieved from eleven interviews of doctors/nurses of two levels of care in Recife, 2014. A content analysis of the theoretical framework of coordination was performed in the light of the hermeneutic approach. Most professionals knew the duties of coordination, without identifying its execution. The primary care physician was not recognized as responsible for the clinic, nor for his role by the specialist physician, while the primary care physician resented it. Failures in the use/completion of reference/counter-reference mechanisms and organizational barriers emerged. The unavailability for the "conversation game" and "fusionality" was evidenced in the lack of recognition of authority in the authoritative character of the primary care physician by that of the specialized, feeling of less value for that and technicist and specialized posture in everyone's practice. The coordination in on professionals' view revealed the "there-to-be-understood" condition that needs to be launched in the "game of comprehension" to build dialogical practices focused on integral care.
这项研究旨在了解卫生专业人员对医疗服务层级之间协调的思维和行为。这是一项来自国际多中心研究 Equity-LA II 的定性研究。2014 年，在累西腓对两个医疗层级的 11 名医生/护士进行了访谈，检索了这些访谈的音频。在解释学方法的指导下，对协调理论框架进行了内容分析。大多数专业人员了解协调的职责，但没有意识到协调的执行。初级保健医生不被认为对诊所或其专家医生的角色负责，而初级保健医生对此感到不满。参考/反参考机制的使用/完成失败和组织障碍出现了。在缺乏对初级保健医生权威性的认可，以及在专业人士的权威性特征中缺乏“对话游戏”和“融合性”，这表现在对该医生的价值感较低，以及每个人的实践中都存在技术主义和专业化的姿态。在专业人士看来，协调揭示了“有待理解”的条件，需要在“理解游戏”中启动，以建立关注整体护理的对话实践。
