Assistência à pessoa com condições crônicas na Atenção Primária à Saúde

• Ano de defesa: 2020
• Autor(a) principal: Larissa Viana Almeida de Lieberenz
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; Brasil; ENFERMAGEM - ESCOLA DE ENFERMAGEM; Programa de Pós-Graduação em Enfermagem; UFMG
• Palavras-chave em Português: Doenças Crônicas; Atenção Primária à Saúde; Equipe multiprofissional; Doença Crônica; Equipe de Assistência ao Paciente; Assistência à Saúde
• Link de acesso: http://hdl.handle.net/1843/34429; https://orcid.org/0000-0003-4039-246X

Contextualization of the theme: Chronic conditions require continuous care over the years, they present multiple causes, and the treatment involves changes in lifestyle and interdisciplinary monitoring. The demographic change is associated with an increase in the prevalence of chronic conditions and, afterward, a greater need for health among the population. In addition to mortality, chronic conditions present a heavy burden of related morbidities, also involving significant loss of quality of life. The need to redirect health professionals' actions, strengthen strategies to promote health and prevent complications, and organize the care network for chronic conditions from the perspective of the completeness care for the user is evident. In this sense, the Ministry of Health redefines the care network for chronic conditions, placing the PHC as the coordinator of care. Guiding questions: How is the work of FHS professionals set up to assist patients with chronic conditions? What working conditions does the management provide for the care of patients with chronic conditions? Justification: high representativeness of chronic conditions in PHC and the difficulty in complying with the guidelines of the Care Model for Chronic Conditions, prepared by the Ministry of Health. Furthermore, in national and international literature, studies are still focused on the monitoring of some specific chronic conditions (diseases of the cardiovascular system, diabetes, among others) and rarely address organizational aspects that hinder or facilitate assistance to chronic conditions, in a broad sense. Goals: to analyze the work of FHS professionals in caring for patients with chronic conditions, focusing on management support for carrying out actions. Methodology: This is a single case study, of qualitative nature, developed in the context of FHS with 19 health professionals from the FHS and six municipal managers from Sete Lagoas. Data were collected through interviews with a semi-structured script, non-participant observation, and document analysis, carried out between July and October 2019. The interviews were submitted to Thematic Content Analysis and both the observations and the document analysis enriched the analysis process. MAXQDA® software, version 18.1 was used for data organization, coding, and support for the analysis. Three categories of analysis were built, to be precise: “The situation of the chronic condition carrier from the perspective of professionals”, “The paradox of invisibility of the patient with Chronic Conditions and the ideology of assistance to SUS users”, and “The interface of organizational and administrative work in the context of chronicity”. Results and discussion: The first category presented the understanding of chronic conditions in PHC, the interventions performed to ensure care for these people, and the repercussions of chronic conditions for PHC professionals, including teamwork, in addition to health promotion and prevention of diseases interventions, and encouraging self-care. The second category revealed that the greatest demand for the FHS is from users with chronic conditions; however, acute patients (both acute and chronic who aggravate) occupy most of the PHC professionals' schedule, which makes it difficult for chronic patients to access health care networks and consequently fails in the completeness of care, showing the invisibility of chronic conditions in PHC. And the third category analyzed the influence of administrative and organizational work on the particularities of chronic patient care, highlighting the process of continuing education and the weaknesses of management (lack of resources, precarious physical structure, and limited supply of professionals). Final considerations: Thus, it is concluded that the care provided by professionals is aimed at acute patients seeking the FHS, with chronic conditions still invisible. Moreover, some challenges have not yet been overcome, such as administrative and management problems. It is suggested that to guarantee the completeness of care, it is necessary to overcome the traditional biomedical model and change to a continuous, complete and proactive model.