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      Atenção especializada ambulatorial no Sistema Único de Saúde: para superar um vazio Translated title: Specialized outpatient care in the Unified Health System: how to fill a void

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          Abstract

          Resumo A estruturação da atenção especializada ambulatorial é um gargalo na construção do Sistema Único de Saúde. A partir de breve discussão desse vazio de um modelo organizativo, propomos a indução federal de um formato de serviços especializados a partir das experiências dos Núcleos de Apoio à Saúde da Família (NASF), cuja atuação matricial adaptada é um protótipo ótimo de organização do cuidado especializado ambulatorial. Ela permite a equidade no acesso e a máxima proximidade do cuidado especializado da realidade dos usuários, o relacionamento personalizado e a articulação íntima entre as equipes de saúde da família e os especialistas, viabilizando educação permanente mútua, regulação negociada e aumento da resolubilidade da atenção básica. Aspectos das experiências municipais de Florianópolis e Curitiba são sintetizadas como exemplos parciais da proposta. É brevemente descrita a estruturação do cuidado em saúde mental de Florianópolis, toda organizada como apoio matricial; e a mudança de enfoque das equipes de apoio de Curitiba, que progressivamente passaram a sem empenhar, envolver e mediar a relação entre a atenção básica e a especializada. Este formato pode ser adaptado e expandido para a maioria das especialidades médicas.

          Translated abstract

          Abstract The structuring of specialized outpatient care is a bottleneck in the operation of the Unified Health System. Based on a brief discussion about this void in an organizational model, we propose the federal induction of a format of specialized services from the experiences of Centers of Support for Family Health (NASF). They adapted matrix operations and constitute an excellent prototype for the organization of specialized outpatient care. It allows for equal access and maximum proximity to the specialized care of the reality of primary care users, the personal relationship and the close relationship between the family health teams and medical and non-medical specialists, enabling mutual lifelong learning, negotiated regulation and increased efficacy of primary care. Municipal experiences of Florianopolis and Curitiba are synthesized as partial examples of the proposal. the structure of care in mental health of Florianópolis, all organized as a matrix support is briefly described; and we focus on the change in the action of the support teams of Curitiba, which gradually began to engage, involve and mediate the relationship between basic and specialized care. This format can be expanded to most medical specialties.

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          As Redes de Atenção à Saúde

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            Meta-analysis: effect of interactive communication between collaborating primary care physicians and specialists.

            Whether collaborative care models that enable interactive communication (timely, 2-way exchange of pertinent clinical information directly between primary care and specialist physicians) improve patient outcomes is uncertain. To assess the effects of interactive communication between collaborating primary care physicians and key specialists on outcomes for patients receiving ambulatory care. PubMed, PsycInfo, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and Web of Science through June 2008 and secondary references, with no language restriction. Studies that evaluated the effects of interactive communication between collaborating primary care physicians and specialists on outcomes for patients with diabetes, psychiatric conditions, or cancer. Contextual, intervention, and outcome data from 23 studies were extracted by one reviewer and checked by another. Study quality was assessed with a 13-item checklist. Disagreement was resolved by consensus. Main outcomes for analysis were selected by reviewers who were blinded to study results. Meta-analysis indicated consistent effects across 11 randomized mental health studies (pooled effect size, -0.41 [95% CI, -0.73 to -0.10]), 7 nonrandomized mental health studies (pooled effect size, -0.47 [CI, -0.84 to -0.09]), and 5 nonrandomized diabetes studies (pooled effect size, -0.64 [CI, -0.93 to -0.34]). These findings remained robust to sensitivity analyses. Meta-regression indicated studies that included interventions to enhance the quality of information exchange had larger effects on patient outcomes than those that did not (-0.84 vs. -0.27; P = 0.002). Because collaborative interventions were inherently multifaceted, the efficacy of interactive communication by itself cannot be established. Inclusion of study designs with lower internal validity increased risk for bias. No studies involved oncologists. Consistent and clinically important effects suggest a potential role of interactive communication for improving the effectiveness of primary care-specialist collaboration. RAND Health's Comprehensive Assessment of Reform Options Initiative, the Veterans Affairs Center for the Study of Provider Behavior, The Commonwealth Fund, and the Health Foundation.
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              A atenção primária à saúde nos países da União Européia: configurações e reformas organizacionais na década de 1990

              Propósitos de contenção de gastos em saúde e exigências de mudanças no perfil epidemiológico, impulsionaram durante a década de 90 reformas organizacionais dos serviços de atenção primária em países da União Européia, com o objetivo de promover a coordenação dos serviços prestados pelos diversos níveis de atenção. Neste artigo, a partir de revisão bibliográfica, análise documental e entrevistas com informantes-chave são analisadas as configurações institucionais do primeiro nível de atenção à saúde e discutidas as reformas organizacionais pró-coordenação nos países da União Européia. A atenção ambulatorial de primeiro nível é prestada nesses países com grande variedade de configurações institucionais, observando-se diferenciados mecanismos de financiamento, gama de profissionais envolvidos, espectro de serviços clínicos oferecidos e posição do profissional médico de atenção primária no sistema de saúde. Com as reformas da última década, ocorreu diversificação de modelos organizacionais da atenção ambulatorial com ampliação das funções clínicas, gerenciais de coordenação da atenção, e financeiras dos profissionais de atenção primária, indicando processo em transição com redefinição das funções do clínico geral como condutor dos cuidados ao paciente.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                csc
                Ciência & Saúde Coletiva
                Ciênc. saúde coletiva
                ABRASCO - Associação Brasileira de Saúde Coletiva (Rio de Janeiro, RJ, Brazil )
                1413-8123
                1678-4561
                March 2017
                : 22
                : 3
                : 941-951
                Affiliations
                [2] Curitiba Paraná orgnameUniversidade Federal do Paraná orgdiv1Departamento de Saúde Comunitária Brazil
                [1] Florianópolis Santa Catarina orgnameUniversidade Federal de Santa Catarina orgdiv1Centro de Ciências da Saúde orgdiv2Departamento de Saúde Pública Brazil charles.tesser@ 123456ufsc.br
                Article
                S1413-81232017002300941
                10.1590/1413-81232017223.18842016
                28301001
                d2602139-bdc4-4002-98c7-8ca3aa3760e6

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 15 February 2016
                : 21 August 2016
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 56, Pages: 11
                Product

                SciELO Brazil


                Sistema Único de Saúde,Atenção secundária,Políticas de saúde,Planejamento de serviços de saúde,Unified Heath System (SUS),Secondary care,Health policies,Health services planning

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