Análise dos atendimentos da demanda espontânea em unidade básica de saúde de um município do interior de São Paulo.
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Data
2021-08-27
Autores
Carvalho, Simone da Silva
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: As pessoas definem suas necessidades de saúde com formas e graus variados e momentos variados, caracterizando a demanda espontânea na unidade de saúde. O não acolhimento dessas necessidades resultam em reclamações, retornos repetidos e Prontos Socorros (PS) e Unidades de Pronto Atendimento (UPAs) sobrecarregados com casos passíveis de serem resolvidos nas Unidades Básicas de Saúde/Estratégia Saúde da Família (UBS/ESF). Frente ao exposto, este estudo teve como objetivo principal analisar os atendimentos de demanda espontânea realizados em uma unidade básica de saúde, de um município do interior de SP. Como objetivos secundários: analisar a conduta/desfecho destes atendimentos; identificar junto aos profissionais de saúde, que atuam nessa UBS, as principais dificuldades enfrentadas para o atendimento de casos de urgências/emergências; compreender a percepção desses profissionais em relação ao suporte oferecido pelo município para realização destes atendimentos na UBS onde foi realizado o estudo; identificar estratégias para melhorar o atendimento dos casos de urgências/emergências nessa UBS; identificar os problemas de acesso e registro das informações nos prontuários; elaborar um plano de ação de educação permanente adequado ao contexto da UBS estudada. Métodos: estudo descritivo, exploratório, transversal de abordagem mista. A coleta foi realizada em duas etapas: na primeira foram levantados os atendimentos de demanda espontânea realizados em uma unidade básica do interior de São Paulo, no período de setembro de 2019 a maio de 2020; na segunda foram entrevistados 10 profissionais de saúde, atuantes neste serviço há mais de um ano, e que consentiram na participação. As entrevistas foram transcritas e analisadas utilizando-se a estratégia metodológica do Discurso do Sujeito Coletivo. Resultados: Dos 306 prontuários analisados referentes à demanda espontânea no período estudado, a maioria era de mulheres (58,5%), com idade média de 57 anos, que procuraram o serviço por necessidade de assistência burocrática 225 (73,5%), como pedidos de renovação de receitas, exames diversos e solicitação de encaminhamentos para especialistas. Constatou-se que apenas 81 (26,5%) pacientes receberam algum cuidado local e nenhum paciente foi transferido para o serviço de emergência. Na segunda fase da pesquisa foram entrevistados 10 profissionais de saúde, cuja síntese das entrevistas contribuíram para elaboração do discurso do sujeito coletivo, agrupado em três temas: dificuldades enfrentadas pelos profissionais para o atendimento de urgência/emergência na unidade básica de saúde; suporte oferecido pelo município para realização dos atendimentos de urgência/emergência na atenção básica; propostas para melhoria dos atendimentos de urgência/ emergência. Conclusão: Os resultados apresentados demonstram que a maioria dos atendimentos realizados na demanda espontânea referem-se à assistência burocrática e que casos complexos ou mesmo urgências/emergências não são encaminhados para a UBS estudada. Portanto, os atendimentos são eletivos e resolvidos na própria unidade. Os discursos evidenciaram que o serviço não tem condições de atender casos de urgência/emergência, em virtude do despreparo da equipe e falta de recursos humanos e materiais. Além disso, não há preocupação do município em oferecer condições mínimas para que este atendimento seja realizado na UBS. Como proposição de melhorias os participantes destacaram a necessidade de treinamento e capacitação dos profissionais de saúde, investimento em recursos materiais e aquisição de equipamentos, bem como permanência de médico em período integral no serviço e implantação de protocolos de atendimento. A coleta dos dados identificou problemas nos processos de trabalho, falta de qualificação dos profissionais e de investimento da gestão municipal para atendimento dos casos de urgência/emergência nesta unidade de atenção básica. Considerando que grande parte dos problemas encontrados podem ser abordados com ações de Educação Permanente em Saúde (EPS), elaborou-se um plano de ação para implementação de educação permanente na UBS Macro II, como produto da pesquisa.
Introduction: People define their health needs in different ways and degrees and at different times, characterizing the spontaneous demand in the health unit. Failure to meet these needs results in complaints, repeated visits, and Emergency Room (ER) and Emergency Care Units (ECU) overloaded with cases that can be resolved in Basic Health Units/Family Health Strategy (BHU/FHS). Consequently, this study had as its main objective: to analyse the spontaneous demand care provided in a basic health unit in a city in the interior of São Paulo. As secondary objectives: to analyse the conduct/outcome of these appointments; identify with the health professionals who work in this UBS, the main difficulties faced in the care of urgent/emergency cases; understand the perception of these professionals in relation to the support offered by the municipality to carry out these services at the BHU where the study was carried out; identify strategies to improve the care of urgent/emergency cases; identify problems in accessing and recording information in medical records; prepare a permanent education action plan appropriate to the context of the UBS studied. Method: descriptive, exploratory, cross-sectional study with a mixed approach. The collection was carried out in two stages: in the first, spontaneous demand services carried out in a basic unit in the interior of São Paulo were surveyed, from September 2019 to May 2020; in the second, 10 health professionals working in this service for over a year and who consented to participate were interviewed. The interviews were transcribed and analyzed using the methodological strategy of the Collective Subject Discourse. Results: The 306 medical records analyzed referring to spontaneous demand in the study period, the majority were women (58.5%), with an average age of 57 years, who sought the service due to the need for bureaucratic assistance 225 (73,5%), as requests for revenue renewal, various exams, and request for referrals to specialists. It was found that only 81 (26,5%) patients received some local care, and no patient was transferred to the emergency department. In the second phase of the research, 10 health professionals were interviewed, whose synthesis of the interviews contributed to the elaboration of the collective subject's discourse, grouped into three themes: difficulties faced by professionals for urgent/emergency care in the basic health unit; support offered by the municipality to carry out urgent/emergency care in primary care; proposals for improving urgent/emergency care. Conclusion: The results presented show that most of the care provided in spontaneous demand refer to bureaucratic assistance and those complex cases or even urgencies/emergencies are not referred to this unit. Therefore, the appointments are elective and resolved in the unit itself. The speeches showed that the service is unable to attend urgent/emergency cases, due to the team's unpreparedness and lack of human and material resources. In addition, the municipality is not concerned about offering the minimum conditions for this service to be carried out at the UBS. As a proposal for improvements, the participants highlighted the need for training and qualification of health professionals, investment in material resources and acquisition of equipment, as well as the permanence of a full-time physician in the service and implementation of care protocols. Data collection identified problems in the work processes, lack of professional qualification and municipal management investment to care for urgent/emergency cases in this primary care unit. Considering that most of the problems found can be addressed with Permanent Health Education (PHE) actions, an action plan was drawn up for the implementation of permanent education at BHU Macro II, as a product of the research.
Introduction: People define their health needs in different ways and degrees and at different times, characterizing the spontaneous demand in the health unit. Failure to meet these needs results in complaints, repeated visits, and Emergency Room (ER) and Emergency Care Units (ECU) overloaded with cases that can be resolved in Basic Health Units/Family Health Strategy (BHU/FHS). Consequently, this study had as its main objective: to analyse the spontaneous demand care provided in a basic health unit in a city in the interior of São Paulo. As secondary objectives: to analyse the conduct/outcome of these appointments; identify with the health professionals who work in this UBS, the main difficulties faced in the care of urgent/emergency cases; understand the perception of these professionals in relation to the support offered by the municipality to carry out these services at the BHU where the study was carried out; identify strategies to improve the care of urgent/emergency cases; identify problems in accessing and recording information in medical records; prepare a permanent education action plan appropriate to the context of the UBS studied. Method: descriptive, exploratory, cross-sectional study with a mixed approach. The collection was carried out in two stages: in the first, spontaneous demand services carried out in a basic unit in the interior of São Paulo were surveyed, from September 2019 to May 2020; in the second, 10 health professionals working in this service for over a year and who consented to participate were interviewed. The interviews were transcribed and analyzed using the methodological strategy of the Collective Subject Discourse. Results: The 306 medical records analyzed referring to spontaneous demand in the study period, the majority were women (58.5%), with an average age of 57 years, who sought the service due to the need for bureaucratic assistance 225 (73,5%), as requests for revenue renewal, various exams, and request for referrals to specialists. It was found that only 81 (26,5%) patients received some local care, and no patient was transferred to the emergency department. In the second phase of the research, 10 health professionals were interviewed, whose synthesis of the interviews contributed to the elaboration of the collective subject's discourse, grouped into three themes: difficulties faced by professionals for urgent/emergency care in the basic health unit; support offered by the municipality to carry out urgent/emergency care in primary care; proposals for improving urgent/emergency care. Conclusion: The results presented show that most of the care provided in spontaneous demand refer to bureaucratic assistance and those complex cases or even urgencies/emergencies are not referred to this unit. Therefore, the appointments are elective and resolved in the unit itself. The speeches showed that the service is unable to attend urgent/emergency cases, due to the team's unpreparedness and lack of human and material resources. In addition, the municipality is not concerned about offering the minimum conditions for this service to be carried out at the UBS. As a proposal for improvements, the participants highlighted the need for training and qualification of health professionals, investment in material resources and acquisition of equipment, as well as the permanence of a full-time physician in the service and implementation of care protocols. Data collection identified problems in the work processes, lack of professional qualification and municipal management investment to care for urgent/emergency cases in this primary care unit. Considering that most of the problems found can be addressed with Permanent Health Education (PHE) actions, an action plan was drawn up for the implementation of permanent education at BHU Macro II, as a product of the research.
Descrição
Palavras-chave
Atenção Primária à Saúde, Emergência, Acesso ao serviço de saúde, Treinamento/capacitação, Educação permanente em saúde, Profissionais de saúde, Enfermagem, Primary health care, Emergency, Nursing