Resolubilidade do cuidado oftalmológico em centro de atendimento secundário sob a ótica dos pacientes diabéticos e não diabéticos
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Data
2017-09-22
Autores
Oliveira, Inês Paula Regina Mainini [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A resolubilidade em saúde é a resposta satisfatória que o serviço fornece ao usuário quando busca atendimento para alguma necessidade. Frente ao exposto este estudo teve como objetivo principal avaliar a resolubilidade do cuidado oftalmológico em Centro Integrado de Saúde, sob a ótica dos usuários diabéticos e não diabéticos. E, como objetivos secundários: identificar as principais causas de solicitação de avaliação oftalmológica em ambos os grupos; identificar o tempo de espera para o atendimento oftalmológico; identificar os pacientes que tiveram indicação de cuidado oftalmológico para a rede de atenção à saúde, em ambos os grupos; conhecer os motivos que dificultam/atrasam a realização do cuidado, na rede de atenção à saúde, sob a ótica dos mesmos; propor estratégias para otimizar o cuidado aos pacientes que necessitam de cuidado oftalmológico. Método: estudo descritivo, exploratório, transversal e com abordagem mista. Uma amostra não probabilística foi constituída por todos os pacientes atendidos no Centro Integrado de Saúde do interior de São Paulo, no período de novembro de 2013 ao mesmo mês de 2015. Para responder os objetivos do estudo os participantes foram divididos em dois grupos: diabéticos e não diabéticos. A coleta de dados foi realizada em duas etapas: consulta a um banco de dados institucional para caracterização dos participantes e do atendimento médico; e entrevista com os pacientes que tiveram indicação de cuidado oftalmológico no Centro Integrado de Saúde e na rede. Os dados qualitativos foram transcritos e analisados por meio da estratégia metodológica do Discurso do Sujeito Coletivo. Resultados: Na primeira fase foram identificados 816 pacientes, em 920 consultas. A maioria não diabéticos (76,2%), do sexo feminino (61,6%), com nível médio de ensino (65,1%), brancos (92%) e com companheiro (75,7%). A principal causa de solicitação de avaliação oftalmológica, em ambos os grupos, foi a consulta com o especialista, cujo tempo de espera foi menor para os não diabéticos, com diferença estatisticamente significante (p=0,0268). Do total de pacientes, 241 (29,5%) receberam indicação de cuidado oftalmológico, sendo o maior percentual de não diabéticos (69,2%). Na segunda fase do estudo foram entrevistados 208 pacientes cuja síntese das entrevistas contribuíram para elaboração do discurso do sujeito coletivo, agrupado em três temas: Resolubilidade do cuidado oftalmológico sob a ótica dos pacientes; Obstáculos para a realização do cuidado proposto na rede de atenção a saúde e Contribuições para a melhoria do cuidado oftalmológico. Conclusão: Os resultados apresentados evidenciaram que o Centro Integrado de Saúde onde a pesquisa foi realizada apresenta condição de resolubilidade para atender, em grande parte, as reais necessidades oftalmológicas dos usuários do Sistema Único de Saúde. Do total de pacientes atendidos no período do estudo praticamente 30% receberam indicação de cuidado oftalmológico na rede de atenção à saúde, e destes, 69% não eram diabéticos. O principal motivo de avaliação oftalmológica foi a consulta com o especialista, em ambos os grupos, cujo tempo de espera foi maior para os pacientes diabéticos, demonstrando que não há critérios que priorizem o atendimento. Os discursos apontaram que o município não tem controle sobre os desfechos dos cuidados oftalmológicos referenciados a outros serviços, e tão pouco, da contrarreferência. As dificuldades de resolução na rede, sob a ótica dos participantes, referem-se a problemas de gestão, burocráticos e a falta de recursos materiais que dificultam a realização de procedimentos diagnósticos e terapêuticos. Produto da dissertação: Desta forma, o estudo tem como produto a proposição de um protocolo para reorganização do cuidado oftalmológico no Centro Integrado de Saúde tendo como premissas ações regulatórias pautadas em classificação de risco e estabelecimento de fluxo de referência e contrarreferência na rede de atenção à saúde do interior de São Paulo. Outro produto foi o desenvolvimento de uma cartilha sobre as principais complicações oculares ocasionadas pelo diabetes para treinamento da equipe multiprofissional.
Introduction: Resolubility in health is the satisfactory answer that the service provides to the user when seeking care for some need. In view of the above, the main objective of this study was to evaluate the resolubility of ophthalmologic care in the Integrated Health Center, from the perspective of diabetic and non-diabetic users. And, as secondary objectives: to identify the main causes of request of ophthalmological evaluation in both groups; Identify the waiting time for ophthalmologic care; Identify the patients who had an indication of ophthalmologic care for the health care network in both groups; To know the reasons that hinder / delay the performance of care in the health care network, from the point of view of care; Propose strategies to optimize care for patients who need eye care. Method: descriptive, exploratory, transversal study with mixed approach. A non-probabilistic sample consisted of all patients attended at the Integrated Health Center from the interior of São Paulo, from November 2013 to the same month of 2015. In order to respond to the objectives of the study, participants were divided into two groups: diabetic and non-diabetic. Diabetics. Data collection was carried out in two stages: consultation of an institutional database to characterize participants and medical care; And interview with the patients who had indication of ophthalmologic care in the Integrated Health Center and in the network. The qualitative data were transcribed and analyzed through the methodological strategy of the Discourse of the Collective Subject. Results: In the first phase, 816 patients were identified, in 920 consultations. The majority were non-diabetic (76.2%), female (61.6%), with a mean level of education (65.1%), whites (92%) and partners (75.7%). The main cause of request for ophthalmologic evaluation in both groups was consultation with the specialist, whose waiting time was lower for non-diabetics, with a statistically significant difference (p = 0.0268). Of the total number of patients, 241 (29.5%) received an indication for ophthalmologic care, the highest percentage being non-diabetic (69.2%). In the second phase of the study, 208 patients were interviewed whose synthesis of the interviews contributed to the elaboration of Discourse of the Collective Subject, grouped into three themes: Resolubility of ophthalmological care from the perspective of the patients; Obstacles to the realization of the proposed care in the network of health care and Contributions for the improvement of ophthalmological care. Conclusion: The presented results showed that the Integrated Health Center where the research was performed presents a resolubility condition to meet, in large part, the real ophthalmological needs of Unique Health System users. Of the total number of patients seen in the study period, almost 30% received an indication of ophthalmological care in the health care network, of which 69% were non-diabetic. The main reason for ophthalmologic evaluation was consultation with the specialist, in both groups, whose waiting time was higher for diabetic patients, demonstrating that there are no criteria that prioritize the care. The speeches pointed out that the municipality has no control over the outcomes of ophthalmological care referenced to other services, and so little, of the counterreference. The difficulties of solving in the network, from the perspective of the participants, refer to problems of management, bureaucratic and the lack of material resources that make difficult the accomplishment of diagnostic and therapeutic procedures. Product of the dissertation: In this way, the study has as a product the proposal of a protocol for the reorganization of ophthalmologic care in Integrated Health Center, based on regulatory actions based on risk classification and establishment of referral flow and counter-referral in the health care network from the interior of São Paulo. Another product was the development of a playbook on the main ocular complications caused by diabetes for multiprofessional team training.
Introduction: Resolubility in health is the satisfactory answer that the service provides to the user when seeking care for some need. In view of the above, the main objective of this study was to evaluate the resolubility of ophthalmologic care in the Integrated Health Center, from the perspective of diabetic and non-diabetic users. And, as secondary objectives: to identify the main causes of request of ophthalmological evaluation in both groups; Identify the waiting time for ophthalmologic care; Identify the patients who had an indication of ophthalmologic care for the health care network in both groups; To know the reasons that hinder / delay the performance of care in the health care network, from the point of view of care; Propose strategies to optimize care for patients who need eye care. Method: descriptive, exploratory, transversal study with mixed approach. A non-probabilistic sample consisted of all patients attended at the Integrated Health Center from the interior of São Paulo, from November 2013 to the same month of 2015. In order to respond to the objectives of the study, participants were divided into two groups: diabetic and non-diabetic. Diabetics. Data collection was carried out in two stages: consultation of an institutional database to characterize participants and medical care; And interview with the patients who had indication of ophthalmologic care in the Integrated Health Center and in the network. The qualitative data were transcribed and analyzed through the methodological strategy of the Discourse of the Collective Subject. Results: In the first phase, 816 patients were identified, in 920 consultations. The majority were non-diabetic (76.2%), female (61.6%), with a mean level of education (65.1%), whites (92%) and partners (75.7%). The main cause of request for ophthalmologic evaluation in both groups was consultation with the specialist, whose waiting time was lower for non-diabetics, with a statistically significant difference (p = 0.0268). Of the total number of patients, 241 (29.5%) received an indication for ophthalmologic care, the highest percentage being non-diabetic (69.2%). In the second phase of the study, 208 patients were interviewed whose synthesis of the interviews contributed to the elaboration of Discourse of the Collective Subject, grouped into three themes: Resolubility of ophthalmological care from the perspective of the patients; Obstacles to the realization of the proposed care in the network of health care and Contributions for the improvement of ophthalmological care. Conclusion: The presented results showed that the Integrated Health Center where the research was performed presents a resolubility condition to meet, in large part, the real ophthalmological needs of Unique Health System users. Of the total number of patients seen in the study period, almost 30% received an indication of ophthalmological care in the health care network, of which 69% were non-diabetic. The main reason for ophthalmologic evaluation was consultation with the specialist, in both groups, whose waiting time was higher for diabetic patients, demonstrating that there are no criteria that prioritize the care. The speeches pointed out that the municipality has no control over the outcomes of ophthalmological care referenced to other services, and so little, of the counterreference. The difficulties of solving in the network, from the perspective of the participants, refer to problems of management, bureaucratic and the lack of material resources that make difficult the accomplishment of diagnostic and therapeutic procedures. Product of the dissertation: In this way, the study has as a product the proposal of a protocol for the reorganization of ophthalmologic care in Integrated Health Center, based on regulatory actions based on risk classification and establishment of referral flow and counter-referral in the health care network from the interior of São Paulo. Another product was the development of a playbook on the main ocular complications caused by diabetes for multiprofessional team training.
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Palavras-chave
Sistema Único de Saúde, Diabetes Mellitus, Atenção secundária à saúde, Saúde ocular, Enfermagem, Unique Health System, Secondary health care, Eye health, Nursing