O cuidado à saúde de crianças com Síndrome de Down na atenção primária à saúde em Botucatu-SP: limitações e potencialidades do Sistema Único de Saúde.
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Data
2021-07-22
Autores
Tannuri, Ana Gabriela Silva
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Universidade Estadual Paulista (Unesp)
Resumo
No Brasil, estima-se que a cada 700 nascimentos ocorre 1 caso de trissomia do 21, somando em torno de 300 mil pessoas com a síndrome. A importância de conhecê-la e suas implicações na saúde, crescimento e desenvolvimento, alem de seus protocolos já bem estabelecidos mundialmente, é fundamental para melhora na qualidade de vida, prognóstico, inclusão social e educacional. No Brasil, a Atenção Primária à Saúde (APS), deve ser a porta de entrada para todos no Sistema Único de Saúde (SUS), bem como deve ser o integrador do cuidado a todas as crianças e às suas famílias, com uniformidade no cuidado e fluxo estabelecido para os diferentes níveis da assistência à saúde. Assim, este estudo objetivou analisar como se dá o cuidado integral à saúde da criança com SD na APS de Botucatu, através da percepção de seus médicos e dos gestores de serviços sobre a assistência a estas crianças. Método: Trata-se de uma pesquisa descritiva qualitativa com entrevista aberta, com roteiro, que buscou identificar as percepções dos médicos generalistas, pediatras e dos gestores/coordenadores da APS do município de Botucatu acerca da atenção integral à saúde e da importância da abordagem e seguimento multiprofissional das crianças com SD neste nível de atenção á saúde. A descrição dos inclusos (dados quantitativos) foi analisada por meio de estatística descritiva simples e a análise do conteúdo do discurso (entrevistas), através da técnica de Bardin. Estudo ocorreu entre os anos de 2019 e 2021. Resultados: Foram entrevistados um total de 21 médicos e 4 gestores da APS de Botucatu, sendo eles os coordenadores da APAE (Associação de Pais e Amigos dos Excepcionais), da APAPE (Associação de Pais e Amigos de Pessoas portadoras de necessidades Especiais) e do NASF (Núcleo de Apoio a Saúde da Família). Foram identificados 7 núcleos de sentido principais na fala dos entrevistados: dificuldade na formação acadêmica; desconhecimento de normativas, gráficos e fluxogramas específicos; as comorbidades reconhecidas e a solicitação de exames de rotina; a influência de um serviço terciário e da falta de um fluxo ou protocolo de assistência no município; da influência da sobrecarga de trabalho na integralidade do cuidado; da comunicação, ou falta dela, entre instituições conveniadas; e o desencontro de informações em relação ao funcionamento da APS, ou os ruídos na comunicação. Potencialidades e limitações foram encontradas. Considerações finais: Pesquisar como ocorre, e como está estruturada a assistência às crianças com SD na APS foi relevante para delinear como ela está organizada em Botucatu, contribuindo para a reflexão sobre as políticas públicas na área e identificando potenciais para a melhoria da qualidade das práticas de saúde dirigidas a estas crianças e suas famílias. Considerando os resultados obtidos, identificamos a necessidade de qualificação e educação permanente dos profissionais de saúde que atuam na APS, para a realização da assistência integral à criança com SD, além da elaboração de um protocolo de assistência, que possa definir e garantir um fluxo homogêneo no encaminhamento e acompanhamento destas crianças, capaz de propiciar a assistência integral e multidisciplinar que necessitam, com os recursos existentes na APS e na rede de assistência à saúde em Botucatu, sem sobrecarregar nenhum nível de atenção e exercitando o princípio de integralidade do cuidado do SUS.
In Brazil, it is estimated that every 700 births there is 1 case of trisomy 21, totaling around 300 thousand people with the syndrome. The importance of knowing it and its implications for health, growth and development, in addition to its well-established protocols worldwide, is essential for improving quality of life, prognosis, social and educational inclusion. In Brazil, Primary Health Care (PHC) must be the gateway for everyone in the Unified Health System (“SUS”), as well as being the integrator of care for all children and their families, with uniformity in care and stabilized flow for different levels of health care. Thus, this study aimed to analyze how the comprehensive health care of children with DS is provided in the PHC of Botucatu, through the perception of their physicians and service managers about the assistance to these children. Method: This is a qualitative descriptive research with an open interview, with a script, which sought to identify the perceptions of general practitioners, pediatricians and PHC managers/coordinators in the municipality of Botucatu about comprehensive health care and the importance of the approach and multiprofessional follow-up of children with DS at this level of health care. The description of the subjects (quantitative data) was analyzed using simple descriptive statistics and the analysis of the content of the speech (interviews), using the Bardin technique. The study took place between 2019 and 2021. Results: A total of 21 doctors and 4 managers of the PHC of Botucatu were interviewed, being the coordinators of APAE (Association of Parents and Friends of the Exceptional), APAPE (Association of Parents and Friends of People with Special Needs) and the NASF (Family Health Support Nucleus). Seven main meaning cores were identified in the interviewees' speech: difficulty in academic training; ignorance of specific regulations, graphics and flowcharts; the recognized comorbidities and the request for routine exams; the influence of a tertiary service and the lack of an assistance flow or protocol in the municipality; the influence of work overload on comprehensive care; communication, or lack thereof, between partner institutions; and the mismatch of information regarding the functioning of the PHC, or the noise in communication. Potentials and limitations were found. Final considerations: Researching how the assistance to children with DS in PHC occurs and how it is structured was relevant to outline how it is organized in Botucatu, contributing to the reflection on public policies in the area and identifying potentials for improving the quality of practices for these children and their families. Considering the results obtained, we identified the need for qualification and continuing education of health professionals working in PHC, in order to carry out comprehensive care for children with DS, in addition to the elaboration of a care protocol that can define and guarantee a homogeneous flow in the referral and monitoring of these children, capable of providing the comprehensive and multidisciplinary care they need, with the existing resources in the PHC and in the health care network in Botucatu, without overloading any level of care and exercising the principle of comprehensive care of the SUS.
In Brazil, it is estimated that every 700 births there is 1 case of trisomy 21, totaling around 300 thousand people with the syndrome. The importance of knowing it and its implications for health, growth and development, in addition to its well-established protocols worldwide, is essential for improving quality of life, prognosis, social and educational inclusion. In Brazil, Primary Health Care (PHC) must be the gateway for everyone in the Unified Health System (“SUS”), as well as being the integrator of care for all children and their families, with uniformity in care and stabilized flow for different levels of health care. Thus, this study aimed to analyze how the comprehensive health care of children with DS is provided in the PHC of Botucatu, through the perception of their physicians and service managers about the assistance to these children. Method: This is a qualitative descriptive research with an open interview, with a script, which sought to identify the perceptions of general practitioners, pediatricians and PHC managers/coordinators in the municipality of Botucatu about comprehensive health care and the importance of the approach and multiprofessional follow-up of children with DS at this level of health care. The description of the subjects (quantitative data) was analyzed using simple descriptive statistics and the analysis of the content of the speech (interviews), using the Bardin technique. The study took place between 2019 and 2021. Results: A total of 21 doctors and 4 managers of the PHC of Botucatu were interviewed, being the coordinators of APAE (Association of Parents and Friends of the Exceptional), APAPE (Association of Parents and Friends of People with Special Needs) and the NASF (Family Health Support Nucleus). Seven main meaning cores were identified in the interviewees' speech: difficulty in academic training; ignorance of specific regulations, graphics and flowcharts; the recognized comorbidities and the request for routine exams; the influence of a tertiary service and the lack of an assistance flow or protocol in the municipality; the influence of work overload on comprehensive care; communication, or lack thereof, between partner institutions; and the mismatch of information regarding the functioning of the PHC, or the noise in communication. Potentials and limitations were found. Final considerations: Researching how the assistance to children with DS in PHC occurs and how it is structured was relevant to outline how it is organized in Botucatu, contributing to the reflection on public policies in the area and identifying potentials for improving the quality of practices for these children and their families. Considering the results obtained, we identified the need for qualification and continuing education of health professionals working in PHC, in order to carry out comprehensive care for children with DS, in addition to the elaboration of a care protocol that can define and guarantee a homogeneous flow in the referral and monitoring of these children, capable of providing the comprehensive and multidisciplinary care they need, with the existing resources in the PHC and in the health care network in Botucatu, without overloading any level of care and exercising the principle of comprehensive care of the SUS.
Descrição
Palavras-chave
Atenção primária a saúde, Atendimento multidisciplinar, Criança, Multiprofissional, Síndrome de Down, Primary health care, Multidisciplinary care, Child, Multi-professional, Down's syndrome