Organização da atenção primária à saúde integrada a atenção ambulatorial especializada na linha de cuidado materno infantil da Região de Saúde Sul Mato-Grossense

Abstract

The reorganization of the Health Care Network, through Health Care Planning (PAS), is a theoretical-methodological proposal that has been implemented in Brazil, adopting the Model of Care for Chronic Conditions (MACC). The PlanificaSUS-MT Project, began in Mato Grosso in 2019 by the Southern Mato Grosso Health Region and prioritized reorganizing the Maternal and Child Health Care Network due to the high maternal mortality in the state. The objective of this research is "To analyze the organization of Primary Health Care integrated to Specialized Outpatient Care in the maternal-child care line, in the Southern Mato-grossense Health Region, in the period from 2019 to 2021." from the perspective of municipal health secretaries, EFA tutors and PHC tutors. This is a descriptive, exploratory study, with a quali-quantitative research approach. Through videoconferences, semi-structured interviews were carried out, with a script for the interviewer's use, containing 47 opens questions. They were recorded, transcribed, and validated by the participants. Data collection took place in 2022. Data analysis was conducted by means of content analysis of BARDIN (2010), revealed that with PAS care was facilitated in the region when: the identification of family vulnerability was performed; the demands scheduled or not were welcomed by the teams; the flows for care of high and very high risk pregnant women were established; the barriers of access were used as windows of opportunity for management with the enrolled population; the block of hours was implemented; the stratification of high and very high risk pregnant women and children was performed; the checklist was applied to identify the care sharing needs for the SEA; the continuous care was marked by risk stratification and focus on chronic conditions; the communication with the EFA was made possible through institutional emails, social networks or direct telephone exchange between professionals; an action plan was prepared based on the needs of the region; the access to specialized services started to be regulated directly between the PHC and EFA; the return was made effective by the EFA determining the needs for the next care cycle. As for the organizational difficulties, it was revealed that many managers still did not believe in the potential for change that the project generates in the coverage territory; the turnover of professionals in PHC and EFA; the negative interference of the policy in the processes of change of the management model of service provision for the population-based management model; the accumulation of duties of the tutors, hampered the development of the municipal and regional action plan, delaying the achievement of goals and expected results. The PAS presented itself as an important management tool for the RAS in the South Mato Grosso health region.