Análise da relação entre unidades de Atenção Primária à Saúde e de Pronto Atendimento: determinantes, escolhas e desafios organizativos.

Abstract

There is a growing demand for urgent and emergency services that are often not considered to correspond to the urgency character. On the other hand, the APS is singled out for remaining focused on preferentially “preventive and programmatic” actions, to the detriment of welcoming and attending to citizens affected by low-complexity acute conditions. In Brazil, 24-hour Emergency Care Units (UPA) had a great expansion from the year 2008, and despite the emphasis on the assistance and emergency services, it was formulated with the legal mission of composing a care complex linked to primary care. However, some evidence points to an informal and fragmented relationship between the "APS" and the UPA, especially in the conduct of less severe emergency care, which deserves further investigation. The objectives of the study were: To analyze the organizational dynamics established in the relationship between the Primary Health Care (APS) and 24-hour Emergency Care (UPA) units in the city of Petrolina-PE; Identify assistance flows and existing integration mechanisms between APS and UPA services; Analyze the attributions and competences of the APS and UPA in situations of low urgency; Characterize the determining factors in the choices of users between the search for emergency services and APS. This is a unique case study in a municipality of the Interstate Health Network of the Middle São Francisco Valley (PEBA Network), Northeastern Brazil. The primary sources of evidence were the information recorded in the researcher's field diary, data obtained through semi-structured interviews with professionals, managers and users of the 24h UPA and APS and, as secondary sources, documents from the State and Municipal Health and UPA. The information was processed with the help of the NVIVO software. Four dimensions of integration were adopted as categories of analysis based on the concept of 'integrated health system' proposed by Contandriopoulos: Clinical integration; Functional Integration; Systemic Integration and Normative Integration. The evidence produced indicates low integration between APS and UPA in the different dimensions studied. From the more operational elements, predominantly described in functional integration, to the more subjective elements, referred to in normative integration, they point out gaps for the effective integration between services. Furthermore, there is a mismatch between the profile of care related to low severity emergencies provided by the two levels of care and the “ideal view” of professionals and managers regarding what this care should be. In the UPA, mostly low severity situations are attended to, a service profile understood by the actors as adequate for APS. On the other hand, the ESF have limitations for exercising this function. As a result, this user profile is not prioritized in both services. Still, the UPA has just accounting for a large portion of this demand, causing the search subject in the perception that are even more unsuccessful by APS, resulting in low confidence and credibility in relation to services in primary care.