| Low visibility of people with disabilities. |
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| Difficulty to apply the biopsychosocial model on the overall assessment, when setting therapeutic goals and on qualified hospital discharge. |
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Communication deficit between workers and between workers and patients/families.
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Biology-centered practices and fragmented assessment by different workers.
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Low or no adherence to the International Classification of Functioning, Disability and Health (ICF) or instruments based on it.
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Resistance of families / caregivers to accept discharge, due to fears regarding the continuity of care in a home environment or continuity of disability welfare payments (BPC).
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Low capacity of workers to manage care and lack of evaluation of the quality of care.
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Fragmentation of care and therapeutic projects based on the biomedical model, with unilateral practices established without dialogue.
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Difficulty to set therapeutic priorities and allocate professionals to cases.
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Lack of autonomy of patient and families in to manage care.
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Low resolution of actions, with patients staying longer than necessary and increased repressed demand.
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Periodic meetings between workers and family members to develop a unique therapeutic project.
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Global assessment based on the ICF, with the presence of the entire team of workers.
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Articulation with other points of the network for continued care.
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Construction and revision of protocols to guide health car delivered by the CER.
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Development of indicators for evaluation and monitoring of the quality of care delivered in CER.
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| Difficulty to articulate the CER with other services of the disability care network with other care networks and with other sectors. |
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Little recognition and appreciation of CER within care networks.
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Communication failure between the CER and other RCPD services and other care networks.
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Low qualification of health workers and other sectors to deliver care for people with disabilities and promote inclusion.
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Logistical difficulties such as lack of sanitary transport and compatibility of schedules.
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Little or no intersectoral articulation.
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Discontinuity of care and social inclusion of persons with disabilities.
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Worsening distance between specialized attention, other points of the network and social participation of persons with disability.
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Periodic meetings with the presence of representatives of attention networks and sectors with other levels of technological density.
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Development of flowcharts to illustrate the relationship between services and protocols for referral.
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| Inflexibility of ordinances of the Ministry of Health and allocation of resources. |
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Disregard of local peculiarities and realities.
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Poor or non-existent communication between the CER and the Ministry of Health.
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Incompatibility of the values in the SUS table with the actual cost of products / services.
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Monthly resource for funding.
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Mismanagement of resources.
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Joint resources for CER and other services.
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Bureaucratization when implementing new CER and lack of interest of managers in doing so.
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Fragmentation of care by type of disability, causing patients to travel to several points of the network in cases of multiple disabilities or different habilitation needs of the nearest CER.
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Need to reallocate other resources to meet the financial demands or diversion of CER resources allocated by MAC.
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Difficulty regarding technological advancement of the service.
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High demand for the service and assistance delivered not adequate to the reality of the territory.
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Publication of studies on CER to problematize the need for changes in normative instruments.
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Listening to agents involved with CER to develop guidelines applicable to the service and attention to persons with disability.
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Reconsidering qualifications by type of disability and creating regulatory systems for access to specialized care and therapeutic inputs such as orthoses and prostheses.
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| Difficulties concerning Information Systems |
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Use of the information in the systems for transfer of funds.
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Electronic medical records not unified between primary care and CER.
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Information systems based on the diagnosis and biological factors of disability, disregarding the influence of context in the production of disabilities.
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Information systems do not reflect the quality of services, which end up being evaluated poorly.
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Fragmentation of the individual’s health information, hindering access to data by rehabilitation teams and Family Health Strategy, which compromises the comprehensiveness of care.
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Lack of information systems that allow issuing data on functioning, limitation to activities, restriction to participation and contextual factors.
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Encouraging an organizational culture that promotes values of cooperation in the service, planning of actions and evaluation of such actions.
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Expansion of the electronic medical record of citizens in the e-SUS to include information about CER, enabling a general analysis of individuals through their medical records.
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Use of information systems with ICF-based data.
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| Difficulties related to the permanence and qualification of workers, adequate physical structure and alternative therapies. |
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Workers bound to the service by contract.
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Low affinity of workers with the CER care model.
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Back-to-back work shifts, with activities in other care delivery places.
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Insufficient financial resources for continued education of teams.
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High turnover of the care teams.
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Difficulty in establishing and maintaining the professional-patient bond.
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Team qualifications are out of date.
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Curative treatment, based on the biomedical model.
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Public tenders and performance assessment to encourage the permanence of workers fit for the service.
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Periodic evaluation of CER to check on issues related to structure, processes and results obtained.
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Construction and validation of a logical model for specialized Rehabilitation Centers
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