Regulatory process of the Family Health Strategy for specialized care

Silveira, Milene da Silva Dantas; Cazola, Luiza Helena de Oliveira; Souza, Albert Schiaveto de; Pícoli, Renata Palópoli

doi:10.1590/0103-1104201811605

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ORIGINAL ARTICLE • Saúde debate 42 (116) • Jan-Mar 2018 • https://doi.org/10.1590/0103-1104201811605 copy

Regulatory process of the Family Health Strategy for specialized care

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

It was aimed to know the regulatory process of the Family Health Strategy for specialized care in Campo Grande, Mato Grosso do Sul. Descriptive study, with 53 physicians, whose data collection used a structured and self-administered questionnaire. The professionals (50.9%) considered that the regulation contributes to the coordination of the care, that the return of the referrals is due to the lack of clarity of the test results (57.1%) and that the main measure to improve the access to the specialized care would be the increase of positions. A greater communication among the professionals involved in the regulatory process should be encouraged, in order to provide the full exercise of their functions.

KEYWORDS
Health regulation and monitoring; Family Health Strategy; Health services accessibility

Variables	n	^%
Regulation
Contributes to the coordination of care	27	50,9
Interferes negatively in the coordination of care	18	34,0
Does not know how to inform	4	7,5
No information	4	7,5
Frequency of referrals authorization
Always	2	17,0
Most of the time	41	77,4
Never	1	1,9
Does not know how to inform	2	3,8
Frequency of referrals returned
Weekly	13	24,5
Bimonthly	5	9,4
Monthly	12	22,6
Users themselves report the return	12	22,6
Does not know how to inform	10	18,9
No information	1	1,9
Waiting time for consultation with a specialist
Satisfactory		3,8
Little satisfactory	9	17,0
Unsatisfactory		34,0
Very unsatisfactory	23	43,4
Does not know how to inform	1	1,9
Degree of difficulty for specialized consultation
Difficult		50,9
Moderate	23	43,4
Easy	1	1,9
No information	1	1,9
Difficulties
Reduced offer of vacancies for the specialty	31	58,5
Low malleability of regulation	10	18,9
Difficulty in meeting the requirements demanded by the protocol	4	7,5
No information		1,9

Variables	n	%
Knowledge of protocol
Does not know	3	5,7
Know, have access and use it most of the time	46	86,8
Know, have access, but do not use it	2	3,8
No information	2	3,8
Performance of the training on protocol management
Yes, it helps to improve the work process	3	5,7
Yes, however, it was not useful in the work process	4	7,5
No, but considers that it would be important to do so	37	69,8
No, because it would not improve the work process	9	17
Means of communication with the Regulation Center (RC)^a a More than one alternative could be signaled.
By phone, via management	24	45,3
By e-mail	5	9,4
By telephone, with direct communication with the medical regulator	2	3,8
Never had other forms of communication	18	34,0
No information	1	1,9
In case of priority^a a More than one alternative could be signaled.
Meets minimum requirements and reports on urgency	34	64,2
Notifies RC, by e-mail or phone	18	34,0
Follows the protocol and prioritizes regulation	10	18,9
Uses the risk classification in the request form	7	13,2
Uses personal influence	3	5,7
No information	1	1,9

Reason for return	Opinion of the FHS doctor
	1	2	3	4	5
	n(%)	n(%)	n(%)	n(%)	n(%)
Improve clinical state description	9(25,7)	11(31,4)	5(14,3)	5(14,3)	5(14,3)
Improve description of required basic exams	20(57,1)	7(20,0)	1(2,9)	5(14,3)	2(5,7)
Correct the ICD-10 informed	1(2,9)	7(20,0)	14(40,0)	9(25,7)	4(11,4)
Modify requested specialty	1(2,9)	8(22,9)	10(28,5)	12(34,3)	4(11,4)
Correct typing error	4(11,4)	2(5,7)	5(14,3)	4(11,4)	20(57,2)
No information	18	18	18	18	18

Strategy	Opinion of the FHS doctor
	1	2	3	4	5
	n(%)	n(%)	n(%)	n(%)	n(%)
Conduct review of protocols by specialist doctors, regulators and the FHS	14(36,8)	8(21,1)	5(13,2)	3(7,9)	8(21,1)
Improve communication between the RC and the FHS	3(7,9)	8(21,1)	18(47,4)	16(15,8)	3(7,9)
Improve the management of the clinic at FHS	0(0,0)	3(7,9)	6(15,8)	9(23,7)	20(52,6)
Improve the management of the clinic in the RC	2(5,3)	8(21,1)	4(10,5)	18(47,4)	6(15,8)
Increase the number of vacancies for specialists	19(50,0)	11(28,9)	5(13,2)	2(5,3)	1(2,6)
No information	15	15	15	15	15

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[1] Conflict of interests: non-existent