Care coordination in primary health care: an evaluative study in a municipality in the Northeast of Brazil

Aleluia, Italo Ricardo Santos; Medina, Maria Guadalupe; Almeida, Patty Fidelis de; Vilasbôas, Ana Luiza Queiroz

doi:10.1590/1413-81232017226.02042017

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ARTICLE • Ciênc. saúde colet. 22 (6) • June 2017 • https://doi.org/10.1590/1413-81232017226.02042017 copy

Care coordination in primary health care: an evaluative study in a municipality in the Northeast of Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

International and Brazilian studies have highlighted the importance of the coordination of care for the organization of local health systems. This study aimed to analyze the coordination of care by Primary Health Care (PHC) in a municipal health system in the State of Bahia. This study was conducted in the lead municipality of the macro-region and involved two levels of analysis: PHC team and municipal management. Outlining conditions for the study were defined (hypertension and diabetes mellitus) and an objective image corresponding to the coordination of care was developed based on current national and international literature review. Semi-structured interviews with professionals, managers of PHC services were conducted and current documentary sources were also used. It was demonstrated that the coordination of care has not been met by municipal systems, where only 14 of the 22 proposed criteria have been met. The main difficulties and reasons were: a lack of health care protocols and the non-implementation of computer systems and telecommunication technologies. The results and the conceptual framework to assess the coordination of care are relevant contributions to this study, which can be applied to other contexts with similar characteristics.

Health evaluation; Primary health care; Coordination of care; Non-communicable chronic disease

Categories and corresponding criteria	Team A	Team B
I Planning of individual assistance	-	++
1. Construction of individual therapeutic plans shared amongst professionals in the team	-	+++
2. Planning of assistance based on the stratification of risks	-	-
3. Request and making an appointment for exams and basic consultations	++	+++
4. Request and making an appointment for exams and specialized consultations	++	++
5. Existence of lists and contacts of professionals and reference services	-	-
6. Identification and articulation with professionals from other levels in the construction of therapeutic projects	-	-
II Standardization of conduct	-	-
7. Existence of protocols and therapeutic guidance	-	-
8. Use of protocols and therapeutic guidance	-	-
9. Regular register of assistance given	++	++
III Referrals	-	++
10. Referral criteria used by the team that is consistent with the standard documents	++	++
11. Existence of tools for referrals and subsequent referrals of users	+++	+++
12. Existence of referrals and flows defined for those with hypertension and diabetes	-	-
13. Existence of contact with the central regulation unit in the referrals process (when necessary)	-	+++
14. Existence list/form with contacts and data from professionals and referral services in the network	-	-
IV Communication	-	-
15. Existence of telecommunications technology for the exchange of information	-	-
16. Flow and channel of institutionalized communication for the exchange of information amongst professionals e services	-	-
17. Existence of non-computerized tools for the exchange of information	+++	+++
18. Existence of regular information exchange amongst PHC professionals and others primary health care levels	-	-
19. Existence of discussions of regular cases amongst PHC professionals in the teams	-	-
20. Existence of discussions of regular cases amongst PHC teams and other levels in PHC	-	-
V Accompaniment of the users	++	++
21. Existence of regular registers of referrals that are carried out	+++	+++
22. Existence of tools for accompanying users	+++	+++

Categories and corresponding criteria	Agreement	Disagreement
I Planning of individual care
1. Construction of individual therapeutic plans shared amongst professionals in the team	++	-
2. Planning of care based on the stratification of risks	++	-
3. Request and making an appointment for exams and basic consultations	++	-
4. Request and making an appointment for exams and specialized consultations	++	-
5. Existence of lists and contacts of professionals and reference services	++	-
6. Identification and articulation with professionals from other levels in the construction of therapeutic projects	++	-
II Standardization of conduct
7. Existence of protocols and therapeutic guidance	++	-
8. Use of protocols and therapeutic guidance	++	-
9. Regular register of care given	++	-
III Referrals
10. Referral criteria used by the team that is consistent with the standard documents	++	-
11. Existence of tools for referrals and subsequent referrals of users	++	-
12. Existence of referrals and flows defined for those with hypertension and diabetes	++	-
13. Existence contact with the central regulation unit in the referrals process (when necessary)	++	-
14. Existence list/form with contact and data from professionals and referral services in the network	-	++
IV Communication
15. Existence of telecommunications technology for the exchange of information	++	-
16. Flow and channel of institutionalized communication for the exchange of information amongst professionals e services	-	++
17. Existence of non-computerized tools for the exchange of information	++	-
18. Existence of regular information exchange amongst PHC professionals and others primary health care levels	++	-
19. Existence of discussions of regular cases amongst PHC professionals in the teams	-	++
20. Existence of discussions of regular cases amongst PHC teams and other levels in PHC	++	-
V Accompaniment of the users
21. Existence of regular registers of referrals that are carried out	++	-
22. Existence of tools for accompanying users	++	-

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

IRS Aleluia and MG Medina participated in developing the idea for this paper as well as: setting its scope, providing analysis and interpretation of the data, drafting the critically reviewed paper and approving the version to be published. PF Almeida and ALQ Vilasbôas participated in providing analysis and interpretation of the data, drafting and critically reviewing the paper and approving the version to be published.