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ORIGINAL ARTICLE • Saúde debate 41 (115) • Oct-Dec 2017 • https://doi.org/10.1590/0103-1104201711507 copy

The role of Family Health Support Center in assistance coordination of Primary Health Care: limits and possibilities

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The aim of this study was to analyze how the Family Health Support Center has contributed to Family Health Teams in the fulfillment of its assistance coordination function. A qualitative case study was performed in the city of Camaragibe, State of Pernambuco. Data collection was held from January 2015 to May 2015 by means of focal groups, document analysis, and participatory observation. Results demonstrate that the Family Health Support Center, which acts following the logic of matrix support, is able to collaborate for the reinforcement of the Primary Health assistance coordination function.

KEYWORDS
Primary Health Care; Access to health services; Comprehensive health care

Activity	Objective	Target audience	Periodicity
Meeting between EqSF and Nasf	Discuss and analyze the cases of individuals and families who are accompanied at the Family Health Unit (FHU) and who require intervention from the EqSF and Nasf team or need to be referenced to the specialized network. At these meetings, unique therapeutic projects, collective action planning and discussion of clinical issues are built according to the need of the EqSF.	EqSF and Nasf team and, eventually, trainees and residents, territory manager and other professionals working in the network of health services, education and social assistance.	Monthly.
Technical meetings between Nasf teams	Promote integration between the Nasf teams and their coordination, giving priority to dialogue, exchange of experiences and reflection on the organization and development of the work process in the territory with the EqSF, as well as the construction of ways to evaluate and monitor actions.	All the professionals that make up the Nasf teams, the territory managers and Nasf Coordination.	Monthly.
Meetings for articulation of the service network	Strengthen the communication between the services with the aim of aligning the care to the user in an organized way within the care network. At these meetings, there are discussions about the flow of care, discussion of the more complex cases identified by the EqSF and the Nasf team or by reference services.	Professionals who make up Nasf teams and representatives of the other services of the health network and assistance of the municipality, i.e. Psychosocial Care Center, Municipal Rehabilitation Center, Social Assistance Reference Center, etc.	Monthly.
Attendance at FHU	Provide individual or shared care for evaluation, educational guidance and therapy. This care cannot be characterized as outpatient. Cases that require systematic care should be referenced for specialized services.	Users needing individualized or shared care, identified from the meetings of the team.	Monthly, and may vary according to the demand of each EqSF.
Home visit	Individual and/or shared visit for evaluation, educational and therapeutic guidance to the family and/or caregiver. Cases that require systematic care should be referenced for specialized services.	Users in need of socioeconomic evaluation or assistance, identified from the meetings of the team, who are bedridden or unable to travel to the FHU.	Variable. According to the demand of each EqSF.
Health and/or Therapeutic Education Groups	Perform collective activities with educational or therapeutic focus. These activities can be performed with programmatic groups of EqSF (Hiperdia, pregnant, adolescents, etc.) or groups created from the epidemiological profile of the territory (postural education, community therapy, benzodiazepine dependents, nutritional disorders, etc.). These groups can be held at the headquarters of the FHU or social facilities.	Population attached to EqSF.	Variable. According to the demand of each EqSF.

Categories	Subcategories
Coordination of information	Transfer of the information	- Formal mechanisms
	Transfer of the information	- Informal mechanisms
	Use of the information
Coordination of clinical managemen	Coherence of attention	- Clinical objectives and shared treatments
	Coherence of attention	- Clinical adequacy of patient transfer
	Adequate patient follow-up	- Access monitoring
		- Fragility in the existence of responsible for clinical follow-up
		- Assistance support from PC until the establishment of access to the SC
		- Assistance support from PC until the establishment of access to the SC
Administrative Coordination

Dimension: Coordination of Information
	Result found	Evidence
Transfer of intra -level information	Formal mechanism: Team meeting and registration in the family medical record	Communication on clinical cases is basically done through meetings. (Prof.3_Nasf). Here with Nasf, along with us discussing the case, the integration is much more interesting. (Medical.1_FH).
		Professionals of Nasf record the guidelines, prescriptions and referrals made during the visits and home visits, in the family medical record in the field diary.
	Informal mechanism: telephone and messages	[...] we communicate through WhatsApp, over the phone. [...] there is no bureaucracy to speak on the day of the case discussion. (Prof.1_Nasf).
	Informal mechanism: telephone and messages	When we come to the service, for an attendance... We interact a lot, the communication is ample. (Prof.3_Nasf).
Transfer of inter-level information	Formal mechanism: referral form to the specialist and meeting for network articulation	The network articulation meeting serves to establish the triage and risk criteria that we use in the queue to be able to organize the queue. (Prof.1_Nasf).
		Patients are referenced from basic care with that specialist referral form; when they are discharged, we do the counter-referrals. So we say what the treatment was for the post, how that patient evolved and how it should continue [..]. I always say, 'Look, now you're going to get this paper here and you're going to give it to that physical therapist there from the Nasf who is accompanying you'. (Prof.1_NR).
	Informal mechanism: telephone and messages	When I call to articulate, to speed up the process of the patient. (Prof.1_Nasf).
Use of Information	The shared information about the social conditions in which the patients live and their clinical history are considered in the construction of the therapeutic behaviors of all the teams.	This information about the patient is handled in the meetings to bring the feedbacks. (Prof.4_Nasf).
Use of Information		The social information given, mainly, by the health agents and the clinical behaviors are considered by the Nasf and Family Health professionals in the therapeutic conduction of the patients. In meetings with specialized services, the more complex cases are also discussed and the specificities of the patients are considered in the therapeutic decisions, it is recorded in the field diary.

Dimension: Clinical Management Coordination
	Result found	Evidence
Coherence of Attention	Existence of clinical objectives and shared intra and inter levels treatments	In the meetings between teams, the more complex cases of the Unique Therapeutic Projects (UTP) are constructed. In addition, each professional share the information about the consultations he has done individually and asks how the follow-up of these patients by the EqSF and the Community Health Agents (CHA) is going. In some of these meetings, Caps AD (Alcohol and Drugs) and disorder professionals also participate and build UTP along with Family Health and Nasf, both during discharge moments of some Caps patients and in division of activities when the patient is in semi-intensive care. It is recorded in the field diary.
		We hold a meeting here once a month, where all cases are brought and discussed together with the Nasf. Then, we will address each case: if you need an appointment, a visit, a referral. (Nurse.1_FH).
		In network articulation meetings also happen case discussions and agreements are made on the timing of the discharge of the specialized care, agreeing on what is necessary and possible to do in PC. It is recorded in the field diary.
	Clinical adequacy of patient transfer	Sometimes, I'm not sure where he's going to and Nasf helps me to understand. Sometimes, what I thought that belonged to a certain professional, I discover that it is not, that he must go to another professional, and that serves as knowledge even for a next patient, a next appointment that I do. (Medical.1_FH).
		In the Nasf implantation process, a workshop was carried out between Nasf and specialized services to define the profiles of patients that should be sent to each service, as well as the demands Nasf could help resolve in PC. This workshop product has already been discussed and adjusted a few times in networking meetings. (Prof.2_Nasf).
		Some cases presented by EqSF in team meetings are attended by the professionals of Nasf to make a more specialized listening or evaluation and help about the decision by referral to SC. This action helped to better judge who and when must be referred. (Prof.5_Nasf).

Dimension: Clinical Management Coordination
	Result found	Evidence
Adequate patient follow-u	Access monitoring	When the Nasf meeting happens, there is that exchange of how that patient was, how he was referred, where he went, what happened to him. (CHA.3_FH). If he did not have access, we put the case in the discussion and the whole team interacts and sees the best way. (Prof.4_Nasf).
	Fragility in the existence of responsible for clinical follow-up	The responsibility of tracking patient follow-up is usually left to the CHA because they visit the patient, or the Nasf, because they attend meetings with the SC and monitor the access of the patient. But this does not happen evenly with all EqSF. In units where the work process seems to be less organized or the CHA are not as collaborative, the follow-up of the patient is impaired is recorded in the field diary.
	Support assistance from PC until access to the SC	Even if the access takes time, she does not release the patient. It's taking a while, but send he back to me, let me see him again, let's see how we can do it, let's try another way... you understand, so this way we don't stop helping, don't stop there. Done, I've referred him and it's over. (Nurse.1_FH).
	Support assistance from PC until access to the SC	In order to avoid the worsening of the sequel, the patient is being treated in PC, by the Family Health or Nasf, until he gets access to the specialized service it is recorded in the field diary.
	Continuity of bond with PC	It does not mean that he becomes a reference; this patient continues to be monitored. So, he really is accompanied by the referral service, but it does not mean it's not our responsibility anymore. At any moment we know that we can also be driven to help with this care. (Prof.3_Nasf).

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