Organização do processo de trabalho na perspectiva dos profissionais da atenção primária à saúde a partir de uma avaliação do serviço

• Autor(a) principal: Siqueira, Valeria de Carvalho Araújo
• Data de Publicação: 2022
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UFMT
• Texto Completo: http://ri.ufmt.br/handle/1/5394
• topic: Atenção primária à saúde; Estratégia saúde da família; Processo de trabalho; Avaliação de serviços de saúde; CNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVA; Primary health care; Family health strategy; Work process; Health services assessment

Considered the gateway to the health network and the main contact of users with services, Primary Health Care (PHC). It has the Family Health Strategy (ESF) as its priority model for the reorganization of services in the Brazilian Unified Health System. Several PHC evaluation initiatives in the country have been carried out in recent years and in 2011 the Ministry of Health implemented the National Program for the Evaluation of Improved Access and Quality of Primary Care (PMAQAB). Among several aspects evaluated in the health services, the organization of the team's work process stands out as an object of investigation. Concepts from the theoretical framework of the health work process were adopted, relating them to PHC and its evaluation. It is assumed that the evaluations carried out in the services contribute to improvements in the organization of the health work process. The general objective is to analyze the organization of the work process from the perspective of primary care professionals based on service evaluations. It is a field research, exploratory, descriptive and with a qualitative approach. The subjects of the studies were the professionals of the family health teams and the managers who were members of the primary care board of the municipal health department of Cuiabá-MT. As inclusion criteria, the professionals who are part of the seven family health teams with the best certification in the third cycle of the PMAQ-AB in the municipality and the managers who have the role of coordinating and/or supervising the work process of these teams were used, totaling 79 people. For data collection, we used a questionnaire on the profile of professionals, focus groups, individual semi-structured interviews and direct participant observation of the routine per health unit and the team meeting, with records in a field diary. To organize the questionnaire data, a simple descriptive analysis was carried out to characterize the subjects in the investigation scenario. In the analysis of qualitative data, thematic content analysis was adopted with approximations to the methodological framework of hermeneutics-dialectics. In this process, four thematic categories emerged: the professionals' perception of the organization of the work process in PHC; the experience of professionals with assessments in health services as an instrument of the work process; potentialities identified in the qualification of the work process to meet health needs; and limitations in the qualification of the work process of the family health teams. The study was approved by the Health Research Ethics Committee of the Federal University of Mato Grosso under Opinion No. 3,653,768/2019. The empirical results showed that the teams have an organized work process, and the team's commitment and the fact that the professionals have been inserted in that community for a long time are important factors for this. It was observed that the presence of the university in the place with teaching, research and extension activities promotes more effective health actions. Among the difficulties mentioned, the lack of institutional support was highlighted due to the lack of planning and evaluation by the municipal management, which ends up generating a lack of continuity of actions, lack of material resources, precarious infrastructure and fragility in the health care network. health, impacting, therefore, the work process of the teams. With regard to service evaluations, it was observed that the professionals experience with the PMAQ-AB, and managers have little knowledge about this ministerial program, with the exception of a manager who worked directly throughout this evaluation process. Professionals perceive that the evaluation of the service contributes in some way to the organization of the work process, and that other aspects need to be valued, such as: the continuity of actions and the application of resources. It was highlighted that the welcoming, bonding, teamwork and community participation strategies are a differential of these teams and contribute significantly to comprehensive care, sometimes overcoming the barriers they encounter for job qualification. It was concluded that the fact that the teams have an organized work process contributed to a better evaluation of the service. The study provided an opportunity to reflect on the work process and evaluation as a tool to improve the organization of the work process, in order to meet the health needs of users. It is expected to provide subsidies for health teams and municipal management in the planning, monitoring and evaluation of Primary Health Care services in order to qualify the work process in the family health unit.