Cuidado integral às crianças com necessidades especiais de saúde na atenção primária em um município de fronteira

• Autor(a) principal: Casacio, Gabriela Dominicci de Melo
• Data de Publicação: 2022
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações do UNIOESTE
• Texto Completo: https://tede.unioeste.br/handle/tede/5957
• topic: Atenção primária à saúde; Integralidade em saúde; Crianças com deficiência; Saúde na fronteira; Pesquisa qualitativa; Primary health care; Comprehensive health care; Disabled child; Emmigration and immigration; Qualitative research; Atención primaria de salud; Integralidad em salud; Niños com discapacidad; Salud fronteriza; Investigación cualitativa; CIENCIAS DA SAUDE::SAUDE COLETIVA

Technological advances and actions to promote health and prevent health problems provided better living and health conditions for the population and led to a reduction in infant mortality rates. However, these modifications were accompanied by epidemiological changes and an increase in the number of chronic conditions in childhood. Children with special health care needs have complex demands for care and require continuous and specialized attention, in greater quantity than children in general. To achieve comprehensive care, their families go a long and arduous way, especially in regions of greater vulnerability, such as border municipalities. The interdependence between border countries and the high individual, social and programmatic vulnerability of these areas make access to health services difficult, since shared spaces and complex population and health dynamics interfere in Primary Health Care. Thus, the barriers encountered by families for the care of their children harm the construction of the Therapeutic Itinerary and further aggravate their health condition. The objective of this study was to understand the care provided by Primary Care to children with special health care needs in a municipality on the international border, considering the elements of comprehensive care. This research is characterized by a qualitative, descriptive approach, based on the theoretical-methodological framework of hermeneutic-dialectic. In-depth interviews were conducted based on a guiding question and a semi-structured script based on the principles of Primary Care and the elements of comprehensive care. In addition, the caregivers built a Talking Map to represent the path taken with the children in search of assistance, from diagnosis to treatment. Forty-five people participated in the study, 19 caregivers of children with special health needs under six years old, 11 professionals (social workers, psychologists and pedagogical coordinators) from three philanthropic institutions that provide social care, educational and health care for people with multiple disabilities and 15 nurses from Primary Health Care units of reference for selected children. For data analysis, the deductive thematic analysis was used. As a result, the categories were: functional barriers to access to Primary Care services; lack of connection and interaction between the professional and community networks; fragility of the integral look for the recognition of problems; time-consuming and disorganized coordination; restrictions on access by foreigners and repercussions of the COVID-19 pandemic on child care. These challenges hindered the construction of the Therapeutic Itinerary, which proved to be disconnected and not very resolutive, leading to the lack of care of children with special needs. It is urgent to reorganize Primary Care services, in order to make the entrance door more effective, strengthen the bond and interaction between the subjects involved in care, empower professionals regarding the needs and rights of children, facilitate delivery flows, establish effective linkage between services, reduce bureaucracy in cross-border access, promote inter-country integration policies and improve support for philanthropic institutions, so that children achieve comprehensive and resolutive care.