Retrato das equipes de atenção primária à saúde do Brasil que possuem integração ensino-serviço

• Autor(a) principal: Jordão Júnior, Walace [UNESP]
• Data de Publicação: 2024
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UNESP
• Texto Completo: https://hdl.handle.net/11449/257333
• topic: Integração ensino-serviço; Preceptoria; Serviços de integração docente-assistencial; Atenção primária à saúde; Serviços de saúde

The demand for comprehensive, person-centered care, based on an expanded concept of health, has led to the need for changes in health education. In this context, the Primary Health Care (PHC) service has stood out as a favorable setting for the development of various competencies. The update of curricular guidelines, in line with public health policies, has further encouraged the integration of students in training into these services. However, no national study has been identified in the literature that characterizes the PHC services that embrace this proposal of integration with health education. Therefore, the objective was to analyze the integration of trainees into primary health care teams across Brazil, creating a mechanism for disseminating their structural and organizational characteristics through an infographic. A case study with a quantitative, exploratory, and descriptive approach and a cross-sectional design was conducted. Secondary data from the external evaluation of the National Program for Access and Quality Improvement in Primary Care (PMAQ-AB) in 2018, throughout the national territory, were used. The case considered was the PHC services, and the variables of interest were the different levels of students integrated into the services. The exploratory variables selected included the structural and organizational characteristics of the services, as well as planning actions and community activities. Of the 36,355 teams that participated in the PMAQ-AB, nearly half reported no integration of teaching and service into their work routines (n=17,076; 46.7%). Among those reporting such integration, the Southeast region of the country had the highest concentration, with a focus on medical residency (61.5%). Across the country, undergraduate students (21%), followed by technical students (18%), were the most represented, with 54% of the teams having students from different educational levels. The results showed that 28.3% of the teams were trained in tutoring/preceptorship, and the majority were located in municipalities with fewer than 100,000 inhabitants (64.1%) and that had higher education institutions (61.5%), with a minority linked to teaching and research hospitals (16.5%). Most teams had a minimum composition (69.5%), including community health workers (99.5%). The majority used planning mechanisms to organize their practices (83.7%), although only 60% held weekly and/or biweekly meetings (59.8%). About 78% organized care to address territorial and user vulnerabilities, but only 15.6% discussed detected situations with schools. There was a predominance of health surveillance actions (average=94.0%), with fewer teams offering health promotion and disease prevention actions (average=59.6%). Regarding access and service quality, teams with a higher level of integration were concentrated among those with regular performance (32.0%), followed by good performance (30.6%). Thus, it is concluded that the identified structural profiles and organizational conditions may foster critical reflections and care practices more aligned with the principles of the SUS, reaffirming the importance of teaching-service integration as an essential strategy to qualify the training of health professionals and strengthen the SUS. At the same time, they highlight the lack of preparation among health professionals to act as preceptors, as well as an organization that tends to reproduce a still hegemonic care model focused on individual, disease-centered care rather than on health promotion actions. Keywords: Teaching Care Integration Services. Preceptorship. Primary health care. Health services.