Abstract
The study assessed care for high-risk pregnancy, including access, functioning, and use of health services, ranging from primary healthcare (PHC) to specialized care. This was an evaluative study anchored in an analytical model that used triangulation of different information sources and comparative analysis of care for high-risk pregnancy in four Brazilian metropolises. The selected analytical categories were: access to consultations and tests, linkage between components of the healthcare networks and between users and healthcare professionals, and the care provided. Contexts of care for high-risk pregnancy were characterized by health system information indicators and a qualitative descriptive study produced by key informants, in addition to a questionnaire applied to 1,886 pregnant women seen at specialized services, having been referred by PHC. Triangulation of data obtained from secondary sources, contextualization of healthcare networks, and a survey with high-risk pregnant women allowed encompassing the complexity of the organizational arrangements in the healthcare network among the municipalities. Significant differences were identified in access, linkage, and care provided for high-risk pregnancy in the four metropolises. Campinas (São Paulo State, Brazil) was the municipality with the best performance in the indicators related to linkage and access by pregnant women to PHC. São Paulo and Porto Alegre (Rio Grande do Sul State) showed fair performance on the set of indicators as a whole, while Fortaleza (Ceará State) revealed the need for improvement in the three categories analyzed.
Highlights
an evaluative study anchored in an analytical model that used triangulation of different information sources
Contexts of care for high-risk pregnancy were characterized by health system information indicators
a qualitative descriptive study produced by key informants
Summary
Avaliou-se a atenção à gestação de alto risco, incluindo o acesso, o funcionamento e a utilização dos serviços de saúde, desde a atenção primária à saúde (APS) até a atenção especializada. Caracterizaram-se os contextos de atenção à gestação de alto risco por meio de indicadores dos sistemas de informação em saúde e de estudo descritivo qualitativo produzido por informantes-chave, além de questionário aplicado a 1.886 gestantes dos serviços especializados, encaminhadas pela APS. Os municípios de Campinas (São Paulo), Fortaleza (Ceará), Porto Alegre (Rio Grande do Sul) e São Paulo foram selecionados pela magnitude populacional e, consequentemente, pela importância que representam ao sistema de saúde, além da heterogeneidade que apresentam na composição e organização dos serviços e suas RAS, possibilitando verificar diferenças na organização da atenção à gestação de alto risco, tanto na APS quanto na atenção especializada. A terceira fase do estudo contou com a coleta de novos dados primários, que ocorreu por meio da aplicação de questionário junto a gestantes residentes nos municípios e encaminhadas pela APS para acompanhamento na atenção especializada devido à gestação de alto risco (critérios de inclusão).
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