Abstract
ABSTRACT Objective: to understand care management in Primary Health Care based on the meanings attributed by workers who work in this context and build a theoretical-explanatory model. Method: this is a qualitative research based on the Grounded Theory on Constructivist Data, developed in the Primary Health Care network of a municipality located in southern Brazil. Participants were selected inductively according to theoretical sampling, totaling 37 workers, divided into four sample groups. Data collection through semi-structured interviews, from January 2017 to November 2018. Data analysis took place in two phases: initial coding and focused coding. The initial codes were classified, synthesized and integrated for the development of the categories, which, articulated, gave rise to the model. To support the analysis, Nvivo®11 was used. Results: the central phenomenon “Managing care in Primary Health Care” was supported by four categories: “Organizing care management”, “Implementing care management in the care environment”, “Relating with other subjects for care management”; “Articulated socially and politically”. These categories composed the theoretical model supported by the constitution of four interdependent dimensions: organizational, relational, care and sociopolitical. Conclusion: care management, implemented in daily work, reveals itself in a variety of practices, conditions and situations that integrate the intertwined world of work and the lives of users and workers of healthcare services. The model helps those involved in care management in Primary Health Care to expand and strengthen care practices committed to users.
Highlights
The Brazilian experience of Primary Health Care (PHC), configured in Family Health Strategy (FHS) and a structuring part of the Unified Health System (SUS – Sistema Único de Saúde) was mentioned by several authorities during the Astana Conference - held in October 2018 - as successful model, due to its results in improving access and population’s health, reinforcing the need to organize health systems, with the aim of affirming and renewing the political commitment to universal health coverage and sustainable development[1]
The central phenomenon that emerged after data analysis was called “Managing care in Primary Health Care”, which represents the central idea envisioned in the data
The theoretical-explanatory model of the phenomenon presents care management implemented in daily work and permeated by the complexity of the relationships between managers, workers and users, the latter being the central focus of all actions
Summary
PHC, in Brazil, is the fundamental structure for the ordering of care and coordination of the care network, with the potential to support continuous, articulated, comprehensive and quality care for the universality of the population[2] It establishes the fields of care practice, subjective manifestations, links, the strengthening of intersectorality and popular participation. Health care management practices are part of a new paradigm for the organization of the health care network and with the capacity to mediate in the complex needs demanded by health system users[3] It is assumed, that care management is embodied in the actions of subjects, managers, health workers and users who inhabit and attend healthcare services, building a collaborative and coordinated network, to ensure continued care to users in an appropriate and more opportune location[4]. It is important to pay attention to the improvement of working conditions
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