Organization of specialized outpatient care in the context of integrated healthcare networks

Abstract

Abstract Problem/Issue The Specialized Outpatient Care (SOC) organization is a worldwide concern, aiming to ensure integrality and equity of health care. Description of the problem Implantation of SOC services regionalized and integrated in a healthcare network coordinated by Primary Care (PC) seems to be a potential strategy to restore balance between demand and supply by SOC. The “Health Care Planning” (HCP) method, proposes a population-based management SOC model with horizontal and collaborative relation between SOC and PC, different from the conventional model focused on medical specialties. Thus, SOC assumes three functions besides assistance: educational, research and supervisory. In 2018, the PlanificaSUS project started the implantation of this model in 25 regions of 19 Brazilian states. Each region chose one SOC service and one priority line of care, based on local epidemiological indicators. Workshops and tutoring activities were conducted and SOC teams were trained based on the continuous care cycle, in an inter-professional and collaborative way. Results Priority lines of care were chosen as follows: maternal and child (n = 17); elderly health (n = 1); mental health (n = 1); and hypertension and diabetes (n = 6). Each SOC service mapped PC services in region, defined evidence-based clinical guidelines in the healthcare network and organized SOC portfolio, composed of multi-professional team, equipment and physical structure. Team training was concluded in 19 SOC services, in which educational function was introduced with PC through a risk stratification course. This course was based on common clinical guideline between PC and SOC, contributing to shared and resolutive care. Lessons The proposed model for SOC organization could be a potential strategy to integrate SOC with PC in different settings, in spite of important challenges, such as: covid-19 pandemic, necessity local health managers' protagonism and politics to support SOC integration in healthcare network. Key messages Organization of SOC integrated in healthcare networks must be promoted to ensure integrality, equity and longitudinally of shared and resolutive care. Population-based management and a horizontal and collaborative relation between SOC and PC should be encouraged to improve quality and effectiveness of care in the healthcare network.