PHP85 - Integration Of Basic Attention To The Specialized Attention Network In Brazil’s Health System

Abstract

In universal health systems, integral care management is considered the structural axis in overcoming health care fragmentation of services. This research intends to propose a classification for the integration level between basic and specialized attention and to apply this classification in the analysis of the integration between the care complexity levels on Brazil's health system. Transversal study with data from 17.202 family health teams that answered the external evaluation questionnaire of the National Program to Access and Quality Improvement of Basic Attention (PMAQ), 2012. In order to estimate the team’s integration level, the answers of 19 selected questions from PMAQ were fitted with the Gradual Response Model of the Item Response Theory (IRT). Based on the results, the usual IRT scale was categorized in three levels of integration: low, medium and high. The assumption of unidimensionality was considered valid. Cronbach’s alpha indicated high internal consistency (0.85). Southeast region has got the lowest percentages of teams with low integration and the highest percentages in the high integration, similarly to the South region. From the selected questions, twelve carried a greater amount of information about team’s integration to the network. Of these, we highlight matricial support actions (medical appointment; case discussions; shared clinical actions; joined construction of therapeutic projects; permanent education activities; discussion of work processes; interventions on territory and visits with a basic attention professional). In high integration level was recorded frequency of positive answers referred to communication (institutional flow, communication channel and contact list). Nine questions presented negative answers frequency around 50%. According to the proposed integration levels, matricial support actions improved the team’s performance. Communication devices between them reinforce this understanding. However, in order to consolidate integral care, a need to qualify the integration between the actions of basic and specialized attention was observed.