Matrix Support Research Articles

Role of management and human resource factors on matrix support in secondary oral health care in Brazil.

To investigate the association between health management and human resource factors on matrix support (MS) in a nationally representative sample of Dental Specialty Centres (DSCs) in Brazil. This survey included 1042 DSCs (Response rate=94.99%) in the second cycle of the National Program for the Improvement of the Quality and Access to the Dental Specialty Centres (PMAQ-CEO, in Portuguese) in 2018. Previously trained interviewers extracted information on MS, health management and human resources of the DSC by using a structured instrument. An MS score was created by adding the number of positive answers to the 10 MS questions. Negative binomial regression models were used to estimate the unadjusted and adjusted rate ratios (RR) and corresponding 95% confidence interval (CI). Of all the DSCs (n=1042), 116 (11.1%) performed all 10 MS procedures. Those DSCs with a manager who had a higher education degree in the area of Public Health or Public Management (RR=1.01, 95% CI, 1.01-1.02) and with human resources that received incentives, bonuses or financial awards for performance related to the PMAQ-CEO result (RR=1.01 95% CI 1.01-1.02) are more likely to perform MS, when compared to the reference categories. The DSCs that are more likely to perform MS include those that developed actions as a result of periodic planning and evaluation with confirmatory documentation (RR=1.06, 95% CI; 1.01-1.10); those that received support for planning and organizing the work scheme (RR=1.03, 95% CI; 1.01-1.05); those that monitored and analysed the goals set for each specialty offered at the DSC, with (RR=1.06, 95% CI; 1.01-1.10) or without confirmatory documentation (RR=1.06, 95%CI; 1.02-1.11); those whose team periodically performed self-assessment processes, using the Ministry of Health's formal self-assessment (AMAQ in Portuguese) (RR=1.04, 95% CI; 1.02-1.05); those who followed clinical guidelines (with confirmatory documentation) regarding the referral of patients from primary care to the DSC (RR=1.02, 95% CI; 1.01-1.04). On the contrary, DSCs that did not use the results achieved in previous PMAQ cycles in the organization of the DSC's team work scheme proved to be less likely to perform MS (RR=0.98, 95% CI; 0.96-0.99). Matrix support is associated with human resources and management factors in secondary oral health care in Brazil. Continuing professional development and some management characteristics are important for secondary dental care quality and could be considered in health policy initiatives.

Matrix support in Mental Health: narrative revision of the concepts horizontality and supervision and their practical implications.

The Matrix Support (MS) is one of the cornerstones of the integration between Primary Health Care (PHC) professionals and Mental Health professionals (MH). A narrative review was conducted on the articles on MS in MH published in national databases from 1998 to 2017, considering a brief history of the PHC reorganization processes that led to the creation of the MS proposal. The aim was to understand the meanings attributed to the terms "horizontality" and "supervision" as well as the descriptions of the "matrix support" itself. We sought to identify factors contributing to the difficulties that have been described in the practices and literature, based on the assumption that these concepts are polysemous and it is possible to generate ambiguities that operate to the detriment of interprofessional practices. Based on the analysis of the selected articles, we were able to conclude that, in addition to polysemy, the obstacles' force lies in the hegemonic model of professional Health training, as it is traditional, hierarchical and uni-professional, and hinders the development of dialogic relations that favor the integration of the matrix support teams and PHC and consequent resolubility and quality of care.

Possibilidades e desafios do apoio matricial na atenção básica: percepções dos profissionais

The study aimed to analyze the operation of the matrix support (MS) in mental health, at primary health care. This is a qualitative research conducted in a Family Health Center in Fortaleza, Ceara, Brazil. The study participants were professionals from the Family Health Strategy and Psychosocial Care Center. Data were collected through semi-structured interviews and systematic observations of the practices and submitted to content analysis. The results indicate that the MS takes different forms depending on the context in which it develops and the perceptions of the professionals involved. Its effectiveness suggests a change in the professional’s practices, with the inclusion of interdisciplinary activities and sharing of knowledge. In this dynamic, the level of commitment and engagement of managers, health professionals, users, family and community are implicated, that in a shared way, decisively contributes to the reorganization of primary care in mental health care. Keywords: matrix support; mental health; primary health care; health promotion; delivery of health care.