Emergency care or primary care: patient's choices on the national health service

Abstract

One of the main outcomes of care model in Brazil is the burden placed on emergency care services forpeople with complaints compatible with the Primary Health Care. Despite international studies whichshow that countries that have organized their health systems from the Primary Care had better levels ofhealth and more efficiently, our system is still predominantly focused on acute health problems. Initiatives to strengthen the Primary HealthCare (PHC), as the implementation of Family Health Strategy and the creation of the National PHC policy, are enrolling in our country with reference to its four main attributes: attention to the first contact, longitudinality of care, comprehensiveness or completeness careand integration or coordination of care. This study sought to ascertain the reasons for not adhering tobasic units and family health (UBS and USF) by patients who sought the service of Attendance (PA) withcomplaints compatible with the PHC. Descriptive and quantitative approach, developed into a healthdistrict with 140,000 inhabitants, comprising teams of Family Health, UBS and BP service to emergencyrooms 24 hours. At the emergency unit, were analyzed sheets of two typical months, distinguishingpatients with complaints compatible with the PHCof those with complaints and disorders related to PA.We identified its overall frequency to the National Health Service (SUS) and specifically in the PA duringthe period of 67 months. There were semi-structured household interviews the patients defined by lot.Although coming from 12 different UBS / PSF, 3 of them were concentrated 54.6% of patients who soughtthe PA . 55% of them sought the SUS by at least 30 times in the period. Among them 14 patients whosought the SUS more than 200 times, one of them by 1012 times, 1097 times for one and other times by2744, all seeking procedures typical of PHC. Of the 347 visits were obtained 105 interviews. As to thereasons that motivated the search for the PA 76% of patients interviewed indicated factors related toaccess and accessibility (opening hours, waiting time, distance) and 19% reported aspects of the establishment of ties. They considered that, when met, support for HPC/ PSF is good for 57% and 16% forRegular, Bad for 27% of respondents. The highest technological upgrading of the PA was also mentionedas a stimulus to seek it. Overcome the difficulties pointed requires investments to increase the technicalcapacity and management system, strengthening of HPC and review of work processes, the ContinuingEducation and recovery of users in the construction of new social actors.