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Unidades de Recursos Assistenciais Partilhados : desenvolvimento organizativo e operacional
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RESUMO - Introdução: O modelo organizacional adotado pela reforma dos Cuidados de Saúde Primários (CSP) constitui nos Agrupamentos de Centros de Saúde (ACES) um conjunto de unidades funcionais com autonomia administrativa e técnica entre as quais se encontram as Unidades de Recursos Assistenciais Partilhados (URAP). A sua equipa é de natureza mais complexa e distinta da das restantes unidades, uma vez que configura um vasto leque de competências e recursos especializados. Devido a estas caraterísticas específicas, a sua gestão e coordenação são mais desafiantes. Objetivos: Este estudo tem como objetivo geral recolher, analisar e discutir dados relativos ao estado e à realidade das URAP quanto à organização, gestão e impacto da sua intervenção. Metodologia: Este estudo é de cariz qualitativo, com recurso a entrevistas semiestruturadas a uma amostra de conveniência de 12 coordenadores de URAP (3 ARS Norte; 3 ARS Centro; 3 ARS Lisboa e Vale do Tejo; 1 ARS Alentejo e 2 ARS Algarve). Foi realizada a transcrição integral e a análise de conteúdo das entrevistas através do MAXQDA 12. Resultados: Segundo a maioria dos coordenadores entrevistados, a ausência de regulamentação da unidade justifica a disparidade encontrada tanto quanto às valências profissionais presentes como quanto ao grau de articulação interna e externa, que chega a ser diferente consoante a área profissional. O facto de não existir ainda um processo de contratualização implementado não permite a monitorização e avaliação do desempenho da URAP. Mas também a inexistência de indicadores específicos para a URAP inviabiliza a contratualização. Em grande parte isto deve-se ao facto dos sistemas de informação e comunicação se encontrarem em desenvolvimento e em diferentes estados de implementação consoante as áreas profissionais dentro de uma mesma unidade. E consequentemente não permitem a monitorização eficaz da produção da unidade e dos resultados de saúde da população que serve. Os recursos disponíveis foram considerados insuficientes ou não adequados às necessidades da URAP, e evidenciam que a sua rentabilização e a cobertura nacional dos cuidados de saúde prestados pelos profissionais da URAP, não foram alcançados. Conclusão: Os resultados encontrados permitem concluir que o grau de implementação das URAP se mantém incipiente e com uma organização variável por região de saúde. A sua existência nos moldes em que foi idealizada faz sentido, mas será necessário ajustar a sua dimensão ao ACES e à população que serve, ajustando os recursos humanos tanto em número como valência, e os recursos materiais de forma a permitir responder às necessidades de saúde identificadas.
ABSTRACT - Introduction: The organizational model assumed by the Primary Health Care (PHC) reform proclaim a set of functional units in groups of health centres, with administrative and technical autonomy, such as the Shared Assistance Resource Units (SARU). This team is more complex and distinct from other units, since it figures a wide range of specialized skills. Due to these specific characteristics, it’s coordination and management is more challenging. Objectives: The purpose of this study is to collect, analyze, and discuss data related to the reality and state of the SARU, regarding the level of organization, management and impact of it’s intervention. Methodology: This qualitative study was carried out using semi-structured interviews with a convenience sample of 12 SARU coordinators (3 Regional Health Administration of North, 3 Regional Health Administration of Center, 3 Regional Health Administration of Lisbon, 1 Regional Health Administration of Alentejo and 2 Regional Health Administration of Algarve). Full transcript and content analysis of the interviews were performed through MAXQDA 12. Results: According to the majority of the interviewed coordinators, the absence of unit regulation justifies the disparity found, as much as the identified professional areas, and the degree of internal and external articulation, which can be different according to the area of practice. The fact that there is not yet an implemented contractualisation process does not allow the monitoring and evaluation of SARU’s performance. But also lack of specific indicators for the SARU impair the contractualisation process. This has largely to do with the still in development and in diferente stages of implementation of the information and comunication systems according to the professional area. Consequently does not allow an effective unit’s production monitoring, and the health outcomes of the population it serves. The available resources were considered insuficient or not adequate to the SARU’s needs, and show that their profitability and healthcare national coverage provided by SARU’s professionals were not achieved. Conclusion: The results found allow us to conclude that the level of implementation of SARU, remains incipient and with a variable organization by health region. Its existence in the form in which it was conceived makes sense, but it will be necessary to adjust its dimension to the groups of health centres, and the population it serves, adjusting the human in number and professional area, and the material resources in order to respond to the identified health needs.
ABSTRACT - Introduction: The organizational model assumed by the Primary Health Care (PHC) reform proclaim a set of functional units in groups of health centres, with administrative and technical autonomy, such as the Shared Assistance Resource Units (SARU). This team is more complex and distinct from other units, since it figures a wide range of specialized skills. Due to these specific characteristics, it’s coordination and management is more challenging. Objectives: The purpose of this study is to collect, analyze, and discuss data related to the reality and state of the SARU, regarding the level of organization, management and impact of it’s intervention. Methodology: This qualitative study was carried out using semi-structured interviews with a convenience sample of 12 SARU coordinators (3 Regional Health Administration of North, 3 Regional Health Administration of Center, 3 Regional Health Administration of Lisbon, 1 Regional Health Administration of Alentejo and 2 Regional Health Administration of Algarve). Full transcript and content analysis of the interviews were performed through MAXQDA 12. Results: According to the majority of the interviewed coordinators, the absence of unit regulation justifies the disparity found, as much as the identified professional areas, and the degree of internal and external articulation, which can be different according to the area of practice. The fact that there is not yet an implemented contractualisation process does not allow the monitoring and evaluation of SARU’s performance. But also lack of specific indicators for the SARU impair the contractualisation process. This has largely to do with the still in development and in diferente stages of implementation of the information and comunication systems according to the professional area. Consequently does not allow an effective unit’s production monitoring, and the health outcomes of the population it serves. The available resources were considered insuficient or not adequate to the SARU’s needs, and show that their profitability and healthcare national coverage provided by SARU’s professionals were not achieved. Conclusion: The results found allow us to conclude that the level of implementation of SARU, remains incipient and with a variable organization by health region. Its existence in the form in which it was conceived makes sense, but it will be necessary to adjust its dimension to the groups of health centres, and the population it serves, adjusting the human in number and professional area, and the material resources in order to respond to the identified health needs.
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Cuidados de Saúde Primários Unidades de Recursos Assistenciais Partilhados Organização e Gestão Primary Health Care Shared Assistance Resources Units Organization and Management