ABSTRACT
Resumo Tendo em vista o olhar ampliado de saúde proposto pelo SUS, a abordagem dada ao processo do adoecimento exigiu um prisma voltado à visão biopsicossocial, e não mais ao modelo biomédico, o que levou a um reordenamento na formação dos profissionais de saúde. Assim, as Diretrizes Curriculares Nacionais foram instituídas norteando os projetos pedagógicos dos cursos rumo ao modelo biopsicossocial, de forma que a Classificação Internacional de Funcionalidade, Incapacidade e Saúde contribui para esse cenário por meio de sua abordagem multidimensional e não reducionista. Entretanto, historicamente, a fisioterapia tem forte influência do modelo biomédico, distanciando-a da atenção básica (AB). Este é um estudo exploratório, descritivo e quantitativo, com fonte de dados secundários obtidos por meio do Cadastro Nacional dos Estabelecimentos de Saúde do Brasil, e cujo objetivo foi verificar, dentro de um intervalo de dez anos, em qual nível de assistência à saúde está concentrada a maior parte dos fisioterapeutas e sua representatividade na AB. Os achados indicaram que a AB representa o cenário minoritário dos postos de trabalho ocupados pelos fisioterapeutas, refletindo a hegemonia do modelo biomédico e reforçando o caráter reabilitador dado historicamente à profissão.
Abstract In view of the expanded view of health proposed by the Unified Health System (SUS), the approach given to the illness process required a prism focused on the biopsychosocial view and no longer on the biomedical model, which led to a reorganization in the training of health professionals. Thus, the National Curriculum Guidelines were established guiding the pedagogical projects of the courses towards the biopsychosocial model, so that the International Classification of Functionality, Disability and Health contributes to this scenario through its multidimensional and non-reductionist approach. However, physiotherapy has historically been strongly influenced by the biomedical model, distancing it from primary care (PC). This is an exploratory, descriptive and quantitative study, with secondary data source obtained through the National Register of Health Establishments in Brazil, whose objective was to verify, within a 10-year interval, at which level of health care most physiotherapists and their representation in PC are concentrated. The findings indicated that PC represents the minority scenario of jobs occupied by physical therapists, reflecting the hegemony of the biomedical model and reinforcing the rehabilitation character historically given to the profession.
ABSTRACT
Introducción: Para lograr el control de la hipertensión arterial se requiere de la vigilancia de sus factores de riesgo, del manejo integral de la enfermedad y la eliminación de brechas que atentan contra la calidad del proceso de atención. Objetivo: Identificar las principales brechas que afectan el proceso de atención de las personas hipertensas en un área de salud del municipio Guanabacoa durante el periodo 2016-2017. Métodos: Se realizó una investigación descriptiva transversal, se aplicó un muestreo por conglomerado bietápico. En una primera etapa de los 41 consultorios se seleccionaron 10, y de estos se seleccionaron aleatoriamente las familias, quedando conformada la muestra por 1458 familias. Se entrevistaron 2297 personas mayores de 35 años. Resultados: El 42,5 por ciento de los entrevistados tenía antecedentes de hipertensión arterial, el 3,0 resultó presunto hipertenso, en el 54,5 por ciento no se encontraron evidencias. Existieron dificultades con la atención de estas personas, dado por problemas organizativos, de funcionamiento del sistema y de comportamiento individual. Las principales brechas fueron en el acceso (36,3 por ciento, seguimiento (28,5 por ciento) y control (17,5 por ciento). El 97,6 por ciento tenía indicado tratamiento farmacológico y el 28 por ciento de los no controlados en el momento de la medición de la presión arterial no estaban adheridos. Conclusiones: Las brechas relacionadas con el acceso a los servicios de salud, diagnóstico, seguimiento, tratamiento y control de los hipertensos, cuyo elemento común es la no búsqueda de atención, repercute en la calidad de la atención(AU)
Introduction: To achieve the control of high blood pressure requires the monitoring of its risk factors, the comprehensive management of the disease and the elimination of gaps that hamper the quality of the care process. Objective: Identify the main gaps that affect the care process of hypertensive people in a health area of Guanabacoa municipality during the period 2016-2017. Methods: A cross-sectional descriptive research was conducted, and a two-stage conglomerate sampling was applied. In a first stage of the 41 family doctor´s offices, 10 were selected, and of these families were randomly selected, with the sample being made up of 1458 families. 2297 people over 35 years old were interviewed. Results: 42.5 percent of the interviewees had a history of high blood pressure, 3.0 percent were suspected hypertensives, in 54.5 percent no evidence was found. There were difficulties with the care of these people, given by organizational problems, system functioning and individual behavior. The main gaps were access (36.3 percent), follow-up (28.5 percent) and control (17.5 percent). 97.6 percent had an indicated drug treatment and 28 percent of those not controlled at the time of blood pressure measurement were not attached. Conclusions: Gaps related to access to health, diagnostic, follow-up, treatment and control services for hypertensive in which the common element is care´s non-seeking have an impact on the quality of care(AU)