Doctors’ Work in Primary Health Care in remote rural municipalities: where is the territory?

Abstract Resolute and comprehensive health care in remote rural municipalities (RRMs) requires Primary Health Care (PHC) with a strong community dimension anchored in the territory. This paper aims to analyze the performance profile of doctors in PHC, considering their work both in the territory and in PHC units. The perspective of doctors, critical agents in PHC, contributes to understanding whether there is an equitable and comprehensive availability of PHC. A qualitative study was carried out in 27 RRMs, with interviews with 46 Family Health doctors. Content analysis, structuring results in dimensions of arrangements in the performance of doctors in the territories and the organization of activities at the PHC units. Doctors concentrated their activities in the PHC units, primarily in municipal headquarters, with heterogeneous work agreements. Knowledge about the characteristics of the territory and the population was weak, especially those assigned at a considerable distance from municipal headquarters. In the rare work conducted within the territory, an itinerant and/or campaigning model was observed, with the mark of discontinuity. Walk-in patients were prioritized over care actions of follow-up and planning. The findings indicate the need to reinforce interaction with the territory in the provision of PHC services in RRMs.

摘要：为偏远农村自治市（remote rural municipalities, RRMs）提供稳固且全面的医疗卫生服务，需依托扎根于当地辖区、具备强社区属性的基层医疗保健（Primary Health Care, PHC）。本研究旨在分析基层医疗保健（PHC）中医师的执业画像，同时考量其在辖区与基层医疗保健机构内的工作开展情况。作为基层医疗保健（PHC）的关键主体，医生的视角有助于明晰基层医疗保健服务的可及性是否公平且全面。本研究针对27个偏远农村自治市（RRMs）开展质性研究，对46名家庭医疗医师进行访谈。研究采用内容分析法，将结果归纳为两大维度：医生在辖区内的执业模式，以及基层医疗保健机构内的活动组织框架。结果显示，医生的工作活动多集中于基层医疗保健机构，且主要位于各自治市行政中心，其工作协议存在显著异质性。医生对辖区与服务人群特征的了解较为薄弱，尤其是被分配至距离自治市行政中心较远区域的医生。在为数不多的辖区内工作中，可观察到流动式或运动式的服务模式，且具有间断性特征。相较于随访与规划类照护服务，门诊即时就诊患者被置于优先服务地位。研究结果表明，在偏远农村自治市（RRMs）提供基层医疗保健服务时，需强化医生与当地辖区的互动联结。