COMMUNITY HEALTH AGENTS AND THE COMPLEXITIES OF THE WORKING WITH PATIENTS USING MEDICINES

Abstract The community health agents are an important element in the management of medication information in primary healthcare setting, improving healthcare team interaction with the community. The aim of this study was to reveal how the use of medicines is present in the routine of agentes and understand the relationships established between agents, users and healthcare team. This is a quantitative and qualitative study, using participant observation, semi-structured interview and focus group. This study was conducted at three basic health units in a municipality of Minas Gerais, Brazil, between March, 2013 and February, 2015. The results show that agents constantly relate with patients who experience drug therapy problems and have doubts about the indication, effects, adverse drug reactions, among other. They perform some interventions directly with the patient, but usually they prefer to refer cases to the healthcare team. Some agents said recognizing the pharmacist as a reference on medicines, but the demand for this professional was low by the subjects of this study. We emphasize the importance of the agents training on medication use to instrumentalize them to recognize problematic situations, to develop interventions with the support of the healthcare team and to follow up patients using medicines.

摘要：社区健康专员（community health agents）是基层医疗卫生场景中药物信息管理的重要组成部分，可优化医疗团队与社区的互动联结。本研究旨在探析专员日常工作中药物使用相关实践的开展情况，并厘清专员、服务对象与医疗团队之间的互动关系。本研究为定量与定性结合的混合研究，采用参与式观察（participant observation）、半结构化访谈（semi-structured interview）及焦点小组（focus group）法开展研究。研究于2013年3月至2015年2月期间，在巴西米纳斯吉拉斯州某市镇的3家基层医疗卫生机构实施。研究结果显示，专员常与存在药物治疗问题、对药物适应证、疗效及药品不良反应等存在疑问的患者开展沟通。部分专员会直接为患者提供部分干预措施，但多数情况下更倾向于将相关病例转诊至医疗团队处理。部分专员表示认可药师作为药物咨询的专业参考，但本研究对象对药师的实际需求较低。本研究强调需加强专员的药物使用相关培训，使其能够识别药物治疗相关问题场景、依托医疗团队开展干预措施，并对用药患者进行跟进随访。