Care for women with high-risk pregnancies in primary care services in the city of São Paulo, Brazil: the healthcare team’s perspective

The study aimed to evaluate care for women with high-risk pregnancies from the healthcare team’s perspective in primary healthcare (PHC) services in the city of São Paulo, Brazil. This is an evaluative study with a qualitative approach that used the open interview technique for data collection from PHC personnel. The data were explored through thematic categories built from the content emerging spontaneously from the interviews, discussed according to Health Work Process Theory. The results evidenced three domains: a “normal work routine”, organized from the perspective of exclusively biological practices and in which the management model sometimes fails to allow compliance with the recommended practices; a “referral and counter-referral” system, which sometimes allows more timely interventions, more unique to the pregnant women's needs, but still disconnected from the referral services; and “shared responsibility of the PHC team for the pregnant woman”, characterized by flexibilization of the work routine that extends beyond application of clinical protocols, encouraging the building of a bond and favoring qualification of care. The study revealed the need for flexibilization of use of patient care protocols in the work process, which can promote the shared responsibility of PHC teams for care, to adjust it to each pregnant woman's unique needs, beyond the limits of services' organization based on the logic of exclusively biological practices.

本研究旨在从医疗团队视角，评估巴西圣保罗市基层医疗（Primary Healthcare, PHC）服务中针对高危妊娠女性的照护实践。本研究为质性评价研究，采用开放式访谈技术采集基层医疗从业人员的相关数据。研究基于访谈中自然涌现的内容构建主题类别，并结合卫生工作过程理论（Health Work Process Theory）展开分析讨论。研究结果明确了三大核心领域：一是「常规工作常态」，其运作完全以纯生物学诊疗实践为核心，而现有管理模式有时无法确保严格遵循推荐诊疗规范；二是「转诊与反向转诊」体系，该体系虽有时可实现更及时的干预措施，提供更贴合孕妇个体需求的服务，但仍与转诊医疗机构存在衔接脱节问题；三是「基层医疗团队对孕妇的共同照护责任」，其特征为工作流程的弹性化调整——这不仅限于临床诊疗方案的执行，更有助于构建医患信任联结，并助力照护服务的专业化提质。本研究揭示，需在工作流程中放宽患者照护方案的适用限制，以此推动基层医疗团队共同承担照护责任，使其能够突破以纯生物学实践逻辑为基础的服务组织框架，适配每一位孕妇的个性化需求。