Health care network (dis)articulation in late and moderate prematurity

ABSTRACT Objective: to analyze the Health Care Network (dis)articulation of late and moderate premature infants in the first year of life. Method: a qualitative study with semi-structured interview, which addressed the care network constitution in a municipality in southern Brazil. Fifteen mothers of infants participated. Thematic content analysis and flowchart were used to describe networks and services. Results: first contact in Primary Health Care is a decisive factor for the recognition and articulation of neonates/infants in the network and enables resolution, especially in childcare demands. Secondary and hospital care services support isolated acute events or chronic conditions, without articulation between levels of care and in a uniprofessional way. Final considerations: attention to health conditions is organized and structured in a uniprofessional, fragmented and disjointed way, which makes it impossible to form a Health Care Network premature infants’ perspective.摘要 研究目的：分析生命首年中晚期早产儿与中度早产儿的医疗保健网络（Health Care Network）的衔接与脱节状况。 研究方法：本研究为采用半结构化访谈（semi-structured interview）的质性研究，针对巴西南部某直辖市的医疗保健网络构建情况开展调研，共纳入15名早产儿母亲作为研究对象。本研究采用主题内容分析（thematic content analysis）与流程图（flowchart）法，对医疗网络及相关服务进行描述。 研究结果：在初级卫生保健（Primary Health Care）机构的首次就诊，是新生儿/婴儿被纳入医疗网络并获得身份认定的决定性因素，可有效解决包括儿童照护需求在内的各类问题。二级医疗与住院医疗服务仅能应对孤立的急性事件或慢性病症，但各级照护环节之间缺乏衔接，且服务模式均为单专业主导。 研究结论：当前健康照护服务的组织与实施均采用单专业模式，呈现碎片化、割裂化的特征，无法从早产儿视角构建完整的医疗保健网络。