The access and rehabilitation working process in Primary Health Care

ABSTRACT For adequate rehabilitation service offer in Brazil, it is necessary to understand the availability of access to Rede Assistencial de Saúde (RAS) [Brazilian Health Care Network (HCN)] and develop practices to meet health needs. The objective was to estimate the distribution trend of rehabilitation human resources in HCN between 2007 and 2015, especially in Primary Health Care (PHC) and get to know the practice of Clínica Ampliada (CA) [Extended Clinical Care (ECC)], Projeto Terapêutico Singular (PTS) [Singular Therapeutic Project (STP)], and Apoio Matricial (AM) [Matrix Support (MS)] of speech therapists, physical therapist, and occupational therapists. We searched for professionals from the Health Care Network using Cadastro Nacional de Estabelecimentos de Saúde (CNES) [Brazilian National Register of Health Establishments (NRHE)], and the monthly trend was elaborated through Prais-Winsten linear regression models. Aiming at knowing the practices of ECC, STP, and MS, “Discourses of the Collective Subject” were made from interviews held with 12 professionals. Medium complexity services had higher concentration of professionals, except for the hospitals in São Paulo city, and PHC had the lower possibility of access. Though shy, healthcare increased for all three professionals, with emphasis on physical therapists in hospitals in São Paulo city, in a comparison between the state (0.73%) and city (0.95%). In PHC, the highest raises were for occupational therapists of São Paulo city and physical therapists in Brazil. For MS, ECC and STP, besides the difficulty of the working process itself, ideas such as “plurality of concepts,” “biopsychosocial perspective,” and “possibility of adaptation” of care were predominant. Despite the growing numbers, the availability of professionals is still low and uneven, concentrated in specialty, and emphasising the expansion of physical therapy in hospitals and occupational therapy in PHC.

摘要 为在巴西提供充足的康复服务，需明确巴西卫生保健网络（Rede Assistencial de Saúde, RAS）的可及性现状，并制定适配健康需求的服务实践方案。本研究旨在估算2007至2015年间巴西卫生保健网络内康复人力资源的分布趋势，尤其是在初级卫生保健（PHC）领域的分布情况，并了解言语治疗师、物理治疗师及作业治疗师所开展的拓展临床照护（Clínica Ampliada, CA）、单一治疗方案（Projeto Terapêutico Singular, PTS）与矩阵支持（Apoio Matricial, AM）实践模式。本研究通过巴西国家卫生机构登记系统（Cadastro Nacional de Estabelecimentos de Saúde, CNES，即巴西国家卫生机构注册库，NRHE）检索卫生保健网络内的从业人员，并采用Prais-Winsten线性回归模型构建月度趋势曲线。为了解拓展临床照护、单一治疗方案与矩阵支持的实践开展情况，研究团队对12名从业人员开展访谈，基于访谈资料形成集体主体话语（Discourses of the Collective Subject）分析材料。研究结果显示，除圣保罗市的医疗机构外，中等复杂度的服务岗位集中了更多康复从业人员，而初级卫生保健领域的可及性相对较低。尽管增速平缓但仍呈上升态势，三类康复从业人员的供给量均有所增长，其中圣保罗市医院的物理治疗师供给增长尤为显著：州级层面供给占比为0.73%，市级层面则达0.95%。在初级卫生保健领域，圣保罗市的作业治疗师岗位增幅最为显著，全国范围内的物理治疗师岗位亦实现较高增长。针对矩阵支持、拓展临床照护与单一治疗方案的实践而言，除工作流程本身存在诸多难点外，"概念多元化"、"生物-心理-社会照护视角"与"照护适配可能性"等核心理念占据主导地位。尽管从业人员总量呈增长态势，但当前康复人力资源的供给仍存在总量不足、分布不均的问题，且过度集中于特定专科领域，未来需重点推进医院物理治疗与初级卫生保健领域作业治疗的服务扩张。