New configurations of matrix support in times of the COVID-19 pandemic

Mattos, Mauricio Pereira de; Gutiérrez, Adriana Coser

doi:10.1590/1413-812320232812.04862023EN

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ARTICLE • Ciênc. saúde coletiva 28 (12) • Dec 2023 • https://doi.org/10.1590/1413-812320232812.04862023EN copy

New configurations of matrix support in times of the COVID-19 pandemic

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The aim of this study was to analyze the different configurations of matrix support stemming from changes prompted by the COVID-19 pandemic by investigating the work process of an Expanded Family Health Center (NASF) in Maricá, Rio de Janeiro, Brazil. We conducted a qualitative study using data collection methods selected according to the circumstances of the pandemic: web survey, semi-structured interviews, document analysis and searches of health information systems. The data were analyzed using the hermeneutic-dialectic method. The findings show an increase in mental health problems among both patients and health workers, the need to mobilize sociopsychological support networks, an expansion of remote support, especially for professionals from supported teams, and reduced presence of specialists in the community. The study shows that work processes became more individualized and focused inside clinics, and that minimum teams had limited capacity to care for the health problems related to COVID-19, confirming that NASFs play an essential role in primary health care.

Key words:
COVID-19; Primary Health Care; Expanded Family Health Center; Matrix Support; Qualitative Research

Professional profile of NASF members
New team, with most members joining during the pandemic due to a switch in management of PHC. Half of the team members had worked in matrix support before joining the team. Most team members received training in matrix support from local management, particularly those who had joined the team before the pandemic. A little over half recognized that the official government documents that guide matrix support practices contribute to their work processes.
Interprofessional relations
NASF work schedules were defined jointly with the supported team; however, some specialists defined schedules independently. The professionals who most sought NASF support were nurses and CHWs. Most of the cases referred to specialists were discussed upon referral or during follow-up. Specialists participated in family health team technical meetings at the invite of mangers and upon the initiative of the NASF, which offered to be present in group meetings. Interconsultations involved mainly NASF members and family health team nurses. NASF specialists worked jointly with other NASF members in many actions. NASF teams held periodic internal planning meetings (generally weekly) with the participation of most of the team. Support materials and continuous training was offered to supported teams when the need was identified or when requested by teams or patients.
Work processes during the COVID-19 pandemic
Most team members took part in pandemic training activities; however, a considerable number of professionals reported not having participated in training on COVID-19. New work processes were discussed mainly with NASF members from the health district, with guidance being provided by management. NASF professionals reported that the professionals who provided most support during the pandemic were other NASF members. Most specialists mentioned that there was an increase in demands over the course of the pandemic. Individual appointments were held respecting all protocols. Collective activities were suspended temporarily, being resumed with the adoption of health protocols. Home visits were performed with a reduced number of professionals. The services provided by the Psychosocial Care Network were the most requested by NASF teams. WhatsApp was the most widely used communication tool to provide remote support to patients and supported teams, using text messages and voicemail; many professionals reported not providing remote support to patients. Physical structure was considered inadequate for the work of professionals during the pandemic.
Health patterns during the pandemic
The most mentioned problems were mental health problems - especially anxiety - followed by problems in the category diet and nutrition. Besides Psychosocial Care Network services, NASF teams also requested social assistance services during the period.
NASF management
The professionals reported that management was supportive when it came to issues involving COVID-19. Few training opportunities were offered by the city council to discuss aspects related to the pandemic. The way in which information on the health care network was made available was considered satisfactory. General meetings promoted by local management were considered spaces that provided the opportunity for discussion.

Strategic NASF area	Problem	Occurrences
Mental health	Anxiety	12
	Mental health	7
	Depression	5
	Panic disorder	2
	Fear	1
	Distress	1
	Insomnia	1
	Global developmental delay	1
	Behavior disorders	1
Diet and nutrition	Obesity	4
	Weight gain	2
	Hunger	2
	Overweight	1
	Unhealthy eating habits	1
	Eating disorders	1
	Irregular eating	1
Rehabilitation	Motor sequelae	3
	Generalized pain	2
	Joint pain	1
	Speech	1
	Language problems	1
	Follow-up with a nutritionist	1
	Respiratory and motor sequelae-related swallowing changes	1
Social service	Family conflict	1
	Intrafamily violence	1
	Domestic violence	1
	Unemployment	3
	Increase in poverty	2
	Lack of family income	1
	Barriers to accessing public policies	1
Body practices and physical activity	Problems related to a sedentary lifestyle	1
	Lack of physical activity	1
	Muscle weakness	1
Women’s health	Menstrual irregularities	1
Other problems	Stroke	1
Other problems	Decompensated diabetes mellitus	1

ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Chief editors:

Romeu Gomes, Antônio Augusto Moura da Silva