Atenção integral e integrada nas políticas de envelhecimento saudável: comparação entre os sistemas de saúde português e brasileiro

Weber, Larissa; Craveiro, Isabel; Colussi, Cláudia Flemming

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ORIGINAL ARTICLE • Physis 34 • 2024 • https://doi.org/10.1590/S0103-7331202434042en copiar

Atenção integral e integrada nas políticas de envelhecimento saudável: comparação entre os sistemas de saúde português e brasileiro

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Este estudo investigou como o cuidado integral e integrado expressa-se na legislação do Sistema Nacional de Saúde português e do Sistema Único de Saúde brasileiro, especialmente nas políticas de envelhecimento saudável. A análise de conteúdo foi realizada através de pesquisa documental envolvendo 24 documentos, 12 de cada país, publicados até 2020. Os achados indicaram que a atenção primária é o nível de atenção responsável pela integração do cuidado nos dois países. Ambos apostaram na formação de redes de atenção, articulação intersetorial e adoção de tecnologias de informação e comunicação para facilitar a integração. As políticas de envelhecimento saudável enfatizaram a importância do cuidado comunitário, integrando usuários, seus familiares, equipamentos de saúde e outros setores, promovendo a autonomia e prevenindo doenças crônicas e situações de violência. As transformações nos dois países acompanham as evidências científicas divulgadas pela Organização Mundial da Saúde e por centros de pesquisa voltados para o envelhecimento saudável e contribuem para tornar seus sistemas mais eficientes e resolutivos. Apesar dos avanços, o risco de descaso e os impactos do isolamento social provocados pela Doença do Coronavírus 2019 desafiam a efetividade da integralidade. Espera-se que os aspectos discutidos contribuam para a construção de formas exitosas de superação deste desafio.

Palavras-chave:
Integralidade em saúde; Assistência integral à saúde; Envelhecimento; Sistemas de saúde

Country	Documents
Portugal	Law Nº 56/79. National Health Service (1979)
	Decree-Law Nº 74-C/84. Creates, within the Ministry of Health, the Directorate-General for Primary Health Care (1984)
	Law Nº 48/90. Basic Law of Health (1990)
	Decree-Law Nº 281/2003. Creates the network of continuous health care (2003)
	National Health Plan 2004-2010 (2004)
	National program for the health of the elderly (2006)
	Decree-Law Nº101/2006. Creates the National Integrated Continuing Care Network (2006)
	Decree-Law Nº 28/2008. Establishes the regime for the creation, structuring, and operation of groups of health centers of the National Health Service (2008)
	National Strategy for Active and Healthy Aging 2017-2025 (2017)
	Law Nº 95/19. Approves the Basic Health Law and repeals Law Nº 48/90, of August 24, and Decree-Law No. 185/2002, of August 20 (2019)
	National Strategic Plan for Telehealth 2019-2022 (2019)
	National Health Plan - Review and Extension to 2020 (2015)
Brazil	Law Nº 8.080/1990. Provides for the conditions for the promotion, protection, and recovery of health, the organization and functioning of the corresponding services, and provides other measures (1990)
	Ordinance Nº 1.395/1999. Approves the National Health Policy for the Elderly (1999)
	Ordinance GM Nº 2.528/2006. Approves the National Health Policy for the Elderly (2006)*
Brazil	Operational Guidelines of the Pacts for Life, in Defense of the SUS and Management (2006)
	National Health Promotion Policy (2006)
	Ordinance Nº 4.279/2010. Establishes guidelines for the organization of the health care network within the scope of the Unified Health System (2010)**
	Decree Nº 7.508/2011. Regulates Law 8,080, of September 19, 1990, to provide for the organization of the Unified Health System, health planning, health care, and inter-federative articulation, and makes other provisions (2011).
	Strategic action plan to tackle chronic non-communicable Diseases in Brazil 2011-2022 (2011)
	Ordinance GM Nº 2.546/GM/2011. Redefines and expands the Telessaúde Brazil Program, which is now called Programa Nacional Telessaúde Brasil Redes (2011)
	Ordinance GM Nº 2.446/2014. Redefines the National Health Promotion Policy (2014)*
	Ordinance Nº 2.436/2017. Approves the National Primary Care Policy, establishing the review of guidelines for the organization of primary care, within the scope of the Unified Health System (2017)
	Law Nº 13.989/2020. Provides for the use of telemedicine during the crisis caused by the coronavirus (SARS-CoV-2) (2020)

Categories	Portugal	Brazil
Primary Health Care	- Main gateway to the health system; - Integrates unscheduled care practices with public health interventions; - Articulates the actions of promotion, prevention, and treatment; - Personalized care; - Multi-professional teams.
Care networks	- RNCCI; - Aimed at providing integrated continuous care, including comprehensive assessment of the needs of the person, rehabilitation, re-adaptation, reintegration, maintenance of comfort and quality of life, in an interface with social care; - Access is determined by the hospital where the user has been hospitalized or by the health center of his/her geographical area.	- RAS; - Aimed at promoting the systemic integration of health actions and services with the provision of continuous, comprehensive, quality, responsible, and humanized care, and at increasing the performance of SUS in terms of access, equity, health effectiveness, and economic efficiency. - User is referenced in the regional or interstate network.
Intersectoral action	- Law nº 56/1979 established that health care also includes social support. Health and social security are linked to other sectors in the formulation of health promotion policies.	- RAS attribute and PNaPS principle, which highlighted the need to articulate the health sector with others in the formulation of health promotion policies.
Information and Communication Technologies	- PENTS 2019-2022; - Tele-consultations, telemonitoring, telediagnosis, telerehabilitation, tele-screening, tele-training; - SNS24 Line provides screening, counseling, and telecare services.	- Brazil Network Telehealth Program integrates education and service and provides teleconsultation, tele-diagnostics, tele-education; - Law nº 13.989/2020 authorizes telemedicine on an exceptional and temporary basis.

Axis	ENEAS (Portugal)	PNSPI (Brazil)
Objectives	To raise awareness of the importance of active aging and solidarity between generations, promoting change in attitudes towards aging and elderly people; to promote cooperation and intersectoral action; to contribute to the development of policies that improve the quality of life of elderly people; To promote health and autonomy throughout all phases of the life cycle; To integrate governance and inter-ministerial cooperation.	To recover, maintain, and promote the autonomy and independence of elderly people, directing collective and individual health measures for this purpose, in accordance with the principles and guidelines of the SUS; Focus on elderly people, acknowledging that healthy aging requires the formulation of health promotion actions at all ages; To instigate intersectoral action, avoid duplicity of actions, correct distortions, and enhance the solidarity network.
Health	The actions are divided between those aimed at people with high and stable levels of intrinsic capacity, to increase or maintain these levels over time, and others aimed at the population with reduced intrinsic capacity, to stop, reverse, and manage this situation. Prioritizes the prevention of chronic diseases and physical and mental incapacitation and the reorientation of the health system in meeting the needs of elderly people, in conjunction with existing programs and strategies; Adoption of Individual Care Plans as integrated intervention instruments to be contracted between different levels of care.	2 guiding axes: coping with frailties and promoting health and social integration, at all levels of care; Promotion of autonomy and independence, with stimuli to self-care; prevention actions - primary, secondary, tertiary; rehabilitation; autonomy and health recovery; social reintegration; Structuring a care line, focusing on the user, and facilitating access to care levels through bidirectional flows; Proposes the adoption of mechanisms that expand the resolution of Primary Health Care, such as home care, and the implementation of State Health Care Networks for elderly people.
Participation	Includes education throughout the life cycle, creation of home care networks, identification and regular evaluation of external factors that contribute to the vulnerability of elderly people, creation of living spaces, support and activities in neighborhoods, encouragement of telemonitoring and e-inclusion to facilitate “aging in place" and elimination of architectural mobility barriers.	Stimulates the participation of elderly people in social facilities, councils, and health conferences where they present their demands and priorities; Encourages the formation of links between health services and their users, giving priority to family and community groups, creating conditions for the effective participation and social control of the elderly part of the population.
Safety and well-being	Proposes measures to prevent and address situations of violence, such as conducting campaigns and training for security, health, and legal professionals, and monitoring and supporting isolation situations.	Proposes actions to prevent accidents at home and on public streets; integrated actions to fight domestic and institutional violence against elderly people; and actions that counteract prejudiced attitudes.
Measurement, monitoring, and research	Focused on the survey of needs and the dissemination of good practices.	Focused on assessing the quality and impact of the policy and improving care.

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