Low risk emergencies: integration analysis between primary care and Emergency Care Unit

Constantino, Luana Rodovalho; O’Dwyer, Gisele; Santos, Vera Lucia Barbosa dos; Seta, Marismary Horsth de

doi:10.1590/0103-1104202113103I

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ORIGINAL ARTICLE • Saúde debate 45 (131) • Oct-Dec 2021 • https://doi.org/10.1590/0103-1104202113103I copy

Low risk emergencies: integration analysis between primary care and Emergency Care Unit

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The study aims to analyze the attention given to low risk emergencies in an area of high socioenvironmental vulnerability in Rio de Janeiro, within the scope of the Family Health Strategy and the local Emergency Care Unit. The methodology used relied on a triangulation of data and sources obtained from medical records, direct observation, interviews, and focal groups with managers, workers and users. The service was analyzed according to diagnosis, type of occurrence, and sociodemographic data; the qualitative data was analyzed through thematic analysis, generating the categories: which urgency for which service; territorial issues; access; positive and negative aspects of services. As a result, the Family Health Strategy takes on the function of answering to urgencies. Previous experiences influence the pattern of users’ access. Socio-environmental fragility increases demand, stresses the Strategy’s programmatic service, and can generate risks by the fast treatment at the Emergency Care Unit, which has been a place of hospitalization, due to the scarcity of hospital beds. The two services work with partial integration. The conclusion shows that the levels of satisfaction with the Family Health Strategy indicated by the population and its centrality to the care networks are enhanced by the accommodation of urgencies.

KEYWORDS
Primary Health Care; Emergency; Health services; Health care needs and demands

Technique used	Duration of each technique	Type of participants	Total
Interview	60 minutes	On-call physicians from ECU	5
		On-call nurses from ECU	5
		Managers and Technical Managers (physicians and nurses) from ECU and FHS	9
Focus group	90 minutes	Physicians and nurses FHS	32
		ACS FHS	37
		Users	20
Total study participants			108

Disease group	FHS			ECU
Disease group	ICD	n. of records	Total	ICD	n. of records	Total
I. Certain infectious and parasitic diseases	A09- Other gastroenteritis and colitis of infectious and unspecified origin A59- Urogenital trichomoniasis B37- Candidal stomatitis B86- Scabies B359- Dermatophytosis, unspecified A15- Tuberculosis of lung B309- Viral conjunctivitis, unspecified	1,452 746 706 704 574 507 507	5,196	^* * ’ designates values lower than 150 appointments that were counted as ‘other ICD records’.	^* * ’ designates values lower than 150 appointments that were counted as ‘other ICD records’.	^* * ’ designates values lower than 150 appointments that were counted as ‘other ICD records’.
IV. Endocrine, nutritional and metabolic diseases	E119- Type 2 diabetes mellitus without complications E109- Type 1 diabetes mellitus without complications E66- Overweight and obesity E39- Endocrine disorder, unspecified	2,189 806 623 308	3,926	^* * ’ designates values lower than 150 appointments that were counted as ‘other ICD records’.	^* * ’ designates values lower than 150 appointments that were counted as ‘other ICD records’.	^* * ’ designates values lower than 150 appointments that were counted as ‘other ICD records’.
IX. Diseases of the circulatory system	I10- Essential (primary) hypertension	3,114	3,114	^* * ’ designates values lower than 150 appointments that were counted as ‘other ICD records’.	^* * ’ designates values lower than 150 appointments that were counted as ‘other ICD records’.	^* * ’ designates values lower than 150 appointments that were counted as ‘other ICD records’.
X. Diseases of the respiratory system	J00- Acute nasopharyngitis [common cold]	695	695	J00	269	269
XIII. Diseases of the musculoskeletal system and connective tissue	^* * ’ designates values lower than 150 appointments that were counted as ‘other ICD records’.	^* * ’ designates values lower than 150 appointments that were counted as ‘other ICD records’.	^* * ’ designates values lower than 150 appointments that were counted as ‘other ICD records’.	M791- Myalgia M545- Low back pain	556 186	742
XVIII. Symptoms, signs and abnormal clinical and laboratory findings	^* * ’ designates values lower than 150 appointments that were counted as ‘other ICD records’.	^* * ’ designates values lower than 150 appointments that were counted as ‘other ICD records’.	^* * ’ designates values lower than 150 appointments that were counted as ‘other ICD records’.	R05- Cough	425	675
Other ICD records			17,288			3,031
Total spontaneous demand services / Green and Blue			30,107	-		5,102

Categories	FHS		ECU		USERS
Categories	Managers	Professionals	Managers	Professionals	USERS
WHICH EMERGENCY FOR WHICH SERVICE	Adequate concept	Adequate concept, without unanimity	Adequate concept	Adequate concept, without unanimity	Adequate concept, without unanimity, but previous experience in services is crucial for the choice.
TERRITORIAL ISSUES	Recognizes that the social fragility of the territory produces demands.	The social fragility of the territory is enhanced by the affiliation of a larger clientele than in other systems.	Social fragility disqualifies the user.	Violence in the territory harms not only the resident population, but also the flow of work.	The socio-environmental conditions of the territory did not appear as an issue brought up by the population, but their interference with care was evident.
ACCESS	There is doubt whether the professional meets spontaneous demand throughout the day. Regrets that the hospitalization demand is directed to the ECU, not the hospital. Priority access to the local ECU vacancy is positive.	Spontaneous demand strains the quality of care and actions of health prevention and promotion.	The user overuses the UPA. The main problem is the lack of access to the hospital bed.	They complain about low risk excess demand.	They understand that they have the right to use the service that is most convenient for them. Complain about the referral to the FHS Possible pilgrimage for services.
POSITIVE ASPECTS	The link with the population and the proximity of a ECU in the territory.	The clinical follow-up that produces quality.	Physician training and material and technological resources Interaction with the local FHS.	Physician training and material and technological resources	Respect and affection in the care provided by the FHS.
NEGATIVE ASPECTS	O desfinanciamento e o contexto adverso da atenção à saúde. O atendimento centrado na queixa. Acomodação de demandas espontânea e programada. Atender usuários de outros territórios da FHS, encaminhados pela ECU.	Excessive spontaneous demand, which interferes with the quality of service to scheduled demand. The gateway under the responsibility of the ACS, which creates insecurity for themselves.	Underfunding and the adverse context of health care. Complaint-centered care. Insufficient qualification of FHS physicians to attend to emergencies. Difficulty in serving users from other territories. The closure of the FHS during the shootings, which burdens the ECU.	Excessive demand interferes with the quality of care and creates risks for the professional.	Speed during service at the ECU. Long wait for ECU service. Risk classification in the ECU. Difficulty in being registered with FHS.

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[1] Conflict of interests: non-existent