Matriciamento em dor na atenção primária à saúde: análise de experiência

Abstract

It is estimated that a qualified Primary Health Care (PHC) service would adequately respond to 85% of the clinical demands presented to it. There are, however, several barriers to qualifying PHC professionals in treating people in pain. For nearly two years, a family physician (FP) and rheumatologist with board certification in Pain provided matrix support in Pain as a Family Health Support Team / Extended Family Health Team for Primary Care (NASF) professional to Family Health Team (eSF) professionals of the PHC units of one of the Health Planning Areas (health districts) in the municipality of Rio de Janeiro, including preceptors and residents of one residency program in family and community medicine (PRMFC). This study aimed to analyze this original experience of matrix support in Pain, through the perceptions of participating professionals. The study explored the changing historical context in which the matrix support experience took place; the local PHC structure; the general content and emphasis of the matrix support on Pain; the profile of activities, consultations, patients, and professionals. A qualitative study was carried out from the perception of preceptors and residents with the greatest number of joint consultations, through semi-structured interviews, analyzed in the light of the hermeneutic-dialectical method. The matrix support was considered instrumentally useful by all respondents, and a practice transformer by most. Respondents highlighted the interlacement of suffering and reactivity between patients and professionals in the face of ‘pain that doesn’t improve’; the achievements and limitations of the experience of matrix support in Pain through NASF; and the potentialities and barriers for reproducing similar experiences in other contexts. In particular, the interviewees highlighted that training should be oriented to the reality, training, paradigms, and attributions of PHC; in a predominant model of joint consultations, supported by teleconsulting; and by doctors with expertise in Pain, PHC, and adult education, including, perhaps advantageously, FPs with appropriate qualification