Limites e potencialidades da assistência ao idoso na Atenção Primária à Saúde: o caso de Piraí, Rio de Janeiro, RJ

Abstract

Primary health care is the major acess point into Brazilian National Health System. It must be aligned with the healthcare network in order to guarantee comprehensive care to all individuals. The elderly represent an emerging group which owns the characteristic of having multiple comorbidities and high use of health resources. In this context, the evaluation of health care delivery for the elderly conducted by primary care arises as a subsidy for the implementation of strategies to improve the quality of services provided to this population. This study aims to analyze the limits and possibilities of the services delivered to elders conducted by Primary health care in the city of Pirai, state of Rio de Janeiro. It was carried out based on the analysis of perceptions of manager and family health professionals about the difficulties and the points of success of assistance to the elderly. A mixed methods design was chosen, with an emphasis on qualitative approach. In this study, three sets of data were articulated: perceptions of 108 health professionals distributed in 10 focus groups; semi-structured interview with the health manager; and quantitative data including demographic, epidemiological and administrative indicators that integrate pre-existing databases. The reports were submitted to theme-based content analysis. Quantitative data was used to complement the information gathered, corroborating or confronting them. The results revealed that the current logic of work process in Family Health Strategie does not differentiate the care delivered to the elderly from those delivered to the adult. Deficiency in training of human resources hinder care planning and represents an obstacle to identification of the resources needed for treatment and rehabilitation of frail elders. In addition, difficulties arisen from work with frail elders were aggravated by the scenario of devaluation of old age as well as by the lack of community resources available in this city. Finally, the fragmentation of the health system and the difficulty of access to secondary and tertiary levels of care, identified in this study, can make this group more vulnerable to functional loss due to loss of continuity of care. In contrast, universal primary care coverage and the strong support of community health workers were seen as the strengths of the health system. It is expected that the knowledge generated by this study can turn into subsidies for the implementation of a model of care for the elderly suitable to local conditions.