A importância da Atenção Primária à Saúde (APS) na Atenção às Urgências e Emergências e a integração com a Unidade de Pronto Atendimento (UPA)

Abstract

The importance of Primary Health Care (PHC) and Emergency Care for the strengthening and structuring of the Brazilian health system has been a strong motivation for this research. Furthermore, it continues to be a significant challenge for PHC, characterized as the care organizer and coordinator of Health Care Networks (RAS), to organize and integrate different levels of care. The objective of this study was to evaluate the performance of PHC in the Emergency Care Network, especially in the Emergency Care Unit (UPA), in addressing low-risk emergencies in a mediumsized pole municipality in the state of Rio de Janeiro, which has 100% coverage of the Family Health Strategy (ESF). It identifies and characterizes spontaneous demand visits to the UPA in 2023 and identifies the main reasons why the population enrolled in the ESF seeks the UPA. This is a descriptive and exploratory research with primary and secondary qualitative and quantitative data collection, referencing current public policies. It encompassed various methodological strategies to gather information and obtain a comprehensive view of the health system in question. On-site observation of the UPA and interviews with users and managers were crucial to understanding the health system's dynamics, identifying potential problems, and obtaining feedback on current local-regional policies and practices. Approximately 90% of users treated at the UPA from 2018 to 2022 were classified as blue risk, indicating users in need of lowcomplexity consultations. The main reasons users sought the UPA directly were the limitations of Family Health Units (USF) in attending only pre-scheduled users (50%), followed by user convenience (25%), while lack of awareness was at 15%. Only 33 out of 283 interviewees turned to the USF before going to the UPA, citing the absence of a doctor (24%) and a lack of scheduling availability at the USF (18%). Musculoskeletal and connective tissue diseases (24.02%), respiratory system diseases (15.1%), infectious and parasitic diseases (11.6%), digestive system diseases (9.5%), among others, were the main diagnoses for users seeking the UPA. The main complaints of interviewed users were grouped, and some health issues with higher incidence reported by users indicate that most of them could be addressed in the USF: flu-like symptoms (24%), musculoskeletal diseases (22%), gastrointestinal infections (18%), and headaches were the most frequent. This study indicates that there is still a real challenge in the day-to-day health services regarding emergency care, and various factors weaken the capacity of primary care to play the role of the main entry point to the Unified Health System (SUS). The results of the organizational diagnosis, consolidated in the SWOT Matrix, indicate that positive factors outweigh the negatives, and based on change-prone areas, it is essential to develop a feasible and achievable action plan to address the challenges.