O cuidado paliativo na atenção primária sob a ótica da análise institucional e saúde coletiva

Abstract

ntroduction: Palliative care (PC) is an approach provided in the health care network, with primary care as the organizer and coordinator. Objective: To understand the care gaps in relation to PC in primary care in a reference health municipality in western Paraná, southern Brazil. Methods: Research carried out from February 2024 to December 2024 at the first level of health care, conducted in three phases: 1) scoping review of the theoretical framework; 2) investigation of the care protocols that guide PC care; 3) critical-collaborative action research with care professionals, health managers and home hospitalization service, to identify the gaps and develop an action considered a priority. The data were transcribed and systematized manually and analyzed based on Institutional Analysis and Public Health. Results: The scoping review resulted in 46 publications, from 2000 to 2023 that addressed institutional analysis as a theoretical framework in the field of collective health and/or public health. The objectives addressed the intersection between health, continuing education, and institutional analysis. From the documentary research, 147 operational standards were identified, of which 11 have elements corresponding to PC, but in an indirect and specific way. In the focus groups, the 3 thematic categories were: Perception of PC in primary care as a point in the health care network; Problems in the work process that hinder PC in primary care; Opportunities for improvement in PC in primary care. The gaps were related to the perception of primary care as a weak point in the network regarding the topic. The most requested action was training on the topic, which took place on a virtual platform, from September to November 2024, with the collaboration of volunteers. The professionals were re-approached and the perception of the action was positive, although with weaknesses. Conclusions: The theoretical framework can assist in the socio-analytical sphere of promoting autonomy. The perception of this care in primary care is supported by insufficiency. Training was perceived as a positive initial action. As contributions, in addition to the instruction of the participants in the action, the study allowed reflections on the possibilities of optimizing PC.