Vânia Sampaio Alves

Um modelo de educação em saúde para o Programa Saúde da Família: pela integralidade da atenção e reorientação do modelo assistencial

This paper aims at critically examining health education practices in the Family Health Program (PSF – Programa de Saude da Familia, Brazil) by building on the assumption that health policies are brought up to date in services by social actors and their everyday actions. The extent to which the principle of integrality is embodied in such practices is investigated, thus contributing to the debate on the grounds and limits of PSF’s strategies towards reorienting its model of assistance by focusing on basic care. In the context of current Brazilian health policy, PSF has played a decisive role in building and consolidating the Brazilian Unified Health System (Sistema Unico de Saude - SUS). Health education practices and their underlying sanitary principles are historically reviewed in order to determine the rationale for such practices. The prevailing health education model, shown to be essentially at odds with the principle of integrality, is then characterized and analyzed against an emerging health education model – herein called “dialogic model” – the logic of which would be in accordance with the integrality of care.

Modelos de atenção à saúde de usuários de álcool e outras drogas: discursos políticos, saberes e práticas

This article aims to characterize health care models for users of alcohol and other drugs in the Brazilian context. Discourse analysis was performed on public drug policy in Brazil from the 1970s. This analysis was contextualized by a brief digression on the main political positions identified in several countries of the world in relation to drug use problems. Beginning in the current decade, drug policies in Brazil have been receptive to harm reduction approaches, resulting in reorientation of the health care model. In conclusion, the structuring and strengthening of a network of care for users of alcohol and other drugs and their families, based on community care and the harm reduction approach and combined with other social and health services, is now a key public health challenge for the country.

A health education model for the Family Health Program: towards comprehensive health care and model reorientation

This paper aims at critically examining health education practices in the Family Health Program (PSF – Programa de Saude da Familia, Brazil) by building on the assumption that health policies are brought up to date in services by social actors and their everyday actions. The extent to which the principle of integrality is embodied in such practices is investigated, thus contributing to the debate on the grounds and limits of PSF’s strategies towards reorienting its model of assistance by focusing on basic care. In the context of current Brazilian health policy, PSF has played a decisive role in building and consolidating the Brazilian Unified Health System (Sistema Unico de Saude - SUS). Health education practices and their underlying sanitary principles are historically reviewed in order to determine the rationale for such practices. The prevailing health education model, shown to be essentially at odds with the principle of integrality, is then characterized and analyzed against an emerging health education model – herein called “dialogic model” – the logic of which would be in accordance with the integrality of care.

Educação em saúde na atenção médica ao paciente com hipertensão arterial no Programa Saúde da Família

Entre os muitos contextos de desenvolvimento da acao educativa em saude, o presente trabalho privilegiou a consulta medica. Com o objetivo de identificar e caracterizar essas acoes na atencao medica, analisaram-se as transcricoes de cinquenta consultas com pacientes hipertensos, realizadas por dez medicos de Saude da Familia em tres municipios baianos. Os resultados demonstram que a conducao da consulta enfatiza a medicalizacao e o controle da hipertensao. A narrativa do paciente e inibida ou interrompida pela narrativa do medico, com a atencao medica circunscrevendo-se aos sintomas individuais, sem apreensao das dimensoes psicossociais e culturais do processo saude-doenca-cuidado. A acao educativa, na maior parte dessas consultas, apresenta-se secundaria e superficial, com recomendacoes prescritivas. Uma abordagem diferenciada foi identificada entre um dos medicos, apontando para a possibilidade de uma atencao medica dialogica e integradora de aspectos biomedicos e socioculturais ao cuidado.

A relação médico-paciente no Programa Saúde da Família: um estudo em três municípios do Estado da Bahia, Brasil

This study discusses the physician-patient relationship under the Family Health Program (FHP) in Bahia State, Brazil. Assuming that the physician-patient relationship is influenced by macro and micro-contextual factors, we linked health surveillance and the ecological model of human development, both influenced by contextualism. The methodological strategies included: a census of FHP physicians in Bahia and direct observation of consultations by 20 physicians in three municipalities (counties). There were significant differences in the implementation of the FHP in the three municipalities, with an impact on the physician-patient relationship. As for orientation of clinical practice, health surveillance has not been incorporated by the physicians observed in this study. According to the micro-contextual analysis, health problems were frequently not treated in a contextualized way. FHP guidelines, when incorporated by the municipalities, produce differences in care as observed in the physician-patient relationship. The health surveillance approach, reported as a tool for collective work, proves efficient for describing, evaluating, and improving the FHP, and this study concludes that it is a powerful conceptual tool for dealing with the physician-patient relationship.

Direitos das pessoas com transtorno mental autoras de delitos

O Movimento pela Reforma Psiquiatrica tem subsidiado propostas de reorientacao do modelo assistencial hegemonico em saude mental. Para a assistencia as pessoas com transtorno mental autoras de delitos instituiu-se o manicomio judiciario, atualmente denominado Hospital de Custodia e Tratamento Psiquiatrico (HCTP). A manutencao dessa estrutura, reconhecida como instituicao total, tem reforcado a exclusao individual, limitando a reinsercao social dos internos. Este artigo discute o direito a saude nos HCTP na perspectiva dos direitos humanos. Os avancos conferidos pela Politica Nacional de Saude Mental nao tem contemplado a reorientacao da pratica assistencial desenvolvida no âmbito do HCTP. Essa instituicao tem preservado o seu carater asilar/segregacionista, evidenciando uma tradicao fundada na negacao dos direitos humanos. O avanco normativo nao consolida, de per si, a materializacao das recentes conquistas advindas a partir da Reforma Psiquiatrica, particularmente quanto ao segmento das pessoas com transtorno mental autoras de delitos. O Estado, em co-responsabilidade com a sociedade, deve promover a efetiva reorientacao do modelo de atencao a saude dessas pessoas, cuja responsabilidade penal devera ser reconhecida ao tempo em que se propicie o tratamento especializado. O respeito aos direitos humanos nao implica a inimputabilidade.

Health education in connection with medical attention to hypertensive patients in the family health program

Entre os muitos contextos de desenvolvimento da acao educativa em saude, o presente trabalho privilegiou a consulta medica. Com o objetivo de identificar e caracterizar essas acoes na atencao medica, analisaram-se as transcricoes de cinquenta consultas com pacientes hipertensos, realizadas por dez medicos de Saude da Familia em tres municipios baianos. Os resultados demonstram que a conducao da consulta enfatiza a medicalizacao e o controle da hipertensao. A narrativa do paciente e inibida ou interrompida pela narrativa do medico, com a atencao medica circunscrevendo-se aos sintomas individuais, sem apreensao das dimensoes psicossociais e culturais do processo saude-doenca-cuidado. A acao educativa, na maior parte dessas consultas, apresenta-se secundaria e superficial, com recomendacoes prescritivas. Uma abordagem diferenciada foi identificada entre um dos medicos, apontando para a possibilidade de uma atencao medica dialogica e integradora de aspectos biomedicos e socioculturais ao cuidado.

Un modelo de educación en salud para el Programa Salud de la Familia: por la integralidad de la atención y reorientación del modelo asistencial

This paper aims at critically examining health education practices in the Family Health Program (PSF – Programa de Saude da Familia, Brazil) by building on the assumption that health policies are brought up to date in services by social actors and their everyday actions. The extent to which the principle of integrality is embodied in such practices is investigated, thus contributing to the debate on the grounds and limits of PSF’s strategies towards reorienting its model of assistance by focusing on basic care. In the context of current Brazilian health policy, PSF has played a decisive role in building and consolidating the Brazilian Unified Health System (Sistema Unico de Saude - SUS). Health education practices and their underlying sanitary principles are historically reviewed in order to determine the rationale for such practices. The prevailing health education model, shown to be essentially at odds with the principle of integrality, is then characterized and analyzed against an emerging health education model – herein called “dialogic model” – the logic of which would be in accordance with the integrality of care.

Educación en salud en la atención médica al paciente con hipertensión arterial en el programa de salud de la familia

Entre os muitos contextos de desenvolvimento da acao educativa em saude, o presente trabalho privilegiou a consulta medica. Com o objetivo de identificar e caracterizar essas acoes na atencao medica, analisaram-se as transcricoes de cinquenta consultas com pacientes hipertensos, realizadas por dez medicos de Saude da Familia em tres municipios baianos. Os resultados demonstram que a conducao da consulta enfatiza a medicalizacao e o controle da hipertensao. A narrativa do paciente e inibida ou interrompida pela narrativa do medico, com a atencao medica circunscrevendo-se aos sintomas individuais, sem apreensao das dimensoes psicossociais e culturais do processo saude-doenca-cuidado. A acao educativa, na maior parte dessas consultas, apresenta-se secundaria e superficial, com recomendacoes prescritivas. Uma abordagem diferenciada foi identificada entre um dos medicos, apontando para a possibilidade de uma atencao medica dialogica e integradora de aspectos biomedicos e socioculturais ao cuidado.