Mapeamento das práticas integrativas na rede de atenção à saúde: uma pesquisa-ação

Abstract

According to the World Health Organization (WHO), the global progress of Traditional, Complementary and Integrative Medicine (TCIM) has received a significant boost in the last decade, and its inclusion in public systems is recommended worldwide. In Brazil, known as Integrative and Complementary Health Practices (PICS), these approaches have been found in the Unified Health System (SUS) since the 1980s and have had a national policy since 2006. However, their provision and organization within the SUS Health Care Network (RAS) remains a challenge. This research addresses the following questions: Which PICS are offered in the RAS of the municipality of Taquaritinga? By which professionals? In which health services of the RAS are PICS offered? How and where are these practices recorded, including in information systems? How is the RAS organized for the provision of PICS, and how can the RAS be organized for this provision? Is there a referral flow for PICS services? In light of these questions, this study has the general objective of mapping the Health Care Network regarding the provision of Integrative and Complementary Health Practices in the municipality of Taquaritinga, from the perspective of key agents. This is a qualitative study conducted through action research in the RAS of the municipality of Taquaritinga, in the interior of the state of São Paulo. Participants included: health professionals from services offering Integrative and PICS in the RAS, users of the Brazilian Unified Health System (SUS) who utilize these respective services, and professionals from the SUS management at the municipal level. Data collection strategies included questionnaires and workshops. The data produced were analyzed using the dialectical process recommended by Dick (2008) for data analysis in action research. In mapping the provision of Integrative and Complementary Practices within the Health Care Network, six integrative practices were identified: Circular Dance, Meditation, Reiki, Aromatherapy, Auriculotherapy, and Phytotherapy. These practices are offered in five health services, two in Primary Health Care (APS) — specifically in two Family Health Strategies — and three in Secondary Care, including the Psychosocial Care Center (adult and child) and the Medical Specialties Outpatient Clinic. The results revealed a lack of knowledge among professionals regarding the mechanisms for registering PICS, as well as the use of a third-party system without integration with the Ministry of Health. The non-use of the Electronic Citizen's Record (PEC) compromises the monitoring, evaluation, financing, and production of reliable data on PICS in the municipal SUS. Furthermore, the scarcity of financial and material resources, coupled with the absence of a municipal policy, constitutes an obstacle to the implementation of these practices. As a result of the study, a patient care flowchart was collectively developed, which facilitated the expansion of the provision of Integrative and Complementary Practices in other primary health care services. The mapping, combined with the collective construction of the patient care flowchart as an organizational strategy, promoted information sharing among services, improved user reception, and contributed to the incorporation of the Patient Care System (PEC) in the scheduling and registration of PICS. These results were made possible by the participants' engagement throughout the action research. It is noteworthy that these advances were enabled by the collective commitment of the study participants—healthcare professionals, management staff, and users—to PICS and, above all, to the consolidation of the SUS.