Avaliação da hierarquização e regionalização da linha de cuidado prioritário ao infarto agudo do miocárdio da rede de urgência e emergência da região metropolitana de Vitória, Espírito Santo

Abstract

In 2018, the Secretary of State for Health (SESA) in Espirito Santo published the document “Clinical Guidelines: Approach to Patients with Acute Coronary Syndromes”. The document guides the care flows and clinical care components for the Line of Priority Care for Acute Myocardial Infarction of the Urgency and Emergency Network of the Metropolitan Region of Vitória, thus seeking to reverse the fragmented logic of the Unified Health System and promote access with quality to the user with this important morbidity. After this publication, this policy entered the implementation phase, involving services of different natures that are part of the Health Care Network. Acute Myocardial Infarction (AMI) care depends on coordination at a specific time, as well as access to resources that vary in complexity and involve technical interpretation, transport and communication between the entities involved. These actors were defined by the guideline and hierarchized according to their complexity of resources and performance at the network points, as well as regionalized with grids of references based on geographic location and presence of human, structural and technological resources that meet this need. It is necessary, in the cycle of Public Policy, to evaluate the implementation of this articulation since access and quality in the Emergency Network of the IAM in the Metropolitan Region of Vitória comes from this complex exercise of services and day-to-day management. Considering the scarcity of literature on the organization of care networks in Brazil aimed at assisting people with AMI, this work aims to evaluate the organizational principles of Regionalization and Hierarchization of this network in the Metropolitan Region of Vitória. For this, a qualitative Evaluative Research study was carried out through semi-structured interviews with 12 members of the various services involved in this Network and who participated in the discussions for its operational flows (Coordination of the Technical Chamber of SESA, SAMU, UPAs and Reference Hospitals). Qualitative data analysis was carried out using the Thematic Content Analysis of a reflective nature. It is observed that there are weaknesses both in the process of governance, training, monitoring and coordination by management, as well as connectivity and integration by the constituents of the operational structure in the context in which the flows take place on a daily basis. Such weaknesses have impacted the results of this line of care and need to be evaluated in the process of implementing the acute myocardial infarction network.