Avaliação da implantação da política de atenção integral a usuários de álcool e outras drogas : um estudo de caso

Abstract

The use of drugs of abuse and its social impact have become a great social concern. In 2004, the Brazilian Ministry of Health released a document entitled A Política do Ministério da Saúde para a Atenção Integral a Usuários de Álcool e Outras Drogas ("Ministry of Health Policy for Integral Care to the Alcohol and Other Drugs Users"), aiming at organizing and enhancing an assistance network, based upon extra-hospital devices, connected to the health care network, especially to the mental health network. The present work evaluated the establishment of the guidelines proposed in the document in the Primary Health Care. It is an evaluative research, carried out by means of a single case study, performed in Maringa, state of Parana, Brazil. A northern Basic Health Care Center was chosen on purpose, for it is located in an area with the highest numbers of hospitalization and violence related to drugs of abuse in the city. Besides, it is an area considered to be of a low social development. The research subjects were three city managers and 16 professionals from the Family Health Care Program, including professionals working at the Family Health Support Nucleus, people considered potential users of the document. As methodological resources, we used documental analyses, observation, two kinds of self-applicable questionnaires, interview and a field journal. The study analysis dimensions were set by means of a theoretical model guiding the evaluation, divided into external context - political, institutional and organizational - and internal context - care completeness and organization. The standard guidelines chosen to steer the evaluation process were intersectorial characteristics, disease prevention and health promotion and protection. From these standards an evaluation logical model was made graphically; it was based upon the construction of "theoretically predicted events" as criteria for comparing the events realized. For judging the establishment level, it was decided that the proportion of responses which presented consistence in relation to the document proposals would correspond to a higher or lower level of establishment. The level of establishment of the guidelines as a whole and the level of establishment of each guideline were obtained by the sum of the frequency percentage, followed by the calculation of the arithmetic mean. They were presented in tables in the form of simple distribution frequency. The research project was approved by the Committee of Ethics and Human Research of Maringa State University (opinion number 102/2011). The research resulted in four levels of information: (1) reflexive and critical study on public policies for fighting the use of drugs of abuse in Brazil, carried out by means of the documental and bibliographical analysis; (2) information on Maringa City Health Network, mainly concerning the assistance to users of alcohol and other drugs, with data relative to the period from 2000 to 2011, discussing the role of the external context in the establishment of the policy for integral care for the alcohol and other drugs users in Maringa; (3) evaluation of the level of the intersectorial, disease prevention and health promotion and protection guidelines, by means of the approach to the potential users of the document, mainly considering the Basic Health Care Center organizational and structural context and the teams' working processes; and (4) perception of the health professionals about the assistance of alcohol and other drugs users at the Primary Health Care, reported in the interview and the observation carried out in 2011. We concluded that, as a whole, the level of establishment of the guidelines evaluated was unsatisfying, with an agreement percentage of 66.9% and a variation of 65.6% for the guideline disease prevention and of 68.3% for the guideline health protection. For municipal managers and for the health professionals of the Family Health Support Nucleus, the level of establishment was acceptable, comprehending percentages of 91.6% and 80.5% respectively. Even knowing only partially the theoretical content of the document, the health professionals from Family Health Support Nucleus and from the Family Health Care Program, develop many actions suggested in the guidelines analyzed. The results show the necessity of expanded studies, allowing the substitution of the mental health network devices, considering the fact that the integral care is constituted of a set of intersectoral devices.