Impact of Co-Management on the Quality of Healthcare Services: A Case Study Based on the Perception of Professionals in a Municipality in Paraná-Brazil
- 1 Department of Graduate Studies in Collective Health, Federal University of Paraná, Paraná, Brazil
- 2 Department of Graduate Studies in Collective Health, Federal University of Paraná, Paraná, Brazil
- 3 Department of Graduate Studies in Collective Health, Federal University of Paraná, Paraná, Brazil
- 4 Department of Graduate Studies in Collective Health, Federal University of Paraná, Paraná, Brazil
Abstract
This study analyzes governance in Brazil’s Unified Health System (SUS), focusing on care coordination between primary and specialized care based on the perceptions of professionals in a municipality in Paraná. Out of 69 professionals invited, 27 voluntarily participated in the study, including PHC physicians, cardiologists, managers, and regulators. Using a mixed-methods approach with online and printed questionnaires, the study identified critical gaps in access to cardiology, such as a shortage of specialists, diagnostic limitations in PHC, and infrequent interdisciplinary case discussions. Most referrals were due to clinical complexity or unavailable diagnostic tests at the primary care level. Although the number of PHC physicians meets national standards, challenges remain in the integration with specialized care. The findings suggest that improving care coordination requires investment in infrastructure, expansion of specialized staff, clear clinical protocols, and workforce retention strategies. Strengthening democratic governance in SUS depends on intersectoral articulation and participatory, effective decision-making.
- Almeida, P. F., De Medina, M. G., Fausto, M. C. R., Giovanella, L., Bousquat, A., & Mendonça, M. H. M. (2018). Coordination of Care and Primary Health Care in the Unified Health System. Saúde em Debate , 42 , 244-260. https://www.scielo.br/j/sdeb/a/N6BW6RTHVf8dYyPYYJqdGkk/
- Bardin, L. (2016). Content Analysis. Edições 70.
- Brazil (1986). VIII National Health Conference: Guidelines and Proposals. Brazil Ministry of Health.
- Brazil (1988). Constitution of the Federative Republic of Brazil of 1988. Federal Senate. https://www.planalto.gov.br/ccivil_03/Constituicao/Constituicao.htm
- Brazil (2017). Criteria and Assistance Parameters for Planning and Programming of Actions and Health Services within the Scope of the Unified Health System. Brazil Ministry of Health.
- Brazil (2023). Program for Improving Access and Quality in Primary Care (PMAQ-AB). Brazil Ministry of Health.
- CRM-PR (2024). Homepage. https://www.crmpr.org.br
- Gurgel Junior, G. D., Pacheco, H. F., Villani, R. A. G., & Melquiades, J. M. (2021). Governance, Governability, and Responsiveness in the New Management of the SUS. In New Management Models in SUS and Inter-Institutional Control Relations in Focus (pp. 17-49). https://editora.ufpe.br/books/catalog/view/38/676/2074
- IBGE (2022). Homepage. Brazilian Institute of Geography and Statistics. https://www.ibge.gov.br
- Lacerda, R. S. T., & Almeida, P. F. (2023). Challenges of Care Coordination in Primary Health Care . SciELO in Perspective: Interface—Communication, Health, and Education. https://humanas.blog.scielo.org/blog/2023/09/21/desafios-da-coordenacao-do-cuidado-na-atencao-primaria-a-saude/
- OECD (2017). Tackling Wasteful Spending on Health. OECD Publishing.
- Oliveira, V. F. (2010). The Impacts of Human Resources Practices in a Health Organization: A Case Study on Job Satisfaction Levels. Postgraduate Thesis, Federal University of Minas Gerais.