Estratégias de gestão local para prescrição de medicamentos por enfermeiros da Atenção Primária à Saúde

Abstract

Introduction: Nurses' prescriptive drug practice (NPDP) is an element that contributes to the profession in Primary Health Care (PHC). In Brazil, this attribution is based on laws regulating the profession, establishing as the activity of nurses integral to the health team in public health programs. However, this practice has been becoming a clearer contour in recent years, through phC notebooks and protocols established by the Ministry of Health. It is remarkable the relevance of the role of the local health manager in supporting and ratifying the prescriptive practice of nurses, since it assumes the direction of the local health system and has non-transferable responsibility in the systemic management of health care, through governance and articulation between workers, responsible for the fomentation of health policies. In Brazil, there are few studies that reveal the positioning of local health managers regarding this practice. Objective: to evaluate the understanding of municipal health managers in relation to the advances and challenges in the use of care protocols for the prescription of medicines by nurses of the Family Health Strategy (FHS). Methodology: A case study was proposed from Yin's perspective, conducted in Paraíba, in the Northeast region. The research field was twelve micro-region host municipalities. The collection took place through a semi structured interview, guided by a script prepared by the researcher. The data were organized through the Atlas ti and the Content Analysis and analyzed from the perspective of dialectical Hermeneutics. Results The results revealed five dimensions of analysis: highlighting those on DPN Regulation and request for exams in the ESF: scenarios of local management and the prescriptive practice of nurses in local scenarios. Most of the managers were nurses; their professional experiences served as a resource for managers. Many considered nurses to be fundamental in the Family Health Strategy, but they were overloaded with various functions within the FHS. Several managers reported problems in the FHS such as funding and lack of a comprehensive care model. None of the managers had knowledge about the laws that provided for the PME and request for exams, however, most of them were favorable to such practices, but with different motivations in their justifications, demonstrating some misconceptions about the scope of this practice. With regard to disfavor, there are allegations of problems with other class councils in the prohibition of DPN (Especially in medicine and pharmacy). Conclusion: The presence of a hybrid model was seen in the Family Health Strategy, based on the observations of managers, with the presence of a medical hospitalocentric model and another model more focused on health promotion and prevention actions. As for the role of the nurse, there is the recognition of managers towards this profession in the FHS, as well as the recognition by most of them for the Prescription of Medications, however, there is a lack of knowledge about the legislation that tangents these practices, at the same time that there is a recognition by the Ministry of Health.