Abstract

SANTOS, Adriano Maia dos; GIOVANELLA, Ligia; BOTELHO, Henrique  and  SOUSA, Jaime Correia de. Organizational challenges in strengthening Primary Health Care in Portugal. Rev. Bras. Educ. Med. [online]. 2015, vol.39, n.3, pp.359-369. ISSN 1981-5271.  https://doi.org/10.1590/1981-52712015v39n3e01542014.

This article examines key aspects of Portugal’s primary health care (PHC) reform, which culminated in the introduction of family health clinics (Unidades de Saúde Familiar, USF), expanded access and improved care coordination processes. It aims to identify advances and constraints on PHC reform in Portugal which, despite the differences in social and historical context, may serve to inform health policies in Brazil. A qualitative case study was conducted in Portugal at four USFs in the Lisbon/Vale do Tejo region and two health centre clusters (Agrupamentos de Centros de Saúde, ACES) in the North region. The data collection techniques comprised twenty semi-structured interviews, systematic observation and documentary analysis. The reform was particularly successful at the micro-policy level, that is, in introducing USFs as a process which health professionals could join voluntarily, which afforded a certain stability even in times of crisis. Portugal’s PHC reform is considered an “extraordinary event”, an example of successful intervention in organisational reforms in Europe to promote coordinated care by general practitioners.

Keywords : Primary Health Care; Health Services Accessibility; Systems Integration; Gatekeeping; Family Practice; Family Health Strategy; Continuity of Patient Care; Medical Education.

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