“The program contract was made so that the polyclinic could be implemented, but later, in the second/third year, I think they could have talked to us (polyclinic staff) to understand the peculiarities, the appointment numbers issue... A neurological consultation lasts thirty minutes to have quality. There’s no way I can make a neuro consultation last only fifteen minutes, as expected in the contract...” (polyclinic technical assistance 1, 2021)
“It’s very difficult to get when demand is really low, but with the consortium demand is much higher. I have an average of one electro neurological consultation a month, it’s expensive to hire this service... The major difference with the polyclinic is the centralization of these difficulties to the municipalities” (Belo Campo 2, 2021)
“When availability was lower, the prices were excessive. Today, the private network sends you pricing schedules, contract discounts, special offers... If the request [for a quote] has the department of health’s stamp, there’s a discount. Tests that in my day were considered high complexity are common today. An MRI scan back then was R$1,200, now you can get one for 400. All this due to the services provided by the polyclinic” (Bom Jesus da Serra, 2021).
“So the polyclinic brought more specialist services to the municipality, which helped a lot but has not solved everything. Demand outstrips supply at the polyclinic, for all imaging tests and some appointments” (Planalto 2, 2021) |
| Health transport |
“The minibus has really helped access, really, by appointment, no worries. It’s fantastic. There’s no political interference at all, you know?” (Belo Campo 2)
“The level of organization of the polyclinic has been reflected in other services in the agreed integrated schedule and doesn’t have the same quality. For example, because in the polyclinic the minibus picks the patients up and drops them off at the clinic, the driver organizes the booking, takes them to the clinic and drops them off in their municipality, but that doesn’t happen in the agreed integrated schedule... So it generates an impact. Every test we book the person says: ‘what about the car?’ ‘This isn’t the same as the polyclinic!’” (Belo Campo 1) |
| Regulated access and care coordination by PHC |
“Primary care today has the role of referring patients to specialized care, but there’s a lack of well-established patient flows, referral protocols, flows, communication, a closer relationship with specialized care. The medical specialists continue to complain that they receive what they don’t need on a more routine basis. More urgent cases are the last to be seen. That hampers follow-up and the intervention. So I reckon it’s a national problem, regulation is a very complex issue” (councilor Vitória da Conquista 2, 2021)
“If it’s really urgent, the doctor calls bookings: ‘I’ve got a patient with so an so, I need an MRI scan’ and so the team is already aware, the professional sends it with the report, so it makes it easier. When the doctor says it’s an ‘informal request’, it’s put on a list. Sometimes the patient arrives and says ‘Ah, it’s urgent’, and the doctor writes ‘informal request’, so we know it’s not urgent...” (Barra do Choça 1, 2021)
“The system (SIGES) has a way of really quickly printing the history, evolution, recommendations. So there are professionals who, mainly when they realize that the patient isn’t educated enough to explain what happened, print the report and ask the patient to go back to primary care with it... Then there are others that follow the outpatient logic, requesting a follow-up appointment and discharging the patient” (polyclinic technical assistance 2, 2021) |
| Integration with other points of care and professionals in the regional HCN |
| “When the polyclinic first arrived, I think they failed to show what a polyclinic is. The health secretary knows very well [what it is], the mayor, but I still feel that doctors on the frontline, nurses on the frontline still don’t really know and what we have...” (polyclinic technical assistance 2, 2021) |
| Interprofessional care in SC |
| “It’s because it’s difficult, apart from the stance of professionals... For example, the nurses, nutritionists, psychologists are extremely involved. In the medical team, some are, for example, on health committees, some are well involved, others not so much. We realize from the team that we can call on them for team working, beyond individual treatment” (polyclinic management 2021) |
| Sharing of electronic patient records, clinical protocols, and access to SC |
| “There’s an access manual for all the polyclinics in the state. Just that we know there are professionals who work one way and others who work another way. So, for example, with colonoscopy preparation, we don’t necessarily use what is in the manual. So the professional writes with me, I format it in a way that the regulator will understand, using accessible language. We try to make this preparation as simple as possible so that patients arrive in a condition in which they can do the examination” (polyclinic technical assistance 1) |
| Engagement between SC services and spaces for citizen participation |
| “The population needs to feel the work of the polyclinic... I think the problem is communication. The impression we have is that we don’t cover Conquista due to the lack of closeness to the community. There’s no point in having a facility that doesn’t engage with the people. People need to understand [the polyclinic’s] role” (local health committee member, 2021) |
| The role of matrix support, permanent education, teaching-service integration, and SC research |
“We are going to have nurses’ week now. There’s going to be a course on basic life support, provided by the Consortium. But we don’t have a training plan” (polyclinic technical assistance 1, 2021)
“And patients compliment [the service] a lot, from entry to exit, their commitment to the patients... the responsibility they show to the patients. I haven’t received any complaints from patients so far.” (DoH Bom Jesus da Serra, 2021) |
