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Chronic disease in childhood and adolescence: continuity of care in the Health Care Network.

OBJECTIVE: To evaluate the continuity of care for children and adolescents with chronic diseases in the health care network.

METHODS: This qualitative study was conducted between February and October 2013 with 12 families, six health managers, and 14 health professionals from different health care services in a municipality of the state of Paraíba, Brazil, using focal groups, semi-structured interviews, and medical record consultation. The data were analyzed by triangulation and thematic analysis.

RESULTS: Two categories were created: "health care management" and "(dis)continuity of care." We found gaps in the system, including poor data recording aimed to facilitate follow-up and guide the planning actions as well as sporadic and discoordinate services with a limited flow of information, which hinders follow-up over time.

CONCLUSION: Continuity of care in the health care network is limited and creates the need to develop strategies to improve these services.

OBJETIVO: Analisar a continuidade do cuidado à criança/adolescente com doença crônica na rede de atenção à saúde.

MÉTODO: Pesquisa qualitativa realizada entre fevereiro e outubro de 2013 com 12 familiares, seis gestores e 14 profissionais de saúde de diferentes serviços da rede de saúde de um município da Paraíba através das técnicas de grupo focal, entrevista semiestruturada e consulta a prontuários. A triangulação dos dados e a análise temática subsidiaram a interpretação dos dados.

RESULTADOS: Foram construídas duas categorias: "Gestão da atenção à saúde" e "(Des)continuidade do cuidado". Constataram-se lacunas como a ausência de cadastro para favorecer o acompanhamento e nortear o planejamento de ações; atendimento pontual e desarticulado entre os serviços com fragilidade no fluxo de informações, que obstaculizam o seguimento ao longo do tempo.

CONCLUSÃO: A continuidade do cuidado na rede de atenção à saúde está fragilizada e há necessidade do desenvolvimento de estratégias que a favoreçam.

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