Fitoterapia na Atenção Primária à Saúde: interação de saberes e práticas de cuidado

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, Florianópolis, 2013The use of medicinal plants as a therapeutic resource is considered one of the earliest forms of health care used by man and is related to the tradition of the people . Given the importance of medicinal plants in health care and simultaneously the scarce literature that analyzes their inclusion in the scope of services of the Primary Health Care, this study aimed to analyze the development of actions/programs with medicinal plants, described Brazilian literature, Brazilian municipalities in PHC services. We prepared an essay on the theoretical and conceptual diversity of knowledge, care settings and usage of medicinal plants that interact with the PHC services. This theoretical essay presents a conceptual approach anchored in the "ecology of knowledge" proposed by Boaventura de Souza Santos and authors of the anthropology of health on the forms and care sectors. The discussion of the state of the art of medicinal plants in the APS involved a documentary analysis of official publications of the Ministry of Health who reported on actions and phytotherapy services deployed in APS, a bibliometric analysis of the scientific production on the subject in the period 1988-2012 and meta-study on actions/programs with Brazilian medicinal plants described in the literature over the same period. We performed an empirical study with a qualitative approach that aimed to understand the risk factors, hindering and contributions of phytotherapy in APS, in four selected municipalities, from the look of health professionals. Information gathering were conducted semi-structured interviews with key informants. Results: discussion of the ecology of knowledge applied to the subject revealed the importance of dialogue between the knowledge and practices of medicinal plants for the NHS and the APS, beyond the scientific discourse, in order to exploit emerging knowledge present and accumulated in Brazilian society, without disparaging the scientific knowledge, important for the consolidation of herbal medicines in Brazil. The analysis of the approaches to forms and contexts of use of plants in Brazil, culturally diverse, produced a proposal for recognition of five contexts of use of the same: family (standalone), folk, traditional, inserted in biomedical rationality and other medical (use heteronomous, in general). A bibliometric analysis showed an increasing publications in the period 1990-2012, although they are few in national and international environment. From the analysis of 24 Brazilian experiences identified in the meta-study, it was found that the insertion of phytotherapy in APS presents different approaches, motivations, practices and services. However, even many years after the publication of the National Policy on Integrative and Complementary Practices and National Policy on Medicinal Plants, in 2006, there are many factors that hinder the expansion and continuity of work with medicinal plants in APS. Among them are: the absence of clinical trials of Brazilian medicinal plants, difficulties in complying with the regulations for public services deficit in the training of health professionals, lack of adequate technical support to the reality of public sector services, lack of support continuing education . The acceptance , qualification and interest (related) professionals , participation and good popular acceptance (especially in smaller city), the presence of joint intersectoral and adequate infrastructure were mentioned as factors facilitating the insertion of different actions with medicinal plants , as well as consider it as a treatment option to be prescribed and a product to be provided in the PHC services . Observed in PHC services investigated the herbal approach contributes to the professional community and strengthens the bond - staff community, is a mediating tool for health education, promotes joint intersectoral and facilitates the interaction of different knowledge circulating in communities. It was concluded that the herbal medicine is a practice that facilitates the interaction of knowledge, values and cultural resources practices and local knowledge. Contributed to bringing together professionals and users through dialogic approaches and empowering. Enriches the therapeutic possibilities autonomous and heteronomous and health promotion in PHC, and consist of a promising source of therapeutic products homemade, handled or processed

Fitoterapia na atenção primária à saúde

OBJETIVO Caracterizar a inserção da fitoterapia em ações e programas na atenção primária à saúde no Brasil. MÉTODOS Realizou-se levantamento bibliográfico de artigos de periódicos e teses e dissertações nacionais. Foram utilizadas as bases de dados: SciELO, Lilacs, PubMed, Scopus, Web of Science e Portal de Teses Capes no período entre janeiro de 1988 e março de 2013. Foram analisados 53 estudos originais sobre ações, programas e aceitação de uso de fitoterápicos e plantas medicinais na atenção primária à saúde do Sistema Único de Saúde. Foram analisados dados bibliométricos, características das ações e programas, local e sujeitos envolvidos na pesquisa, tipo e objetivo dos estudos selecionados. RESULTADOS Entre 2003 e 2013 houve aumento das publicações em diferentes áreas de conhecimento, comparado ao período de 1990-2002. As ações e programas de fitoterapia inseridos nos serviços de atenção primária à saúde variaram em objetivos e ações: inserir outras opções terapêuticas, reduzir custos, resgatar saberes tradicionais, preservar a biodiversidade, promover o desenvolvimento social, estimular ações intersetoriais, interdisciplinares, de educação em saúde e a participação comunitária. CONCLUSÕES Nos últimos 25 anos houve aumento pequeno da produção científica sobre ações/programas de fitoterapia desenvolvidos na atenção primária à saúde. A inserção da fitoterapia nos serviços de atenção primária estimulou a interação entre usuários e profissionais de saúde. Também contribui para socialização da pesquisa científica e desenvolvimento da visão crítica tanto dos profissionais quanto da população sobre o uso adequado de plantas medicinais e fitoterápicos.OBJECTIVE To characterize the integration of phytotherapy in primary health care in Brazil. METHODS Journal articles and theses and dissertations were searched for in the following databases: SciELO, Lilacs, PubMed, Scopus, Web of Science and Theses Portal Capes, between January 1988 and March 2013. We analyzed 53 original studies on actions, programs, acceptance and use of phytotherapy and medicinal plants in the Brazilian Unified Health System. Bibliometric data, characteristics of the actions/programs, places and subjects involved and type and focus of the selected studies were analyzed. RESULTS Between 2003 and 2013, there was an increase in publications in different areas of knowledge, compared with the 1990-2002 period. The objectives and actions of programs involving the integration of phytotherapy into primary health care varied: including other treatment options, reduce costs, reviving traditional knowledge, preserving biodiversity, promoting social development and stimulating inter-sectorial actions. CONCLUSIONS Over the past 25 years, there was a small increase in scientific production on actions/programs developed in primary care. Including phytotherapy in primary care services encourages interaction between health care users and professionals. It also contributes to the socialization of scientific research and the development of a critical vision about the use of phytotherapy and plant medicine, not only on the part of professionals but also of the population

Contribuições das plantas medicinais para o cuidado e a promoção da saúde na atenção primária

Analisaram-se programas e ações de fitoterapia na atenção primária à saúde brasileira (APS) a partir da literatura. O metaestudo incluiu seis bases de dados, de 1988 a 2012, sendo registradas 24 publicações. A inserção da fitoterapia acontece a partir de motivações diversas: aumentar os recursos terapêuticos, resgatar saberes populares, preservar a biodiversidade, educação ambiental e popular, agroecologia e desenvolvimento social. Há uma ambivalência que ora pende para o reforço da autoatenção, as ações educativas, intersetoriais e a participação comunitária, constituindo-se em forma de cuidado e promoção da saúde; ora restringe o processo à incorporação de fitoterápicos manipulados ou industrializados à farmácia dos serviços de APS, para uso estritamente profissional. Ressalta-se uma visão ampliada da fitoterapia que incorpore esses dois enfoques, numa perspectiva de uma ecologia de saberes e práticas em saúde

Phytotherapy in primary health care

OBJECTIVE To characterize the integration of phytotherapy in primary health care in Brazil. METHODS Journal articles and theses and dissertations were searched for in the following databases: SciELO, Lilacs, PubMed, Scopus, Web of Science and Theses Portal Capes, between January 1988 and March 2013. We analyzed 53 original studies on actions, programs, acceptance and use of phytotherapy and medicinal plants in the Brazilian Unified Health System. Bibliometric data, characteristics of the actions/programs, places and subjects involved and type and focus of the selected studies were analyzed. RESULTS Between 2003 and 2013, there was an increase in publications in different areas of knowledge, compared with the 1990-2002 period. The objectives and actions of programs involving the integration of phytotherapy into primary health care varied: including other treatment options, reduce costs, reviving traditional knowledge, preserving biodiversity, promoting social development and stimulating inter-sectorial actions. CONCLUSIONS Over the past 25 years, there was a small increase in scientific production on actions/programs developed in primary care. Including phytotherapy in primary care services encourages interaction between health care users and professionals. It also contributes to the socialization of scientific research and the development of a critical vision about the use of phytotherapy and plant medicine, not only on the part of professionals but also of the population

A educação a distância na qualificação de profissionais para o Sistema Único De Saúde: metaestudo

Resumo Este estudo objetivou caracterizar concepções teórico-pedagógicas em educação a distância na formação/qualificação de trabalhadores do Sistema Único de Saúde e identificar cursos em educação a distância, amparados neste contexto. A busca sistematizada envolveu estudos qualitativos, utilizando os termos: ‘educação a distância' e ‘saúde'. Selecionaram-se 21 estudos para compor o metaestudo, que consistiu de três etapas: metateoria, metamétodos e metanálise. Na metateoria, identificaram-se quatro categorias: construtivismo; pedagogia de Paulo Freire; educação permanente em saúde; e concepções próprias da educação a distância. Na etapa metamétodos, 11 estudos eram relatos de experiência; dois, estudos de caso; três envolveram análise de conteúdo; um envolvia pesquisa-ação; e outro, análise do discurso. Na metanálise, identificaram-se resultados que marcaram: formação de comunidades de aprendizagem; fortalecimento dos espaços de gestão; e formação de redes para projetos em educação permanente. As discussões enfatizaram: fortalecimento do Sistema Único de Saúde; protagonismo dos sujeitos; e formação de redes de cuidados. Constata-se que os estudos se restringiram mais aos aspectos conceituais e teóricos do que aos metodológicos. Ficaram evidentes conceitos amparados no construtivismo, na educação permanente em saúde e em referencial teórico próprio da educação a distância. Nos estudos, a educação a distância foi considerada indispensável para formação/qualificação de profissionais no Sistema Único de Saúde