Redes de atenção à saúde: dispositivo de governamento do paciente e cuidador na atenção domiciliar

Abstract

The objective of this work was to problematize the Health Care Network as governing device and the ways of subjectivation of health professionals in conducting of conduct established for patients and caregivers in home care as a atention point. This documentary analysis study was developed through the analysis of brazilian official documents that directly or indirectly guided the behavior of patients and caregivers within the network. To compose the empirical material, from March to October 2022, 17 documents captured from the primary document Portaria no. 825 of April 25, 2016, which redefines Home Care, and were selected manually and with interest. During the data collection phase, a preliminary analysis was conducted simultaneously, providing guidance during the analysis. The analysis began in late october 2022 and continued until january 2023, involving a thorough reading of excerpts from which three major themes of analysis units were identified: Unified Health System; Health Care Networks and Home Care and Urgency and Emergency as Central in the Network. To problematize the findings organized within the analysis units, the theoretical framework of Michel Foucault and the notions of power, discourse, games of truth, biopolitcs, devices, and governance were used. As the main results, it is pointed out that the Unified Health System serves as the basis for the functioning and formation of the Health Care Network device, based on the strategies, tactics, knowledge, and discourses that come together for its organization and are the conditions of possibility for its emergence. The network, as a governing device, organizes itself with its mechanisms and establishes the flows to be followed by patients and caregivers, leading to changes in their ways of life and guiding their conduct. Home care and emergency services are central to the network's formation, both due to the issues of overcrowding, obstruction, and high costs, and because they allow the inclusion of populations that, in the face of discourses, do not need urgent care. Thus, the device and its mechanisms are capable of adapting to the emerging needs of each time. The emergence of the Health Care Network responds to this need through biopolitical strategies that are capable to govern the population through the discourse of health.