Specialized outpatient care in the Unified Health System: how to fill a void/Atencao especializada ambulatorial no Sistema Unico de Saude: para superar um vazio

The structuring of specialized outpatient care is a bottleneck in the operation of the Unified Health System. Based on a brief discussion about this void in an organizational model, we propose the federal induction of a format of specialized services from the experiences of Centers of Support for Family Health (NASF). They adapted matrix operations and constitute an excellent prototype for the organization of specialized outpatient care. It allows for equal access and maximum proximity to the specialized care of the reality of primary care users, the personal relationship and the close relationship between the family health teams and medical and non-medical specialists, enabling mutual lifelong learning, negotiated regulation and increased efficacy of primary care. Municipal experiences of Florianopolis and Curitiba are synthesized as partial examples of the proposal. the structure of care in mental health of Florianopolis, all organized as a matrix support is briefly described; and we focus on the change in the action of the support teams of Curitiba, which gradually began to engage, involve and mediate the relationship between basic and specialized care. This format can be expanded to most medical specialties. Key words Unified Heath System (SUS), Secondary care, Health policies, Health services planning A estruturacao da atencao especializada ambulatorial e um gargalo na construcao do Sistema Unico de Saude. A partir de breve discussao desse vazio de um modelo organizativo, propomos a inducao federal de um formato de servicos especializados a partir das experiencias dos Nucleos de Apoio a Saude da Familia (NASF), cuja atuacao matricial adaptada e um prototipo otimo de organizacao do cuidado especializado ambulatorial. Ela permite a equidade no acesso e a maxima proximidade do cuidado especializado da realidade dos usuarios, o relacionamento personalizado e a articulacao intima entre as equipes de saude da familia e os especialistas, viabilizando educacao permanente mutua, regulacao negociada e aumento da resolubilidade da atencao basica. Aspectos das experiencias municipais de Florianopolis e Curitiba sao sintetizadas como exemplos parciais da proposta. E brevemente descrita a estruturacao do cuidado em saude mental de Florianopolis, toda organizada como apoio matricial; e a mudanca de enfoque das equipes de apoio de Curitiba, que progressivamente passaram a sem empenhar, envolver e mediar a relacao entre a atencao basica e a especializada. Este formato