Characteristics of primary health care and emergency services may hamper their integration and, therefore, reduce the quality of care and the effectiveness of health systems. This study aims to identify and analyze policy, structural and organizational aspects of healthcare services that may affect the integration of primary health and emergency care networks.

Through our data sources, we suggest a grounded theory for the integration of primary care with emergency services in Brazil based on the identification of policy, structural and organizational aspects. The researchers observed in our study the challenges of integration with limitations for total consolidation.

In the policy aspect, the main difficulty identified is in the different institutions that organize these two levels of attention. In the structural aspect, the incompatibility of planning mechanisms and in the organizational aspect the uncommon points of interfaces in the health system.

Emergency care network

On the other hand, the identification of facilitators for this integration per the perception of several data sources highlights the importance of the study for regional policy and to integrate care.

The organization of primary health care by the Municipal Health Department and the emergency care network by the Regional Health Department demonstrates difficulties for the same institution to maintain this planning.

Other studies in these regions have confirmed the regional institution as the main service organizer in this area. The results have shown that planning for primary health care and the emergency care network is incipient and fragile in relation to the health needs of the population.

There is also evidence of minimal monitoring and evaluation of health indicators. One successful experiment that built this model, centered on patients and health care needs, was a network of researchers, clinicians, and managers. The union of academic and clinical activities helped in planning the integration of primary health care and emergency care networks.

The integration of interfaces in primary health care with the emergency care network is limited to referral and counter-referral mechanisms, and in most cases, is dependent on the health professional, rather than being a standardized activity in the system.

While making therapeutic itineraries with stroke patients in the same regions, Bousquat et al. reported similar results with no communication between services and professionals at different levels of assistance. They confirmed through interviews with patients in this clinical state that there are no mechanisms of continuity of care and care flow or vertical integration.

The recognition of different interfaces highlights the problems of access to health care and the non-continuity of care. An example of this is when patients receive care at walk-in clinics and are not referred for follow-up at the primary care center.

In case studies by Almeida et al. in municipalities in Brazil and Spain, the counter-referral grounds were also demonstrated and justified per the patient’s preference in relation to specialized care, isolation between professionals of the two levels of care, underqualification of the primary care physician and the difficulties experienced by professionals in recording clinical data.