title: Evaluation of innovative strategies in the organization of Primary Health Care.
abstract: OBJECTIVE
  To compare the performance of Primary Care Units according to the implementation of new arrangements and strategies in primary care and mental health.
  
  
  METHODS
  Evaluative research with triangulation of methods and theoretical framework of critical hermeneutics, carried out at six Primary Care Units of the two most populous health districts of the city of Campinas (Southeastern Brazil) in 2007. The Primary Care Units were analyzed according to clinical resolution, articulation between the primary care and mental health networks and implementation of health promotion strategies. Two groups were defined by cluster analysis: one with higher and another one with lower degree of implementation of the actions. The groups were compared based on the improvement in clinical follow-up, given by the occurrence of cerebral vascular accident; evaluation of dispensation of psychiatric medicines; focal groups with workers, users and community health agents; and interviews with users and relatives. Inclusive and participatory research strategies were employed.
  
  
  RESULTS
  There were no pure models, but a mosaic of organizational proposals. Positive advances were identified in the group with higher implementation of innovative strategies in relation to better integration of the community agents in the Units' teams; to the workers' and agents' perception of improvement in the assistance; and to the facility for referrals and assistance of mental health cases. The difficulties identified in both groups were: communication among the levels of care and within the teams, in the implementation of matrix support, and incipient health promotion actions.
  
  
  CONCLUSIONS
  The development and implementation of mechanisms to fix professionals in Primary Care in large cities are necessary. The community health agents are fundamental to perform the territorial work proposed by the Family Health Strategy, using mechanisms to integrate the community health agents into the healthcare teams in order to counterbalance the tendency to isolation. The researched arrangements proved to be potent to produce this integration.
authors.affiliation: Universidade Estadual de Campinas, Campinas, SP, Brasil. rosanaoc@mpc.com.br
authors.forename: Rosana Teresa
authors.initials: RT
authors.lastname: Onocko-Campos
authors.forename: Gastão Wagner de Sousa
authors.initials: GW
authors.lastname: Campos
authors.forename: Ana Luiza
authors.initials: AL
authors.lastname: Ferrer
authors.forename: Carlos Roberto Silveira
authors.initials: CR
authors.lastname: Corrêa
authors.forename: Paulo Roberto de
authors.initials: PR
authors.lastname: Madureira
authors.forename: Carlos Alberto Pegolo da
authors.initials: CA
authors.lastname: Gama
authors.forename: Deivisson Vianna
authors.initials: DV
authors.lastname: Dantas
authors.forename: Roberta
authors.initials: R
authors.lastname: Nascimento
mesh_terms: D001938:Brazil; D003150:Community Health Workers / Q000458:organization & administration / Q000592:standards*; D003695:Delivery of Health Care / Q000458:organization & administration; D017144:Focus Groups; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration*; D017146:Models, Organizational; D009936:Organizational Innovation; D010348:Patient Care Team / Q000592:standards*; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D036301:Qualitative Research