Restructuring of primary health care in Portugal and participation of health centers in the network of care

INTRODUCTION: We describe the restructuring that is taking place in primary health care (PHC) in Portugal and discuss how the new emerging organization and work practices reflect in care transitions and intra- and inter-organizational integration. THEORY AND METHODS: PHC represents an essential support for the restructuring that is taking place in health care in Portugal. We conducted a case study on a health centre located in the Centre Region of Portugal. We identified and analyzed internal units and care transitions and conducted interviews. RESULTS: Health centres are reorganizing toward a new model characterized by an organizational structure based on functional units: Family Health Unit (FHU), Community Care Unit (CCU), and Personalized Healthcare Unit (PHU), which will be in place in all of them plus transversal units, common to a group of these arrangements. The overarch management body is the ACES (Agrupamento de Centros de Saúde), that reports to a Health Regional Administration (HRA). In Portugal, there are five HRA. An ACES may coordinate a number of FHU, CCU and PHU but has only one Public Health Unit and one Shared Resources Care Unit. Units are based on multidisciplinary teamwork, having: specific missions, although inter-cooperative and complementary, organized in a network; administrative autonomy; proper instruments of organizational management; well-defined leadership and clinical governance systems and mechanisms of representation and participation of the community and citizens. CONCLUSIONS AND DISCUSSION: It is too soon to assess the implications that the reorganization of PHC might have in the integration of care in Portugal.