Teamwork and collaborative practice in Primary Health Care

Full text

1525
BY
CC
2018; 22(Supl. 2):1525-34
Teamwork and collaborative practice
in Primary Health Care*
Marina Peduzzi(a)
Heloise Fernandes Agreli(b)
*The initial version of this article
was presented on August 30, 2017,
in the Round Table Primary Care in Large
Centers, during the celebration of the
40 years of Centro de Saúde Escola
Prof. Samuel B. Pessoa (Preventive Medicine
Department of the School of Medicine
of Universidade de São Paulo).
(a) Departamento de Orientação Profissional,
Escola de Enfermagem, Universidade de
São Paulo. Avenida Dr. Enéas de Carvalho
Aguiar, no 419, Cerqueira Cesar. São Paulo,
SP, Brasil. 05403-000. marinape@usp.br
(b) School of Nursing and Midwifery,
University College Cork. Cork, Ireland.
heloise.agreli@ucc.ie
articles
Collaborative practice and teamwork
can contribute to improve universal
access and the quality of healthcare.
However, the operationalization of
interprofessional work constitutes a current
challenge. This challenge is increased by
conceptual imprecisions in the study of
interprofessional work, in which terms like
collaboration and teamwork are often used
as synonyms. This article aims to present
current concepts of interprofessional work,
problematizing them in the context of
primary care. We conclude that teamwork
and collaborative practice in primary care
need to be addressed in a contingent
manner, according to the characteristics
of service users/catchment population
as well as to the context and working
conditions. We highlight that collaboration
involves professionals willing to work
together to provide better healthcare, and
can occur both as “Team collaboration”
and “Intersectoral and community
collaboration”.
Keywords
: Patient care team. Primary Care.
Intersectoral collaboration.
DOI: 10.1590/1807-57622017.0827

TEAMWORK AND COLLABORATIVE PRACTICE IN PRIMARY CARE
1526 2018; 22(Supl. 2):1525-34
2018; 22(Supl. 2):1525-34
Introduction
The teamwork proposal emerged in the 1960s/1970s, with the movements of Preventive,
Community, and Comprehensive Medicine. It gained renewed attention from the 1990s onwards, in
the context of debates about models of healthcare and health systems organization, in view of the
need to replace health professionals’ uniprofessional education by interprofessional education.
Since the year 2000, teamwork has been associated with collaborative practice, as it is not
sufficient to have integrated and effective teams to improve the access and quality of healthcare. It
is necessary that teams from the same service collaborate with each other, and that professionals and
teams from a service collaborate with professionals and teams from other services and sectors in the
logic of networks.
Primary care has been the locus where proposals for the organization of health services based on
teamwork and collaborative practice have most advanced. Comprehensive primary care is recognized
as the best strategy for organizing health systems, as well as the most efficient way of facing health
problems and fragmentation of actions and of the system itself. In Brazil, studies have shown the
effectiveness of primary care, as it produces positive impacts on the access and quality of healthcare1-4.
It has been argued that interprofessional education and interprofessional practice can contribute
to promote universal access and improve the quality of healthcare5-10. However, the operationalization
of interprofessional practice is a current challenge11, and initiatives in Brazil are still incipient12. The
majority model is that of professionals who “continue to be educated separately to work together
in the future”13 (p. 198), reproducing the strong division of health work and the tribalism of
professions14.
In addition to the difficulty in operationalizing interprofessional education and practice, the study of
the themes is marked by polysemy and conceptual imprecision, which end up hindering their advance8.
Terms like collaboration, coordination and teamwork are frequently used as synonyms.
The present article aims to present the current concepts of interprofessional work, problematizing
them in the context of primary care.
Teamwork, interprofessional collaboration
and interprofessional collaborative practice
Interprofessional teamwork has been defined as work that involves different professionals, not
only from the area of health, who share the sense of belonging to a team and work together in an
integrated and interdependent way to meet health needs15,16. Constituting a team demands hard work.
It is a construction, a dynamic process in which professionals get to know each other and learn to work
together, in order to: Recognize each profession’s work, knowledge and roles; learn about the profile
of the catchment population, that is, users’ and population’s health characteristics, demands and
needs; define, in a shared way, the team’s common objectives, and plan, also in a shared way, actions
and healthcare - for example, the shared construction of individual therapeutic projects for users and
families in complex health situations. Interprofessional teamwork involves elements from the social,
political and economic context17.
In the international scenario, Reeves et al.18 criticized the scarcity of studies and theoretical models
incorporating the sociological perspective in the understanding of the complexity of interprofessional
health work. The authors proposed a model for the understanding of interprofessional work in its
relational, contextual and work organization dimensions. In the model, the authors explain the
difference between modalities of interprofessional work: “Teamwork”, characterized by intense
sharing of values, objectives and team identity, and intense interdependence and integration of
actions, tends to respond to unpredictable, urgent and complex care situations; “Interprofessional
Collaboration” is a more flexible form of interprofessional work, with lower levels of sharing and
interdependence of actions; and “Net work”, in which there is even more flexibility and less
interdependence of actions, but networked integration is maintained. The authors argue that teams
alternate between the different forms of work described above (teamwork, collaboration, net work)

Peduzzi M, Agreli HF
articles
1527
2018; 22(Supl. 2):1525-34
2018; 22(Supl. 2):1525-34
according to local needs, in a contingent approach to interprofessional work. This approach to
interprofessional work recognizes that teams do not vary in a linear model that ranges from “weak to
strong”, “real or pseudo teams”. Rather, teams become more effective as they succeed in adapting
different forms of interprofessional work - teamwork, collaboration and net work - in a contingent
manner, according to the needs of users, families and the community.
The contingent approach proposes that it is necessary to expand the traditional notion of
interprofessional work, which, usually, is based only on teamwork, and add others forms of
interprofessionality, such as collaboration and interprofessional collaborative practice18.
Morgan et al.19 consider “Interprofessional Collaboration” an umbrella term that houses other two
terms (Figure 1): “Interprofessional collaborative practice”, used to describe collaboration elements
implemented in the practice of health services, and “Interprofessional teamwork”, a deeper level of
interprofessional work with intense interdependence of actions.
The different terms presented above are related to each other but are not synonyms and cannot be
interchanged, as they refer to different modalities of interprofessional work that, we propose, should
be apprehended under the contingent perspective, that is, depending on the health needs of users,
families and the community, on their context, and on professionals and services. In this approach,
interprofessional work is presented as: Teamwork, interprofessional collaboration, interprofessional
collaborative practice, and net work.
Figure 1. Relationship between interprofessional collaboration, collaborative practice and teamwork
Source: Agreli, HLF.
Prática interprofissional colaborativa e clima do trabalho em equipe na Atenção
Primária à Saúde
20. Adapted and translated from Morgan, Pullon and McKinlay19 and Reeves et al.18
INTERPROFESSIONAL
COLLABORATION
Interprofessional
collaborative practice
TEAMWORK

TEAMWORK AND COLLABORATIVE PRACTICE IN PRIMARY CARE
1528 2018; 22(Supl. 2):1525-34
2018; 22(Supl. 2):1525-34
D’Amour et al.21 use the term collaboration to refer to situations in which
professionals from different areas want to work together to provide the
best healthcare for users but, at the same time, recognize they have their
own interests and want to maintain some degree of autonomy. Instead of
reinforcing the expectation of full autonomy and independence of each
profession, in collaborative practice, professionals aim to reduce competition21
and replace unbalanced power relations in healthcare with relations marked by
interprofessional partnership and collective responsibility22.
The literature on collaborative practice frequently goes beyond
interprofessional issues and includes the perspective of users, families and the
community, with the aim of ‘caring together with people, instead of caring for
people’23. This approach recognizes patient-centered care as a central element of
interprofessional collaborative practice. Shifting professions’ and services’ focus
to people’s health needs - therefore, to patient-centered care - is described as a
component of change in the care model, with potential for improving the quality
of healthcare and for rationalizing the costs of health systems24. The important
participation of users, families and the community in collaborative practice clarifies
the notion that this practice is not restricted to relationships among professionals,
although the term “interprofessional” is frequently used to designate it.
Although the conceptual definitions reveal differences between the terms
teamwork, collaboration and collaborative practice, it is recognized that all the
forms of interprofessional work have teams as their nucleus and focus on patient-
centered care. The literature on teamwork and interprofessional collaboration
highlights the relevance of relational aspects and work organization among
professionals to the establishment of effective, integrated, and collaborative
teams17,25,26. Distinguishing teams according to their effectiveness and impact on
the quality of healthcare is necessary and can be performed by the analysis of
teamwork climate27, as the concept of climate is considered an adequate proxy(c)
to analyze the phenomenon of teamwork.
Interprofessional collaborative practice and teamwork climate
in primary care(d)
Teamwork climate
Teamwork climate is defined as the set of perceptions and meanings shared
by the members of a team concerning the policies, practices and procedures
they experience at the workplace28. Based on the theoretical framework of
team climate for innovation, Anderson and West27 developed the scale Team
Climate Inventory (TCI), which was validated by Silva29 in the Brazilian primary
care context, within the Brazilian National Health System (SUS). Silva et al.30
highlight that the conception of team climate adopted in the TCI corresponds to
the understanding of teamwork described in Brazilian studies in the sphere of the
public policy of the SUS, that is, articulation of actions and interaction among
professionals, with communication playing a major role31.
It is believed that the study of teamwork climate is capable of providing
insights about professional relationships, teamwork organization, and aspects of
interprofessional collaboration. According to Agreli et al.32, teamwork climate and
interprofessional collaboration have four conceptual elements in common:
- Interaction and communication among team members: Sphere of
communication and social interaction among team members as a
sine qua non
for teamwork and collaboration, team members’ capacity for involvement in
(c) Proxy: The term proxy
is used here in the sense
assigned to it in the area
of Statistics, that is, as
a variable measured
to infer the value of a
variable of interest. In
this sense, the variable
team climate is measured
and used to infer the
variable teamwork
climate.
(d) The discussion
presented here is
based on the Doctoral
dissertation “
Prática
interprofissional
colaborativa e clima
do trabalho em equipe
na Atenção Primária à
Saúde
”, carried out at
Universidade de São
Paulo
in collaboration
with the University of
Southampton, authored
by Heloise Agreli and
supervised by Marina
Peduzzi and Christopher
Bailey.

Peduzzi M, Agreli HF
articles
1529
2018; 22(Supl. 2):1525-34
2018; 22(Supl. 2):1525-34
decision-making, perception of a supportive environment that is reliable, not hostile nor threatening,
allowing the expression of disagreements and differences.
- Common objectives around which collective work is organized: Shared construction of the team’s
objectives and perception of one’s and other professionals’ commitment to the outlined objectives,
shared objectives around which collective work is organized.
- Shared responsibility for orienting work towards excellence: Professionals’ and team’s
commitment to and responsibility for developing their work with quality, which demands reflectiveness
- being engaged in reflecting on oneself and on each professional’s and the team’s processes and
action. This is fundamental to guarantee the implementation of changes that become necessary in the
team’s work.
- Promotion of innovation in the workplace: Practical support to team members’ attempts to
introduce new ways of apprehending and responding to the health needs of users, families and
community in the territories. Support to innovation can be considered an indicator of interprofessional
collaboration, as it involves new arrangements of responsibilities between professionals and Institutions21.
The intersection areas outlined above between teamwork climate and collaboration reveal,
conceptually, the relation between the themes and suggest that the understanding of macro aspects
from the organization of interprofessional work, like collaboration for the establishment of
Rede de
Atenção à Saúde
(RAS - Healthcare Network), includes the study of aspects from the micro sphere (of
social interaction) in the immediate context of teamwork in primary care.
Teamwork in primary care
Understanding primary care, specifically the Family Health Strategy, as a strategy to reorganize
the health system implies recognizing it as the coordinator of primary care and the communication
center of the RAS and specialized networks. Networks are a way of facing the hegemony of
fragmented healthcare systems. It is argued that the change from fragmented systems to the RAS
will only be fulfilled if it is supported by high-quality primary care33, with teams capable of amplifying
interprofessional action beyond the scope of the team, to other teams that work in the RAS and in
partnership with users and the community. Collaborative practice refers to this broader situation of
interprofessional action - intra-teams, inter-teams and in network, with the participation of users.
In Brazil, primary care has approximately 43,160 teams implemented in the Family Health Strategy,
attending approximately 64.9% of the population34. The thousands of teams of the Brazilian primary
care have contributed significantly to improve the access and quality of healthcare. They are capable
of meeting health needs in spite of barriers to interprofessional work articulated in different sectors,
with focus on and participation of users, families and the community. Among these barriers, we
cite: Communication and coordination problems in net works35; absence of specialized networks
adequate to the population’s demand and articulated with primary care; fragmentation of care in
primary care services36; and social inequities that intensify unbalanced power relationships between
professionals and users. Fox and Reeves17 analyzed the last barrier mentioned above, discussing the risk
of collaborative practice reiterating hierarchical and unequal relationships between professionals and
users, and the risk of collaborative practice and primary care becoming rhetorical discourses.
However, it is important to mention some characteristics of primary care in the context of the SUS,
approached in the national literature, which can contribute to collaboration in the sphere of teams and
networks:
- Users and families are in the catchment area of teams, which constitute their reference, replacing
the strictly medical reference37. This scenario favors interprofessional practice and reveals the demand
for the effective participation of all the team members.
- The Humanization Policy transverses health practices, fostering teamwork, transdisciplinary action
and the very construction of networks38.
- Work is organized in teams, as established in the public policy of the SUS, and primary care is
recognized as a strategy that reorients healthcare and a form of innovation of the health system in
Brazil29.

TEAMWORK AND COLLABORATIVE PRACTICE IN PRIMARY CARE
1530 2018; 22(Supl. 2):1525-34
2018; 22(Supl. 2):1525-34
- Management Councils are part of the architecture of the SUS and
instruments of expression, representation, social participation and social control,
with potential for political transformation.
In view of the peculiarity of different health systems, the World Health
Organization suggests that efforts to establish and consolidate collaborative
practice should be grounded on the exploration of aspects of the local reality7.
Although there has been an increasing number of national publications focusing
on the interprofessional theme, little is known about the characteristics of
collaborative practice in the Brazilian primary care.
Collaborative practice and teamwork climate
in the primary care of the SUS
A recent study conducted in the Family Health Strategy by Agreli20 revealed a
relationship between collaborative practice and teamwork climate, namely, that
teamwork climate is a key element for collaboration, as Pullon et al.39 had already
discussed in the sphere of international literature. In the study of the Brazilian
primary care, it was found that teams with good teamwork climate presented:
Intense participation of their members in decision-making; activities oriented by
consolidated work assessment mechanisms, such as individual feedback and team
reflection meetings; support to new ideas; and user-centered care (developing
consolidated health promotion and prevention actions with the participation of
users and the community). Teams with higher climate scores were also those
that were most able to expand collaboration from the sphere of teams to that
of networks and work articulated with other sectors. This result suggests that
investing in teams’ permanent education is an important step to comprehensive
care and work in the RAS, not only because it is through teamwork that different
professionals integrate their expertise, but because collaborative teams are
also capable of integrating different social and health services, as well as the
participation of users, families and the community40.
According to Agreli20, collaboration as a form of interprofessional work in
primary care can be understood in two modalities that alternate depending on
users’ conditions and needs. The first modality is “Team collaboration”, in which
professionals search for alternatives among the members of their team or among
teams from the same primary care unit to improve the quality of healthcare, and
collaborate with each other to increase users’ participation in individual clinical
care (supported self-care(e)).
The second modality is “Intersectoral and community collaboration”, in which
team professionals search for alternatives in the team and also in other services,
sectors, and with users, families and the community. This collaboration modality
highlights the importance of interprofessional teamwork in the promotion of
intersectoral work and social participation(f). In addition, it emphasizes the strong
relationship between collaborative practice and primary care, which, together,
constitute the teams’ movement to include users as protagonists, stimulating their
participation in the “doing together” of the interprofessional team.
Final remarks
There must be integration and collaboration in the sphere of teams and also
between them and the other services of the healthcare network, in view of the
increasing complexity of healthcare. As we presented above, collaboration is
(e) Supported self-
care is a proposal for
care management
that incorporates
collaboration between
the health team and
users, instead of a merely
prescriptive action33,41.
(f) Social participation,
which expresses the
relationship between civil
society and the State,
exercised in the SUS by
means of Management
Councils and Health
Conferences40, expands
the sharing of decision-
making from the sphere
of the therapeutic project
to the management of
the health system.

Peduzzi M, Agreli HF
articles
1531
2018; 22(Supl. 2):1525-34
2018; 22(Supl. 2):1525-34
characterized especially by effective communication among professionals, users and the population in
the construction of partnerships:
- With users, families, and social groups of the territories;
- With other teams, services, and sectors in a network.
These partnerships can even constitute forms of resistance against threats of regression in the
health policies that constituted and consolidated the SUS, and expand the access to primary care
services. It is important to highlight that, in Brazil, the Family Health Strategy is a consolidated
interprofessional intervention, as it has been in force for more than two decades.
In the present article, we aimed to present current concepts of interprofessional work. Teamwork
and collaborative practice must contribute and have repercussions in two directions: Improving the
access and quality of the healthcare provided for the territory’s users and population, and promoting
job satisfaction among the professionals involved. To achieve this, teamwork and interprofessional
collaboration in primary care need to be addressed in a contingent manner, that is, according to the
characteristics of users/catchment population and according to the context (health policies, care
models, etc.) and working conditions. It is important to emphasize that collaboration requires the
desire to cooperate with/contribute to the work developed by the other professional. It can occur both
in the micro-context of teams (Team collaboration) and in a broader way, in the scenario of the RAS
and the community (Intersectoral and community collaboration).
Finally, we highlight the importance of interprofessional collaborative practice performed jointly
with users, families and the community, which requires ensuring conditions for their effective
participation.
Authors’ contributions
The authors participated actively and equally in all the stages of the preparation of the
manuscript.
References
1. Macinko J, Harris MJ. Brazil’s family health strategy - delivering community-based
primary care in a universal health system. N Engl J Med. 2015; 372(23):2177-81.
2. Macinko J, Lima Costa MF. Access to, use of and satisfaction with health services
among adults enrolled in Brazil’s Family Health Strategy: evidence from the 2008 National
Household Survey. Trop Med Int Health. 2012; 17(1):36-42.
3. Rocha R, Soares RR. Evaluating the impact of community-based health interventions:
evidence from Brazil’s Family Health Program. Health Econ. 2010; 19 Suppl 1:126-58.

TEAMWORK AND COLLABORATIVE PRACTICE IN PRIMARY CARE
1532 2018; 22(Supl. 2):1525-34
2018; 22(Supl. 2):1525-34
4. Rasella D, Harhay MO, Pamponet ML, Aquino R, Barreto ML. Impact of primary health
care on mortality from heart and cerebrovascular diseases in Brazil: a nationwide analysis
of longitudinal data. BMJ. 2014; 349:4014.
5. Reeves S, Pelone F, Harrison R, Goldman J, Zwarenstein M. Interprofessional
collaboration to improve professional practice and healthcare outcomes. Cochrane
Database Syst Rev. 2017; 6:CD000072.
6. Carter BL, Bosworth HB, Green BB. The hypertension team: the role of the pharmacist,
nurse, and teamwork in hypertension therapy. J Clin Hypertens (Greenwich). 2012;
14(1):51-65.
7. Organização Mundial da Saúde. Framework for action on interprofessional education
and collaborative practice [Internet]. Geneva: OMS; 2010 [citado 4 Abr 2017]. Disponível
em: http://www.who.int/hrh/resources/framework_action/en/.
8. Zwarenstein M, Goldman J, Reeves S. Interprofessional collaboration: effects of
practice-based interventions on professional practice and healthcare outcomes. Cochrane
Database Syst Rev. 2009; (3):CD000072.
9. Goh TT, Eccles MP. Team climate and quality of care in primary health care: a review of
studies using the Team Climate Inventory in the United Kingdom. BMC Res Notes. 2009;
2:222.
10. Proudfoot J, Jayasinghe UW, Holton C, Grimm J, Bubner T, Amoroso C, et al. Team
climate for innovation: what difference does it make in general practice? Int J Qual Health
Care. 2007; 19(3):164-9.
11. Agreli HF, Peduzzi M, Bailey C. The relationship between team climate and
interprofessional collaboration: preliminary results of a mixed methods study. J Interprof
Care. 2017; 31(2):184-6.
12. Silva JA, Peduzzi M, Orchard C, Leonello VM. Educação interprofissional e prática
colaborativa na Atenção Primária à Saúde. Rev Esc Enferm USP. 2015; 49 Spe 2:16-24.
13. Costa MV. A educação interprofissional no contexto brasileiro: algumas reflexões.
Interface (Botucatu). 2016; 20(56):197-8.
14. Braithwaite J, Clay-Williams R, Vecellio E, Marks D, Hooper T, Westbrook M, et al. The
basis of clinical tribalism, hierarchy and stereotyping: a laboratory-controlled teamwork
experiment. BMJ Open. 2016; 6:e012467.
15. Institute of Medicine. Measuring the impact of interprofessional education on
collaborative practice and patient outcomes. Washington, DC: National Academy Press;
2015.
16. Reeves S, Lewin S, Espin S, Zwarenstein M. Interprofessional teamwork for health and
social care. Oxford, UK: Wiley-Blackwell; 2010
17. Fox A, Reeves S. Interprofessional collaborative patient-centred care: a critical
exploration of two related discourses. J Interprof Care. 2015; 29(2):113-8.
18. Reeves S, Lewin S, Espin S, Zwarenstein M. A conceptual framework for
interprofessional teamwork. In: Barr H, editor. Interprofessional teamwork for health and
social care. Chichester: Wiley-Blackwell; 2010.
19. Morgan S, Pullon S, McKinlay E. Observation of interprofessional collaborative
practice in primary care teams: an integrative literature review. Int J Nurs Stud. 2015;
52(7):1217-30.
20. Agreli HLF. Prática interprofissional colaborativa e clima do trabalho em equipe na
Atenção Primária à Saúde [tese]. São Paulo, SP: Escola de Enfermagem, Universidade de
São Paulo; 2017.

Peduzzi M, Agreli HF
articles
1533
2018; 22(Supl. 2):1525-34
2018; 22(Supl. 2):1525-34
21. D’Amour D, Goulet L, Labadie JF, Martín-Rodriguez LS, Pineault R. A model and
typology of collaboration between professionals in healthcare organizations. BMC Health
Serv Res. 2008; 8:188.
22. Khalili H, Hall J, DeLuca S. Historical analysis of professionalism in western societies:
implications for interprofessional education and collaborative practice. J Interprof Care.
2014; 28(2):92-7.
23. Domajnko B, Ferfila N, Kavčič M, Pahor M. Interprofessional education In Europe:
policy and practice. Beyond interprofessionalism: caring together with rather than for
people. Antwerpen/Apeldoorn: Garant; 2015.
24. Agreli HF, Peduzzi M, Silva MC. Atenção centrada no paciente na prática
interprofissional colaborativa. Interface (Botucatu). 2016; 20(59):905-16.
25. Peduzzi M. Equipe multiprofissional de saúde: conceito e tipologia. Rev Saude Publica.
2001; 35(1):103-9.
26. West MA, Lyubovnikova J. Illusions of team working in health care. J Health Organ
Manag. 2013; 27(1):134-42.
27. Anderson NR, West MA. Measuring climate for work group innovation: development
and validation of the team climate inventory. J Organ Behav. 1998; 19(3):235-58.
28. Schneider B, Ehrhart MG, Macey WH. Organizational climate and culture. Ann Rev
Psychol. 2013; 64:361-88.
29. Silva MC. Adaptação transcultural e validação de instrumento de avaliação de trabalho
em equipe: Team Climate Inventory no contexto da Atenção Primária à Saúde no Brasil
[dissertação]. São Paulo: Escola de Enfermagem, Universidade de São Paulo; 2014.
30. Silva MC, Peduzzi M, Sangaleti CT, Silva DD, Agreli HF, West MA, et al. Cross-cultural
adaptation and validation of the teamwork climate scale. Rev Saude Publica. 2016; 50:52.
31. Fortuna CM, Mishima SM, Matumoto S, Pereira MJB. O trabalho de equipe no
programa de saúde da família: reflexões a partir de conceitos do processo grupal e de
grupos operativos. Rev Lat Am Enfermagem. 2005; 13(2):262-8.
32. Agreli HF, Peduzzi M, Bailey C. Contributions of team climate in the study
of interprofessional collaboration: a conceptual analysis. J Interprof Care. 2017;
31(6):679-84.
33. Mendes E. O cuidado das condições crônicas na Atenção Primária à Saúde: o
imperativo da consolidação da Estratégia de Saúde da Família. Brasília: CONASS, OPAS;
2012.
34. Departamento de Atenção Básica. Teto, credenciamento e implantação das estratégias
de Agentes Comunitários de Saúde, Saúde da Família e Saúde Bucal [Internet]. Brasília;
2018 [citado 25 Mar 2018]. Disponível em: https://egestorab.saude.gov.br/paginas/
acessoPublico/relatorios/relHistoricoCobertura.xhtml.
35. Kell MCG, Shimizu HE. Existe trabalho em equipe no Programa Saúde da Família?
Cienc Saude Colet. 2010; 15 Supl 1:1533-41.
36. Cunha GT, Campos GWS. Apoio Matricial e Atenção Primária em Saúde. Saude Soc.
2011; 20(4):961-70.
37. Ministério da Saúde (BR). Clínica ampliada, equipe de referência e projeto terapêutico
singular. Brasilia, DF: Ministério da Saúde; 2008.
38. Ministério da Saúde (BR). Humaniza SUS, Política Nacional de Humanizacão: A
Humanização como Eixo Norteador das Práticas de Atenção e Gestão em Todas as
Instâncias do SUS. Brasília, DF: Ministério da Saúde; 2004.

TEAMWORK AND COLLABORATIVE PRACTICE IN PRIMARY CARE
1534 2018; 22(Supl. 2):1525-34
2018; 22(Supl. 2):1525-34
Translator: Carolina Siqueira Muniz Ventura
Submitted on 11/13/17. Approved on 06/23/18.
39. Pullon S, Morgan S, Macdonald L, McKinlay E, Gray B. Observation of
interprofessional collaboration in primary care practice: a multiple case study. J Interprof
Care. 2016; 30(6):787-94.
40. Presidência da República (BR). Lei nº 8080, de 19 de Setembro. Dispõe sobre
as condições para a promoção, proteção e recuperação da saúde, a organização e o
funcionamento dos serviços correspondentes e dá outras providências. Diário Oficial da
União. 19 Set 1990.
41. Ministério da Saúde (BR). Diretrizes para o cuidado das pessoas com doenças crônicas
nas redes de atenção à saúde e nas linhas de cuidado prioritárias. Brasília, DF: Ministério
da Saúde; 2013.