Avoidable medical references in Porto Alegre health unit : an exploratory study

• Autor(a) principal: Moi Trevisol, Daniele
• Data de Publicação: 2020
• Outros Autores: Melz, Graziela, Dias de Castro Filho, Eno, Nascimento Fontanive, Victor
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Revista Brasileira de Medicina de Família e Comunidade (Online)
• Texto Completo: https://www.rbmfc.org.br/rbmfc/article/view/2129
• topic: Referral and Consultation; Primary Health Care; Delivery of Health Care; Health Systems; Organization and Administration; Family Practice.; Derivación y Consulta; Atención Primaria de Salud;; Prestación de Atención de Salud;; Sistemas de Salud; Organización y Administración;; Medicina Familiar y Comunitaria.; Encaminhamento e Consulta; Atenção Primária à Saúde; Assistência à Saúde, Sistemas de Saúde; Organização e Administração; Medicina de Família e Comunidade.

Introduction: Medical referrals from Primary Health Care (PHC) patients to focal specialties bring relevant issues to the formulation and administration of health system policies. The detection of potentially avoidable routing can allow an improvement in work processes, as well as optimize resource allocation. Objective: To describe the secondary references generated by physicians from a PHC unit linked to the Grupo Hospitalar Conceição (GHC), in 2017, and to build criteria to classify them, discussing their avoidability. Methods: A descriptive exploratory study based on documentation. The data were obtained from the GERCON® system (Query Management System of the Municipal Health Department of Porto Alegre/RS). The referrals were classified according to their motive and according to their avoidability. Results: 799 referrals were generated, to 110 medical specialties in the period. After excluding of high-risk prenatal and dermatology specialties (due to changes in criteria and referral flows during 2017), 733 referrals remained. Of these, 582 were categorized by the researchers as non-preventable and 151 as avoidable. The predominant reasons for referral were: therapies not available in PHC (34%), diagnostic resources not available in PHC (26.5%), and diagnostic or therapeutic doubt (23.2%). 20.6% of preventable referrals were identified with a predominance of those involving physician knowledge/skills/attitude, regarding avoidability. Regarding referrals categorized as non-avoidable (79.4%), those carried out due to the need for knowledge/skills/procedures not proper to PHC predominated. Conclusion: The construction of a concept for avoidable references from empirical studies can enrich the management of PHC services, in view of their resolution. The present study found, in this PHC Unit, a low percentage of potentially preventable referrals.