Dados do Trabalho

Title

QUALITATIVE ANALYSIS OF REFERRALS TO RHEUMATOLOGY SERVICE AT A MEDICAL SPECIALTIES CENTER IN BELEM, PARA, BRAZIL

Background

Although the high prevalence of osteomyoarticular complaint, some difficulties still exist in the medical segment for the early and correct diagnosis of them. The aim of this study was evaluate the characteristics of internal referrals to a Rheumatology service at a medical specialities center in 2017.

Materials and methods

The study was descriptive, with an exploratory documentary analysis. The referrals were verified according to criteria of the Ministry of Health (MS) in Brazil and the National Network of Hospital Specialty and Reference for Rheumatology in Portugal (RNEHRRP) related to osteomyoarticular complaints that frequently motivate referrals to the specialist. The referrals were classified as correct or incorrect, adequate or inadequate. The verification considered the clinical specialties of the specialist doctors of the institution that carried out the referral. All the referrals from the outpatient clinics of the medical center, registered in 2017, were included, as well as those coming from the Municipal Regulation System (SIS-REG). And those referrals that did not have the stamp and signature of the medical professional linked to the institution were excluded; and also those performed by resident physicians.

Results

A total of 148 referrals were analyzed. Of these, 69.6% were classified as incorrect (cases with no real need for rheumatologist referral). Among the correct referrals (40.4%), only 51.1% were classified as adequate (presence of appropriate medical technical terms in the reference guides). The average waiting time at the institution, in order to obtain a consultation in Rheumatology, was 18 months. The highest proportion of referrals came from external doctors, via SIS-REG. Among the specialties of the institution, Dermatology was the one that sent more patients. The highest percentage of correct referrals was observed in the Medical Clinic. In the guides, it was observed that "arthralgia without another description" (21.6%) was the descriptive criteria most frequently used in the referrals to Rheumatology; followed by the criteria "detailed clinical description and previously established diagnosis" (20.3%). Among the previous diagnoses identified, "autoimmune diseases" was the most prevalent (73.4%). It was found that most of the referrals were considered incorrect. Among the referrals classified as correct, only half of them were categorized as adequate.

Conclusions

These results directly affect the late diagnosis and treatment of important osteomyoarticular disorders that can be identified and initially managed by all doctors. These facts also contributes to the overcrowding of outpatient Rheumatology vacancies; besides the impairment about the quality of life of patients with rheumatologic diseases.