ABSTRACT
Abstract Purpose: To evaluate the quality of referrals for a first Rheumatology consultation at a tertiary care center in a southern Brazilian capital (Porto Alegre, RS), having as background findings from a similar survey performed in 2007/2008. Since then, our state has implemented referral protocols and a triage system with teleconsulting support exclusively for referrals from locations outside the capital, permitting a comparison between patients screened and not screened by the new system. Methods: Physicians of the Rheumatology Service at Hospital Nossa Senhora da Conceição prospectively collected information regarding first visits over a 6-month period (Oct 2017 to March 2018). We recorded demographic characteristics, diagnostic hypotheses, date of referral, and the municipality of origin (within the state of Rio Grande do Sul). We considered adequate referrals from primary health care when a systemic autoimmune inflammatory disease (SIRD) was suspected at first evaluation by the attending rheumatologist. Results: Three hundred fifty-seven patients/appointments were eligible for analysis (193 from the capital and 164 from small and medium towns). In 2007/2008, suspected SIRD occurred in 76/260 (29.2%) and 73/222 (32.9%) among patients from the capital and outside counties, respectively (P = 0.387). In 2017/2018, suspected SIRD occurred in 75/193 (38.9%) and 111/164 (67.7%) in patients from the capital and outside counties, respectively (difference: 28.8, 95% CI: 19.0 to 38.9, P < 0.001), indicating a marked improvement in referrals submitted to the new triage system. Conclusion: The quality of Rheumatology referrals in our state improved over the 10-year interval under study, particularly among patients from locations submitted to referral protocols and teleconsulting support.
ABSTRACT
Objetivo: avaliar o tempo de espera para uma primeira consulta de Reumatologia no Hospital Nossa Senhora da Conceição (HNSC) de Porto Alegre, RS. Métodos: num estudo transversal, os médicos do Serviço de Reumatologia do HNSC coletaram informações referentes a todas as primeiras consultas num período de 6 meses. Além de características demográficas, foram registradas as hipóteses diagnósticas, a data do encaminhamento, município de origem, a urgência do caso e se o paciente atendido substituiu a outro que desistiu da consulta. Resultados: das 615 consultas agendadas, 487 (79,2%) pacientes compareceram. O tempo de espera para a consulta variou entre 3 dias e 8 anos (mediana = 3,8 meses, percentis 25-75 = 1,5-10,0, média ± DP = 7,8 ± 11,1 meses). Em modelo de regressão logística múltipla, os fatores associados a uma espera ≥ 10 meses foram as consultas de substituição, a idade e as procedências de Novo Hamburgo e de Alvorada, enquanto casos urgentes foram associados a uma espera < 10 meses. No entanto, esse modelo apresentou baixa capacidade para identificar pacientes com tempo prolongado de espera (estatística C=0,70). Aproximadamente metade dos pacientes apresentavam quadros clínicos como fibromialgia, osteoartrose ou reumatismos de partes moles, sem suspeita de sobreposição com quadros poliarticulares inflamatórios. Conclusão: há grande variabilidade no tempo de espera para consulta de Reumatologia na amostra estudada, e freqüentemente não se puderam identificar as causas de uma longa espera. Grande parte dos pacientes encaminhados poderia ser satisfatoriamente atendida em nível primário ou secundário (AU)
Aim: To evaluate the waiting time for a first rheumatological consultation at the Hospital Nossa Senhora da Conceição (HNSC) of Porto Alegre, South Brazil. Methods: In a cross-sectional study, the clinicians of the Rheumatology Service of the HNSC collected information regarding all the first consultations in a 6-month period. The collected data included demographic characteristics, hypothetical diagnoses, date of referral, place of residence, case urgency, and whether the patient was replacing some other patient who called off the visit. Results: Of 615 scheduled appointments, 487 (79.2%) patients attended. The waiting time for consultation ranged from 3 days to 8 years (median = 3.8 months, percentiles 25-75 = 1.5-10.0, mean ± SD = 7.8 ± 11.1 months). In a model of multiple logistic regression, the factors associated with waiting ≥ 10 months were substitute consultations, age, and coming from the municipalities of Novo Hamburgo and Alvorada, while urgent cases were associated with waiting ≥ 10 months. However, this model was poorly able to identify patients with a long waiting time (statistics 'c'= 0.70). About half the patients presented such clinical pictures as fibromyalgia, osteoarthritis, or rheumatism of soft tissues, without suspicion of overlapping inflammatory polyarticular conditions. Conclusion: There is great variability in the waiting time for consultation with a Rheumatology specialist in the sample studied; often the causes for the long waiting time could not be identified. Many of the referred patients would benefit from primary or secondary care (AU)