ABSTRACT
RESUMO Introdução Conhecer o fluxo de referência e contrarreferência de serviços de saúde de alta complexidade é imprescindível para o aperfeiçoamento da assistência fonoaudiológica. Objetivo Analisar o fluxo de pacientes de um serviço de Fonoaudiologia de alta complexidade no Sistema Único de Saúde (SUS). Métodos Estudo descritivo, realizado em serviço de Fonoaudiologia de hospital de alta complexidade. Foram analisados os dados de 373 usuários submetidos à triagem fonoaudiológica (consulta a prontuários). As variáveis analisadas foram: perfil sociodemográfico e fonoaudiológico; origem dos usuários (referência); tempo entre a referência e a realização da triagem; encaminhamentos após a triagem (contrarreferência); tempo entre a conclusão da triagem e o primeiro atendimento fonoaudiológico no serviço de contrarreferência; grau de satisfação com o atendimento fonoaudiológico de contrarreferência. Resultados Predominaram indivíduos com idades entre 0 e 11 anos e 11 meses, do gênero masculino, residentes na cidade de São Paulo, com ensino fundamental incompleto. A hipótese diagnóstica fonoaudiológica de disfonia foi a mais prevalente. A maioria dos usuários foi referenciada pela atenção terciária. A média de tempo de espera para a triagem foi de 56,6 dias (intervalo predominante de 51 a 60 dias). Pouco mais da metade dos sujeitos foi encaminhada para o nível terciário. O tempo de espera pelo atendimento foi maior no nível secundário. A maioria dos usuários referiu como excelente ou bom o grau de satisfação com o atendimento. Conclusão Observou-se alto grau de resolutividade no serviço analisado (atenção terciária) e necessidade de reorganização dos sistemas de referência e contrarreferência na atenção secundária e primária.
ABSTRACT Introduction For optimum quality in Speech, Language and Hearing (SLH) healthcare, it is essential to be aware of the flow of referrals and counter-referrals for high-complexity health services. Purpose To analyze the flow of patients of a high-complexity SLH service in Brazil's Unified Health System (Sistema Único de Saúde - SUS). Methods Descriptive study, made at a Speech, language and hearing (SLH) service of a high complexity hospital. Participants were 373 users who underwent SLH screening (consultation of health records). The variables analyzed were: social-demographic profile; SLH profile; origin of referral of users; time between referral and screening being carried out; referrals after screening (counter-referral); time between conclusion of screening and first SLH consultation in the counter-referred service; and degree of satisfaction with the SLH consultation of the counter-referral. Results The largest group was the age range zero to 11 years 11 months, male, resident in the city of São Paulo, who had not completed primary education. The most prevalent initial diagnosis in SLH terms was dysphonia. The majority of users were referred to tertiary care. The average waiting time for screening was 56.6 days. Just over half the subjects were referred for tertiary care. The waiting time for care was longest at the secondary level. The majority of users stated their degree of satisfaction with the care to be excellent or good. Conclusion A high degree of resolutiveness was observed in the tertiary care service analyzed; and a need was observed in secondary and primary care for reorganization of the systems of referral and counter-referral.
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Patient Satisfaction , Referral and Consultation/statistics & numerical data , Speech, Language and Hearing Sciences , Triage/statistics & numerical data , Brazil , Dysphonia/diagnosis , Health Services , Hospitals, Public , Patients , Tertiary Healthcare , Unified Health SystemABSTRACT
Introducción: Los Errores Congénitos del Metabolismo (ECM) son enfermedades poco frecuentes, que para su diagnóstico requieren de especialistas y laboratorios específicos no disponibles en todo el país. El programa de referencia/contra-referencia del Hospital Garrahan ofrece la posibilidad de realizar consultas a través de la Oficina de Comunicación a Distancia (OCD). Objetivos: Evaluar la consulta de pacientes con sospecha de ECM en el marco del programa de referencia/contra-referencia. Comparar estas consultas con las efectuadas en forma presencial. Establecer indicadores de impacto y eficiencia asistencial para estas poblaciones. Explorar la calidad de las consultas a distancia y la percepción del consultante en relación a la respuesta obtenida. Metodología: Estudio prospectivo, observacional y comparativo.Unidad de estudio: consultas hechas a través de la OCD y consultas presenciales realizadas al servicio de ECM desde el 1 de julio de 2010 hasta el 15 de mayo de 2011. Se excluyeron las consultas sin intermediario médico y las motivadas por una pesquisa neonatal patológica. Resultados: Se realizaron 142 consultas a ECM a través de la OCD y 254 a través de otras vías de consulta presencial. El tiempo para responder a las consultas por OCD fue de X 30 hs (mediana 24,2 hs) y para las consultas presenciales (en pacientes internados: X 153,6 hs y mediana 48 hs y en pacientes ambulatorios X 1010 hs, mediana 216 hs). No hubo diferencia significativa entre ambos grupos en diagnósticos realizados (RR 0,58; IC: 0,29-1,14) ni en el tiempo necesario para alcanzar o descartar ECM (log rank test p 0,18). Tampoco hubo diferencias en la mortalidad de ambos grupos (RR: 1,1 IC 0,12-9,44). Conclusiones: La OCD es una forma eficiente de consulta al servicio de ECM con rápida respuesta del especialista,que permite diagnosticar o descartar ECM con frecuencia similar a las consultas por otras vías de consultas.
Introduction: Inborn errors of metabolism (IEM) are rare dis-eases. For the diagnosis they require specialists and special-ized laboratories which are not widely available in the country. The referral/counter-referral program of the Garrahan Hospital provides the possibility of consultation with specialists through the Office of Outreach Communication (OOC). Objectives: To evaluate consultations of patients with a suspected IEM within the framework of the referral/counter-referral program and to compare them with those of patients seen at the hospital; to determine impact and efficiency of care indicators for this patient population; to assess the quality of these distance consultations and how the response is perceived by the con-sulting physician. Methodology: A prospective, observational, and comparative study was conducted. Study subject: Con-sultations made through the OOC and consultations made at the service of IEM between July 1, 2010 and May 15, 2011. Consultations that were not made by a physician or those made following neonatal screening were excluded. Results: 142 consultations for IEM were made through the OOC and 254 were made directly at the service of IEM. Mean time to respond to consultations through the OOC was 30 hours (me-dian 24.2 hours) and mean time to respond to consultations at the service of IEM was 153.6 hours (median 48 hours) for inpatients and 1010 hours (median 216 hours) for outpatients. No significant difference was found in diagnoses made (RR 0.58; CI: 0.29-1.14) or in time needed to reach a diagnosis of or rule out IEM (log-rank test p=0.18) between both groups. There were no differences found in mortality between both groups (RR: 1.1; CI: 0.12-9.44). Conclusions: The OOC is an efficient tool for consultation at the service of IEM with a fast response by the specialist allowing to diagnose or rule out IEM with a response rate similar to other forms of consultation.