La autorización previa para acceder al neurólogo desde atención primaria puede ser innecesaria: resultados de un estudio prospectivo y controlado / Prior authorisation to visit the neurologist from primary care may not be necessary: the findings of a prospective, controlled study
Rev. neurol. (Ed. impr.)
; 43(7): 388-392, 1 oct., 2006. graf
Artigo
em Es
| IBECS
| ID: ibc-049628
Biblioteca responsável:
ES1.1
Localização: ES1.1 - BNCS
RESUMEN
Introducción. El sistema de autorización del médico deatención primaria para acceder a la asistencia especializada esconocido como gatekeeping y tiene como función evitar las remisioneserróneas o sencillas al siguiente escalón sanitario. Presentamosun trabajo comparativo entre los diagnósticos finales de 400pacientes que acudieron a un modelo de acceso directo (MAD)frente a 400 pacientes derivados por el médico de atención primariaen un modelo de autorización previa (MAP). Pacientes y métodos.Análisis prospectivo de dos cohortes de pacientes atendidospor el mismo neurólogo en un sistema MAP frente a un sistemaMAD. Se evaluó a los 800 pacientes siguiendo criterios diagnósticossimilares. El objetivo primario del estudio compara a los pacientesremitidos con diagnóstico final de patología no neurológicaen el MAP frente al MAD. Como objetivos secundarios se analizanlos diagnósticos por patologías diferentes entre ambos modelos.Resultados. No existieron diferencias significativas entre lasremisiones consideradas como no neurológicas en el MAP frente alMAD (27,0% frente al 26,3%, p = 0,48). Se realizó un modelo deregresión logística con variable dependiente patología no neurológicae independientes edad, sexo y tipo de modelo (MAP oMAD), con resultados similares. Conclusiones. Nuestros datos sugierenque el papel del médico de atención primaria no es eficaz ala hora de evitar las remisiones erróneas al neurólogo en nuestromedio. Se precisaría de un estudio poblacional con el fin de valorarla tasa de uso de recursos y el gasto sanitario entre ambosmodelos
ABSTRACT
Introduction. The system by which approval must be given by the primary care physician before a patient can visit aspecialist is known as gatekeeping and is aimed at preventing the mistaken or simple referral of patients to the next stage ofhealth care services. We present a study that compares the final diagnoses of 400 patients who used a direct access model ofreferral (DAM) with those of 400 patients referred by a primary care physician in a prior authorisation model (PAM). Patientsand methods. We conducted a prospective analysis of two cohorts of patients who visited the same neurologist in a PAM systemversus a DAM system. The 800 patients were evaluated following similar diagnostic criteria. The primary objective of the studywas to compare the patients who were referred with a final diagnosis of non-neurological pathology in the PAM and the DAMsystems. Secondary aims consisted in conducting an analysis of the diagnoses by different pathologies between the two models.Results. No significant differences were found between the referrals that were considered to be non-neurological in the PAMand the DAM systems (27.0% versus 26.3%; p = 0.48). A logistic regression model was performed with non-neurologicalpathology' as the dependent variable and age, sex and type of model (PAM or DAM) as the independent variables, similar resultsbeing obtained in both cases. Conclusions. Our data suggest that the role played by the primary care physician is not effectivewhen it comes to preventing mistaken referrals to the neurologist in our area. A populational study would be needed to evaluatethe rate at which resources are used and the spending on health care in the two models
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Coleções:
Bases de dados nacionais
/
Espanha
Contexto em Saúde:
ODS3 - Meta 3.8 Atingir a cobertura universal de saúde
Problema de saúde:
Arranjos de Entrega
Base de dados:
IBECS
Assunto principal:
Atenção Primária à Saúde
/
Encaminhamento e Consulta
/
Neurologia
Tipo de estudo:
Estudo diagnóstico
/
Estudo de etiologia
/
Estudo de incidência
/
Estudo observacional
/
Estudo prognóstico
/
Fatores de risco
Limite:
Humanos
Idioma:
Espanhol
Revista:
Rev. neurol. (Ed. impr.)
Ano de publicação:
2006
Tipo de documento:
Artigo
Instituição/País de afiliação:
Hospital Central Cruz Roja/España