Avaliação dos encaminhamentos da atenção primária para a atenção especializada na central de regulação

Abstract

The advances in the organization of Primary Health Care (PHC) in Brazil are remarkable. However, important obstacles need to be overcome for the integration of the Health Care Network (RAS). The experience as a health manager aroused strategies to improve the problematization of the referral demand in the regulation center. The aim of the study was to evaluate the referrals from PHC to specialized care at the regulation center in the municipality of Mombaça-Ceará. It is a mixed method study with explanatory sequential design strategy. In the quantitative stage, the data was collected through the following criteria: clinical justification, waiting time, specialty requested, health region and diagnostic hypothesis. The analysis of this data was accomplished using the Statistical Package for the Social Sciences (SPSS) 20,0 software, and the results were expressed in the shape of absolute frequency and percentage, and analyzed by Fisher’s exact test or Pearson’s chi-square test. In the qualitative stage, a focus group was conducted with PHC physicians, enabling discussions and reflections through guiding questions and the data from the first stage. The analysis of qualitative data was submitted to content analysis, thematic modality of Bardin. The research was submitted and approved by the Research Ethics Committee of the Federal University of Ceará. It was identified that of the 643 referrals from PHC to specialized care, otolaryngology presented 17,7% (n= 113). Spinal tomography expressed the highest number of exams in relation to the shortest waiting time (up to 30 days). 99,7% of referrals are scheduled to the Polyclinic of the Health Region and those with no diagnostic hypothesis totaled 61,6% (n= 392). Headache was the diagnostic hypothesis with the highest proportion 10,2% (n= 25). In the focus group there were reflections on the importance of a structured clinical justification, the anguish related to counter-referral, the problematic of return, health education and the lack of knowledge about the referral protocols of the MS. The approach between management and professionals has broadened the view to strengthen the theme. It is concluded that management will have relevant resources for the implementation of strategies in PHC, regulation center and Health Region for an organization of flow and counter flow of referrals, increasing the quality of patient handling, reducing costs and expanding the comprehensiveness of RAS.