Interconsultas médicas: uma avaliação dos relatórios de referência sob o ponto de vista dos consultores de um serviço público de ensino, referência em endocrinologia e metabologia

Abstract

The health services insufficiency in medical care is a world matter, worsen by disorganization and lack of resources in developing countries like Brazil. A great difficulty verified is the absence of an effective, safely and democratic information transit. The Referral System (RCR) is the aim of the Endocrine and Metabolism Service of the University Hospital (HC) of the Federal University of Minas Gerais (SEEM) since 1998 with the development of a distance ambulatory consultation service. The dissatisfaction of the involved agents in RCR with its inefficacious,besides the perception of its great potential to solve care problems and offer permanent education led us to conduct this study. The RCR has a prominent position in both public and private health system, with profound implications in medical care, permanent education and costs of care. Our objective was to analyze the referral letter (RR) sent to an endocrinology public and university service (SEEM). The study was a quantitative with observational transversal design to evaluate the characteristics of 282 RR. It was observed that: a) 65% of the RR wassent by specialists (ESP), with higher frequency in those of the HC (88% versus 19%, p<0,001); b) 49% of the physician had less than nine years of practice, with higher frequency in those of the HC (66% versus 36%, p=0,0057); 98% of the RR were considered legible; d) The RR that came from the Belo Horizonte City Hall (PBH) were more complete; e) The RR written by general practitioner (CLN) were more complete; f) The RR from specialists of the HC and the ones with the diagnostic of diseases that needs the endocrinologists approach (B group) were more sufficient for the decision of the consultant; g) The RR that contained history,physical examination, complementary findings and diagnostic (B group) were more frequently accept for consultation; h) 68% of the referred patients could be approached in primary care (AB); These results allows us to conclude that to enhance the RCR in a endocrinology public and university service, we should begin to capacitate the new physicians of the institution in elaborate better RR, that includes the history, physical examination, complementary findings and diagnostic. It looks like essential to define and to divulge the endocrine diseases that could beapproached in primary care level.