Capacidade resolutiva em Otorrinolaringologia do médico da atenção primária da rede pública de saúde do município de Belo Horizonte - Brasil

Abstract

Otorhinolaryngological diseases are frequent in primary care and represent a public health problem. The aim of the present study was to evaluate the resolvent capacity and the validity of the diagnosis in otorhinolaryngology in primary care. Four hundred eight children from Belo Horizonte, Brasil, with ear nose and throat complaints were enrolled from march, 2004, to may, 2005. They were firstly evaluated in primary care and referred to secondary care, where they where evaluated again. Diagnoses of the most common otorhinolaryngological illnessesdefined in primary care were compared with the diagnostic reference established in secondary care for the same patient. The chosen diagnoses were: otitis (acute, recurrence, and with effusion) tonsillitis (recurrence, and chronic) , sinusitis (acute, recurrence, and chronic) , allergic rhinitis, tonsillar hypertrophy and adenoidal hypertrophy. The following aspects were evaluated: the specialty of the health professional that referred the patient, the waiting period for consultation, patient gender and age, otorhinolaryngological diagnosis in primaryand in secondary care, general agreement of the involved professionals and validity of the primary care diagnosis. The children average age was 5,3 years (SD=3,1), 214 (52,5%) male and 194 (47,5%) female. The average waiting time for an otorhinolaryngological consultation was 3.77 months (SD = 4.69). The most frequent diagnoses among the diseases considered in this study were allergic rhinitis (35.3%), effusion otitis media (33.8%), recurring tonsillitis (22.7%), adenoidal hypertrophy (19.1%), sinusitis (13,4%) and tonsillar hypertrophy 12 (2,4%), with an average of 1.6 diagnoses per child. Evaluating the primary care, the capacity for correct diagnosis was similar for both pediatric and familyphysicians (P value=0.3). The diagnostic concordance between the primary and secondary care was of 31,6%. Most of the cases referred to a specialist could have been treated at the primary health care level, what demonstrated a limited capacity to solve otolaryngologycal problems at this level of attencion. Inadequate referrals increases unecessarily the costs of the public health system. From the perspective of specialties, it is important for medical teaching in graduate courses to emphasize training in theoretical-practical skills based on the prevalent nosology in basic care. Medical students would greatly benefit from internships in basic care facilities with emphasis in the most common specialties.