Análise da efetividade do fluxograma de encaminhamentos de pacientes ao ambulatório de reumatologia do Centro de Especialidades Médicas do Centro Universitário do Estado do Pará

Abstract

Introduction. Pain is the main symptom of patients affected by rheumatological pathologies, and osteomyomaarticular pain is the most prevalent in the world. Although relatively simple, mistakes are common in referrals made by generalists and specialists, related to complaints and / or diagnostic hypotheses.Objectives: Evaluate the result of the implementation of the flowchart of referral of patients with joint complaints to the rheumatology service of CEMEC. Methodology. The present study was based on the preliminary study developed in 2017/2018, which was carried out in four stages, the fourth stage being the present study, whose research took place in three stages. In the first phase, the intervention was carried out, with a detailed explanation and explanation of the flowchart functioning for medical professionals of all CEMEC specialties and copies of the flowchart were attached on the premises of the establishment. The second phase consisted of a cross-sectional study, through the reapplication of a self-administered questionnaire, identical to that of the preliminary study, to the teaching and resident medical professionals working at CEMEC. The third phase consisted of a descriptive, qualitative, quantitative and comparative study and was based on a documentary analysis of referrals to CEMEC's rheumatology servisse, Results. Most referrals were classified as incorrect (cases with no real need for referral to a rheumatologist), even after the intervention. Among the correct referrals, more than half were classified as adequate (presence of appropriate technical terms in the reference guides), showing an improvement with regard to the number of correct and adequate referrals, compared to the preliminary study. The average waiting time to get an appointment at CEMEC Rheumatology in 2019 was 12 months, with a reduction of 6 months compared to the year 2017. The qualitative analysis of musculoskeletal complaints in the referral guides revealed that the osteomioarticular involvement with description, but without a diagnostic hypothesis was the criterion most frequently used by professionals to justify referrals. Among the specialties, nephrology was the one that referred the greatest number of patients to rheumatology. The highest percentage of correct referrals was observed in pneumology and infectious diseases. The professional profile of the interviewees was: young doctors; women; professionally experienced; and, most graduates from UFPA. The degree of complexity of musculoskeletal complaints was the reason most alleged by the participants to justify the referral. Regarding the degree of technical knowledge of the professionals, they present better clinical information about Gout disease (specific diagnosis and initial management). Conclusion. The increase in the number of correct referrals directly affects the quality of health care provided by the CEMEC Rheumatology service. The maintenance of the largest amount of incorrect and inadequate referrals points to the low adherence to the flowchart by the medical professionals working in the service. Thus, it is necessary to search for ways to encourage adherence to the tool, such as, for example, the periodic explanation of its operation not only to doctors, but also to CESUPA medical students, who are a fundamental part in the patient care.