BackgroundTo improve waiting time for a first consultation with a rheumatologist has become an important challenge in many countries [1, 2]. In 2008, a previous survey [3] evaluating the referrals to our Service, we observed long waiting times (median 3.8 months, interquartile range (IQR)=1.5-10.0, ranging from 3 days to 8 years) and that only 31% of consultations were related to hypothesis of systemic inflammatory rheumatic diseases (SIRD), which should be properly managed at a resourceful tertiary care center. In 2015, a new process of triage for referrals (based on a protocol recording relevant information and judgment by a rheumatologist) was introduced in our state health system aiming to improve quality of referrals and reduce waiting lists [4]. However, this system is applied only for patients from cities other than the capital (Porto Alegre, RS).ObjectivesTo evaluate the waiting time and quality of referral for first Rheumatology consultations at a tertiary care center of South Brazil, comparing the present results with those obtained 10 years ago in a similar survey [3].MethodsIn a cross-sectional study, information regarding all first consultations at the Rheumatology Service of Hospital Nossa Senhora da ConceiÇão were prospectively collected from Oct 2017 to Mar 2018. Referred patients were characterized in terms of demographic features, diagnostic hypothesis formulated by the rheumatologist and time from initial referral. For analytical purposes, patients with adequate referrals were considered to be those that presented high probability of SIRD, needing assistance at secondary or tertiary level of care. The results were compared with data collected in the same way in 2008 [3]. Chi-square test was used for statistical analysis.ResultsOf 444 appointments for scheduled for new patients, 87 (19%) did not attend. The features of the remaining 357 patients were: female=85%, mean (SD) age= 53 (15) years. The waiting time for consultation ranged from 7 days to 63,8 months (median 12.7, IQR= 4.4-14.1). Diagnostic suspicion of SIRD occurred in 186 (52%). Among SIRD, rheumatoid arthritis (23,5%) was the most frequent, while among non-SIRD, osteoarthritis (21,0%) and fibromyalgia (20.7%) were the most common diagnostic hypotheses. A SIRD was the main hypothesis in 75/193 (38.9%) patients from the capital, comparing with 111/174 (67,7%) among those from other cities (P<0,001), indicating better selection of the latter group of patients. A reanalysis of data colleted in 2008 revealed that, at that time, the prevalence of suspected SIRD was not significantly different between patients from capital (76/262, 29.0%) and those from other cities (74/225, 32,9%; P=0.354).ConclusionWe observed improvement in the quality of referrals from other cities comparing to those from the capital of our state, suggesting a better selection process in the former [4]. Despite the efforts to reduce the waiting time for Rheumatology consultations, we observed an increase when compared to 2008. We believe that the delay is secondary to an...
Purpose To evaluate the quality of referrals for a first Rheumatology consultation at a tertiary care center in a southern Brazilian capital (Porto Alegre, RS), having as background findings from a similar survey performed in 2007/2008. Since then, our state has implemented referral protocols and a triage system with teleconsulting support exclusively for referrals from locations outside the capital, permitting a comparison between patients screened and not screened by the new system. Methods Physicians of the Rheumatology Service at Hospital Nossa Senhora da Conceição prospectively collected information regarding first visits over a 6-month period (Oct 2017 to March 2018). We recorded demographic characteristics, diagnostic hypotheses, date of referral, and the municipality of origin (within the state of Rio Grande do Sul). We considered adequate referrals from primary health care when a systemic autoimmune inflammatory disease (SIRD) was suspected at first evaluation by the attending rheumatologist. Results Three hundred fifty-seven patients/appointments were eligible for analysis (193 from the capital and 164 from small and medium towns). In 2007/2008, suspected SIRD occurred in 76/260 (29.2%) and 73/222 (32.9%) among patients from the capital and outside counties, respectively (P = 0.387). In 2017/2018, suspected SIRD occurred in 75/193 (38.9%) and 111/164 (67.7%) in patients from the capital and outside counties, respectively (difference: 28.8, 95% CI: 19.0 to 38.9, P < 0.001), indicating a marked improvement in referrals submitted to the new triage system. Conclusion The quality of Rheumatology referrals in our state improved over the 10-year interval under study, particularly among patients from locations submitted to referral protocols and teleconsulting support.
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