Referência para o ambulatório de nefrologia: inadequação da demanda para o especialista

Abstract

Introduction: There are scarce data in Brazil concerning the referral of the patients with renal diseases to the nephrologist care. Objective: The aim of the present study was to describe the adequacy of early referral of these patients to a nephrology out-patient clinic. Material and methods: It was a cross-sectional study. Data of the first visit of the patient to the nephrologists were collected. The decision of the nephrologist, regarding the admittance of the patient to the follow-up with the nephrology team was also described. Results: We evaluated 150 patients, with mean age of 49 ± 16 years, and 56% of females. The need of a consultation and follow-up with the renal specialist was found in only 71 patients (47.3%) and all these patients were enrolled in the nephrology unit outpatient clinic for, at least, one visit a year. All the patients with chronic kidney disease stages 3 to 5 were recommended to maintaining visits to the nephrologist, whereas 60% of those with diabetes and/ or hypertension and 50% of those with renal lythiasis were also enrolled in the same program. Approximately 50% of patients originated from public health system units and 70% of private doctors were adequately referred. Conclusion: There was inadequate use of the abilities of the nefrologist as a specialist in the care of the patient with early stages of renal diseases. Other studies are needed to evaluate the efficiency of referral systems to the nephrologists in other areas of Brazil, with the purpose to rationalize supply and demand in the nephrology care.

Retrospective analysis of 1,203 cases of referral to a quaternary vascular surgery outpatient clinic within the Unified Health System, São Paulo, Brazil

“…Regarding clinical specialties, both national ( 6 , 25 ) and international ( 21 , 26 ) papers have evaluated referral appropriateness, from primary health care centers. As per those studies conducted in Brazil, the rate of referral inappropriateness is >40%.…”

Management of chronic kidney disease: perspectives of Brazilian primary care physicians

“…Incomplete referrals or referrals at stages that could be treated in primary care and late diagnoses and referrals produce a negative repercussion for these patients' morbidity and mortality. Adequate referral, in turn, can result in efficiency in the health care system, improvement in patients' survival, delay in the need to begin Renal Replacement Therapy (RRT), timely intervention for making permanent access, better treatment choices and options, reduction in the number of emergency dialyses better nutritional patterns for patients and fewer hospitalization days (Bahiense-Oliveira et al, 2010;Coutinho & Tavares, 2011;Diegoli et al, 2015;KDIGO, 2013;McLaughlin et al, 2001;Padovani et al, 2012;Peña et al, 2006;Pena et al, 2012 andNunes et al, 2014). The adoption of regulatory and care protocols guides the requesting professionals' decisions and modulates the evaluation performed by the monitoring physicians (Ministério da Saúde-BR, 2017).…”