Da atenção Primária ao serviço de referência neurológica : análise de encaminhamentos e integração entre os níveis assistenciais

Abstract

This study aimed to analyze the referrals of Primary Health Care (PHC) to a public service of neurology at the city of Montes Claros, in northern Minas Gerais. This was an epidemiological study, cross-sectional, quantitative, descriptive with referred patients of PHC, via central regulatory of appointment scheduled at City Hall. The profile analyzed was sociodemographic of the participants, reason and needs for referrals, waiting times for specialized evaluation, agreement between diagnosis of PHC and specialist, need for complementary tests, fate of patients and integration between healthcare levels. The data was analyzed by Statistical Package for the Social Sciences-SPSS® version 19.0 for Windows, used measures of central tendency, standard deviation, simple and relative frequency, Chi-square test (p<0.05). Four hundred individuals composed the sample, 94% of the urban area, age between 18 and 88 years, most of the female gender, married, brown, with income less than 05 wages and over 05 years of study. The referrals made by physicians (74.8%), nurses (22.5%) and others professionals (2.7%). The first appointment represented the most frequent service (68%). The waiting time varied from 0 to 2357 days with the median of 60.5, 144 and 112 days to first appointment, new appointment and return with tests, respectively. Only 3.7% of patients own forms of reference and counter-reference. Most referrals considered relevant, however, approximately 50% of cases capable of resolution in the first neurological care, in the PHC or should be referred to other specialists. The diagnostic hypothesis was present at 24.8% of referrals being concordant in 90.9% with neurological diagnosis. The most prevalent pathologies were headache (22%) and epilepsy (15.5%). There was a need for additional tests for 49.5% of the patients. Comparative analysis between groups of patients, with or without need for referrals, considered the aspect socio-demographic, complaints and diagnoses and did not show statistically significant differences. It was concluded that there was a predominance of urban-area patients, female gender, brown, little education and low family income. Long waiting time, lack of standard for referral without integration between assistance levels. Headache and epilepsy were most prevalent diseases. Few referrals had diagnostic hypothesis, and in these there was good agreement between expert and PHC. Approximately half of the cases did not need additional tests neither neurological monitoring.