Abstract

ROCHA, Hugo et al. Referral to hospital care using a computer system. Rev Port Med Geral Fam [online]. 2019, vol.35, n.4, pp.285-298. ISSN 2182-5173.  https://doi.org/10.32385/rpmgf.v35i4.12321.

Objectives: In 2003, a study carried out at Senhora da Hora Health Center, prior to computerization of the referral system, found a hospital referral rate of 10.1%, with referral letters mostly of medium quality and a mean waiting time for consultation ranging from one to six months. This study aims to determine the referral rate to Pedro Hispano Hospital (HPH) by all family physicians from the ACeS de Matosinhos in 2016, to evaluate the quality of referral letters, to analyze response times of secondary health care and to assess the relationship between the age of family physicians, the time of consultation and the quality of referrals. Methods: Cross-sectional, analytical study, conducted in Matosinhos’ Local Health Unit. We analyzed the referral letters for patients referred to HPH during the year 2016. Simple random sample, representative of the study population (n=649). The analysis used descriptive and analytical statistics (Kruskall-Wallis). Results: The referral rate was 7.7%. The median age of the referred population was 53 years, 53.7% of the patients were female. The specialties with the greatest number of referrals were ophthalmology (18.0%), orthopedics (14.4%) and general surgery (9.9%). About 54% of the referrals were for diagnosis. The referral letters were judged to be of reasonable quality (66.3%) and of very good quality (31.1%). 6.6% of the referrals were refused, because of the lack of clinical criteria for referral. Of all the letters, 90.6% were screened within 30 days. The quality of the referral letter was associated with more rapid consultation (p=0.003). Discussion: Thirteen years after an initial study of referral in this population, the following changes were noted: transparency in the referral process and improvements in the identification and readability of the information of the reference letters. There was an increase in the number of referrals with reasonable and very good quality. There were changes in the most referred specialties, suggesting that, with an increase in the supply of care, there is a greater demand. The computerization of the referral process allowed greater discrimination of waiting times for hospital appointments. A strength of this study was the ability to track of the booking of hospital appointments, with monitoring of the times of screening, scheduling, and the date of hospital appointments, overcoming limitations due to errors detected in the use of computerized referral software. This study has internal validity and it is important to evaluate to what extent the results may be similar in other contexts.

Keywords : Referral and consultation; Primary health care; Secondary care; Hospitals.

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