Abstract
To assess the suitability of referral from primary to secondary care in pediatric Otolaryngology. The study was performed in the city of Belo Horizonte, in the state of Minas Gerais, from March 2004 to May 2005. A total of 408 pre-school children referred from primary care to secondary care in the department of Otolaryngology presenting with otitis, tonsillitis, sinusitis, allergic rhinitis, and tonsillar/adenoidal hypertrophy was assessed. The studied variables were: agreement between diagnoses in primary and secondary care; waiting time for doctor's appointment; follow-up, and professional (pediatrician or family physician) that examined children in primary care. Agreement of diagnoses was assessed using kappa statistics. Patients were five years old on average, 214 (52.5%) were boys, mean waiting time for appointment was 3.7 months. Diagnoses in primary and secondary care were respectively: otitis (44%, 49%), tonsillar/adenoidal hypertrophy (22%, 33%), tonsillitis (18%, 23%), sinusitis (13%, 21%), allergic rhinitis (3%, 33%). Agreement analysis of kappa was 0.15 for otitis with effusion, 0.35 for recurrent otitis, 0.04 for tonsillar/adenoidal hypertrophy, 0.43 for tonsillitis, 0.05 for allergic rhinitis, and 0.2 for sinusitis. Diagnoses in primary care referred to secondary care were in agreement when given either by pediatrician or family physician. Unsuitability of referrals from primary to secondary care in otolaryngology was expressed by the long time waiting for appointments and by the low agreement between diagnoses in different level of care for the same patients. Primary health care could be more efficient if professionals were better qualified in Otolaryngology.
Highlights
It is estimated that 25% of cases in primary care are related to ear, nose and throat diseases.[3,15] Those more commonly assessed are infectious or allergic diseases occurring more often among the pediatric population.[18]
Diagnoses in primary care referred to secondary care were in agreement when given either by pediatrician or family physician
Unsuitability of referrals from primary to secondary care in Otolaryngology was expressed by the long time waiting for appointments and by the low agreement between diagnoses in different level of care for the same patients
Summary
It is estimated that 25% of cases in primary care are related to ear, nose and throat diseases.[3,15] Those more commonly assessed are infectious or allergic diseases occurring more often among the pediatric population.[18]. Secondary care is the bases for referral/counter-referral, necessary to ensure the efficiency of the current hierarchical model of health care.[21] In Brazil, the introduction of this model and of family medicine, has been facing some problems. One of these problems is the overload of referrals for specialized medical services in secondary care.[5] This could be due to the difficulties of resolution in primary care.[16] One of the main challenges of this level of care is to decide when to refer the patient to be seen by a specialist in second or tertiary care.[21]
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