Quality of referrals to a rheumatology service before and after implementation of a triage system with telemedicine support

Deise Marcela Piovesan,Romulo Gomes Da Silveira,Camila De David Cruz,Guilherme Kopik Bongiorno,Sheron Zamboni,Julio César Simon,Markus Bredemeier,Cynthia Goulart Molina-Bastos,Aline Defaveri Do Prado,Vanessa Barrili Busato,Marcelo Rodrigues Gonçalves,Sheila Hickmann

doi:10.1186/s42358-021-00203-6

Deise Marcela Piovesan, Romulo Gomes Da Silveira + Show 10 more

Open Access

https://doi.org/10.1186/s42358-021-00203-6

Copy DOI

Abstract

PurposeTo 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.MethodsPhysicians 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.ResultsThree 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.ConclusionThe 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.

Highlights

The long waiting time for consultations with specialists is one of the most significant limitations of the Brazilian public health system (Sistema Único de Saúde, SUS)
Our aim in the present study is to evaluate the impact of telemedicine in the quality of referrals to Rheumatology tertiary care, comparing the cases from outsides counties and cases from the capital, having as background the data collected in 2007/2008 [1], when there was no regulation of referrals at all
Suspected systemic inflammatory rheumatic disease (SIRD) by the rheumatologist occurred in approximately half of the cases

Summary

Introduction

The long waiting time for consultations with specialists is one of the most significant limitations of the Brazilian public health system (Sistema Único de Saúde, SUS). The time from first symptoms to the initiation of treatment is one of the main factors related to prognosis [2]. Besides the personal impact caused by the delay in treatment, there is an economic burden associated with the morbidity of rheumatic diseases that the early initiation of the treatment could minimize [3]. In Brazil, rheumatic diseases are an important cause of public healthcare expenditures. Access to care for patients with a systemic inflammatory rheumatic disease (SIRD) is a current challenge in Brazil as well as in developed countries [5]

Methods

Results

Discussion

Conclusion