Reality of the derivation to otorhinolaryngology from primary attention

Abstract

The difficulty in gaining access to a specialist in the public system is a severe problem for the users. The criteria applied to priorize attention are diagnosis and the symptoms enounced in the interconsultation (IC) by the derivating professional. The objectives of this paper are to inform about the reality of Dr. Sotero del Rio Hospital, to identify administrative and medical causes for inadequate derivation, and to try to set the bases to solve these problems. Of a total of 7.750 interconsultations on a waiting list for otolaryngology attention, up to June 2003, a sample of 1.150 interconsultations was extracted and a data base was developed with the information obtained. A sub-group of 115 patients were evaluated by otorhinolaryngologists from the service. Results: 96% of the interconsultations were incomplete, there was a 5% error in derivation, 74% of the IC did not have a diagnostic basis, diagnostic coincidence amounts to 25%. The clinical picture described in the interconsultation was many times not a reliable reference to give priority to the attention of patients. Solutions to the problem of attention by a specialist depend on a cooperative work between university teachers, otorhinolaryngologists, general practitioners and administrative staff.