Barbieri Raquel Rodrigues, Sales Anna Maria, Hacker Mariana Andrea, Nery José Augusto da Costa, Duppre Nádia Cristina, Machado Alice de Miranda, Moraes Milton Ozório, Sarno Euzenir Nunes
Laboratório de Hanseníase, Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, Rio de Janeiro, Brasil.
PLoS Negl Trop Dis. 2016 Oct 12;10(10):e0005059. doi: 10.1371/journal.pntd.0005059. eCollection 2016 Oct.
We evaluated the profile of patients referred to the Fiocruz Outpatient Clinic, a reference center for the diagnosis and treatment of leprosy in Rio de Janeiro, RJ, and analyzed the origins and outcomes of these referrals.
This is an observational retrospective study based on information collected from the Leprosy Laboratory database at Fiocruz, Rio de Janeiro, RJ, Brazil. A total of 1,845 suspected leprosy cases examined at the reference center between 2010 and 2014 were included. The originating health service referrals and diagnostic outcomes were analyzed as well as the clinical and epidemiological data of patients diagnosed with leprosy.
Our data show that the profile of the patients treated at the Clinic has changed in recent years. There was an increase in both the proportion of patients with other skin diseases and those who had visited only one health service prior to our Clinic. Among the total 1,845 cases analyzed, the outcomes of 1,380 were linked to other diseases and, in 74% of these cases, a biopsy was not necessary to reach a diagnostic conclusion. A decrease in new leprosy case detection among our patients was also observed. Yet, among the leprosy patients, 40% had some degree of disability at diagnosis.
The results of the present study demonstrated the importance of referral centers in support of basic health services within the decentralization strategy. But, the success of the program depends on the advent of new developmental tools to augment diagnostic accuracy for leprosy. However, it should be emphasized that for new diagnostic methods to be developed, a greater commitment on the part of the health care system regarding research is urgently needed.
我们评估了转诊至位于里约热内卢州里约热内卢市的Fiocruz门诊诊所的患者情况，该诊所是麻风病诊断和治疗的参考中心，并分析了这些转诊的来源和结果。
这是一项基于从巴西里约热内卢州里约热内卢市Fiocruz麻风病实验室数据库收集的信息的观察性回顾性研究。纳入了2010年至2014年期间在该参考中心检查的总共1845例疑似麻风病病例。分析了转诊的起始卫生服务机构和诊断结果，以及确诊为麻风病患者的临床和流行病学数据。
我们的数据显示，近年来在该诊所接受治疗的患者情况有所变化。患有其他皮肤病的患者比例以及在来我们诊所之前仅去过一家卫生服务机构的患者比例均有所增加。在总共分析的1845例病例中，1380例的诊断结果与其他疾病有关，其中74%的病例无需活检即可得出诊断结论。我们还观察到患者中新发麻风病病例的检出率有所下降。然而，在麻风病患者中，40%在诊断时存在一定程度的残疾。
本研究结果证明了转诊中心在分权战略中支持基本卫生服务的重要性。但是，该项目的成功取决于新的发展工具的出现，以提高麻风病的诊断准确性。然而，应该强调的是，要开发新的诊断方法，医疗保健系统迫切需要在研究方面做出更大的努力。
