Pinto Luiz Felipe, Soranz Daniel, Scardua Mariana Tomasi, Silva Iandara de Moura
Departamento de Medicina da Família e Comunidade, Faculdade de Medicina, UFRJ. Rua Laura Araújo nº 36, 2º andar, Cidade Nova. 20211-170. Rio de Janeiro RJ Brasil.
Escola Nacional de Saúde Pública, Fiocruz. Rio de Janeiro RJ Brasil.
Cien Saude Colet. 2017 Apr;22(4):1257-1267. doi: 10.1590/1413-81232017224.26422016.
Federalism is basis of the Republic of Brazil which is made up of the union of states, municipalities and the Federal District, with the basic principle of political and administrative decentralization in all political, economic and social relations. In the health sector, the primary health care provider should be able to integrate all care that the patient receives through the coordination of health services. This article aims to evaluate the results of referrals for consultations and outpatient examinations in primary health care in the municipality of Rio de Janeiro, highlighting the advances, limitations and challenges for management at the local level. A quantitative study was designed using administrative databases from the Registry of National Health Establishments (CNES), the National Regulatory System (SISREG), and a linkage between them. Between 2011 and 2015, the number of scheduled procedures increased by 86%, reflecting the decentralization of outpatient regulation for family doctors. It can be inferred that there is no shortage of specialists for outpatient care in the city in almost all areas. There are actually artificial bottlenecks that arise as a result of the lack of regulation of most of the workload contracted in specialist areas, that is, the number of vacancies is smaller than the capacity of health services available in health units at the municipal, state, federal levels and those contracted by the Unified Health System (SUS).
联邦制是巴西共和国的基础，巴西由各州、市和联邦区组成，在所有政治、经济和社会关系中遵循政治和行政权力下放的基本原则。在卫生部门，初级卫生保健提供者应能够通过协调卫生服务，整合患者接受的所有护理。本文旨在评估里约热内卢市初级卫生保健中会诊和门诊检查转诊的结果，突出地方层面管理的进展、局限性和挑战。利用国家卫生机构登记处（CNES）、国家监管系统（SISREG）的行政数据库以及它们之间的关联，设计了一项定量研究。2011年至2015年期间，预定程序的数量增加了86%，这反映了家庭医生门诊监管的权力下放。可以推断，该市几乎所有领域的门诊护理专家并不短缺。实际上，由于专科领域承包的大部分工作量缺乏监管，出现了人为瓶颈，即空缺职位数量少于市、州、联邦各级卫生单位以及统一卫生系统（SUS）承包的卫生服务能力。
