Chueiri Patricia S, Gonçalves Marcelo Rodrigues, Hauser Lisiane, Wollmann Lucas, Mengue Sotero Serrate, Roman Rudi, Rodrigues Agostinho Rech Milena, Soares Marcelo de Araújo Vianna, Pertile Jamily, Harzheim Erno
School of Medicine, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo.
School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre.
Fam Pract. 2020 Oct 19;37(5):648-654. doi: 10.1093/fampra/cmaa029.
Primary health care (PHC) delivery in Brazil has improved in the last decades. However, it remains unknown whether the Family Health Strategy teams are meeting the health needs of the population.
To describe the reasons for encounter (RFEs) in PHC in Brazil and to examine variations in RFEs according to sex, age and geographic region.
This descriptive study is part of a national cross-sectional study conducted in 2016. The sample was stratified by the number of PHC physicians per geographic region. Physicians who had been working for at least 1 year in the same PHC unit were included. For every participating physician, 12 patients aged ≥18 years who had attended at least two encounters were included. Patients were asked about their RFEs, which were classified according to the International Classification of Primary Care.
In 6160 encounters, a total of 8046 RFEs were coded. Seven reasons accounted for 50% of all RFEs. There was a high frequency of codes related to test results, medication renewal and preventive medicine. RFEs did not vary significantly by sex or geographic region, but they did by age group (P < 0.001). The rates of prescriptions, requests for investigations and referrals to specialized care were 71.1%, 42.8%, and 21.3%, respectively.
This novel study opened the 'black box' of RFEs in PHC in Brazil. These findings can contribute to redefining the scope of PHC services and reorienting work practices in order to improve the quality of PHC in Brazil.
在过去几十年里，巴西的初级卫生保健（PHC）服务有所改善。然而，家庭健康战略团队是否满足了民众的健康需求仍不明确。
描述巴西初级卫生保健中的就诊原因（RFEs），并根据性别、年龄和地理区域检查就诊原因的差异。
这项描述性研究是2016年进行的一项全国横断面研究的一部分。样本按每个地理区域的初级卫生保健医生数量进行分层。纳入在同一初级卫生保健单位工作至少1年的医生。对于每位参与研究的医生，纳入12名年龄≥18岁且至少就诊过两次的患者。询问患者他们的就诊原因，并根据国际初级保健分类进行分类。
在6160次就诊中，共编码了8046条就诊原因。七个原因占所有就诊原因的50%。与检查结果、药物续订和预防医学相关的编码频率较高。就诊原因在性别或地理区域上没有显著差异，但在年龄组上有差异（P<0.001）。处方率、检查请求率和转诊至专科护理的比率分别为71.1%、42.8%和21.3%。
这项新研究打开了巴西初级卫生保健中就诊原因的“黑匣子”。这些发现有助于重新界定初级卫生保健服务的范围，并重新调整工作方式，以提高巴西初级卫生保健的质量。
