Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Maracanã, Brazil.
Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden.
BMJ Open. 2022 Feb 15;12(2):e051515. doi: 10.1136/bmjopen-2021-051515.
To measure the effect that residency training in family medicine (RTFM) has on continuity and coordination of care.
Observational cohort study using electronic health records.
Rio de Janeiro, Brazil, public primary care system.
504 940 patients, 633 generalists (physicians without RTFM) and 204 family physicians (FP-doctors with 2 years of RTFM) from one health district between January 2015 and December 2018.
Two years of RTFM.
Relative risks of patients being referred to secondary care for outpatient consultations and diagnostics tests; and having a follow-up medical consultation in primary care within 3 and 6 months after being referred.
We examined 2 414 508 medical consultations and 284 754 referrals to secondary care. FPs were less likely to request ambulatory care services (including surgical specialties), but were more likely to request ophthalmology, physiotherapy, rehabilitationand surgical evaluations for their patients. Patients referred to secondary care by FPs were more likely to have a follow-up visit in primary care for almost every service requested. If all medical consultations were performed by FPs, a 37.6% (95% CI 32.4% to 42.4%) increased demand for rehabilitation services would be noticed. Oppositely, 1532 (95% CI 1458 to 1602) fewer requests for dermatology would happen every year.
RTFM improves coordination and continuity of care by making FPs more competent to retain those health conditions that can be properly managed in primary care and making FPs more competent to detect health conditions that require specific biomedical technologies and skills, increasing the demand for those services. Besides, it increases the chances of patients having follow-up visits in primary care. Policy-makers in low-income and middle-income countries must consider investing in RTFM to make primary care systems more comprehensive, with better coordination and continuity of care.
衡量家庭医学住院医师规范化培训（RTFM）对医疗照护连续性和协调性的影响。
使用电子健康记录的观察性队列研究。
巴西里约热内卢，公共初级保健系统。
2015 年 1 月至 2018 年 12 月间，一个卫生区的 504940 名患者，633 名全科医生（未经 RTFM 培训的医生）和 204 名家庭医生（接受过 2 年 RTFM 培训的 FP 医生）。
接受 2 年 RTFM 培训。
患者转诊至二级医疗机构接受门诊咨询和诊断性检查的相对风险；以及转诊后 3 个月和 6 个月内在初级保健机构进行随访医疗咨询的相对风险。
我们共评估了 2414508 次医疗咨询和 284754 次转诊至二级医疗机构的情况。FP 医生不太可能要求提供门诊服务（包括外科专科），但更有可能为患者请求眼科、物理治疗、康复和外科评估。FP 医生转诊至二级医疗机构的患者更有可能在初级保健机构进行几乎所有的服务随访。如果所有的医疗咨询都由 FP 医生进行，康复服务的需求将增加 37.6%（95%CI：32.4%至 42.4%）。相反，每年将减少 1532 次（95%CI：1458 至 1602 次）皮肤科的就诊需求。
RTFM 通过使 FP 医生更有能力保留那些可以在初级保健机构得到适当管理的健康状况，并使 FP 医生更有能力发现需要特定的生物医学技术和技能的健康状况，从而提高这些服务的需求，从而改善医疗照护的协调性和连续性。此外，它增加了患者在初级保健机构进行随访的机会。低收入和中等收入国家的政策制定者必须考虑投资 RTFM，以使初级保健系统更加全面，提高医疗照护的协调性和连续性。
