Guerra Sofia, Martelli Petrônio José de Lima, Dubeux Luciana Santos, Marques Pedro, Samico Isabella Chagas
Grupo de Estudos em Gestão e Avaliação em Saúde, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brasil.
Universidade Federal de Pernambuco, Recife, Brasil.
Cad Saude Publica. 2022 May 30;38(5):e00262921. doi: 10.1590/0102-311XPT262921. eCollection 2022.
This study analyzed the views of physicians towards coordination of clinical management between different levels of care. This was a cross-sectional quantitative study using data from a survey of 182 physicians in primary healthcare (PHC) and specialized care in Recife, Pernambuco State, Brazil, in 2017. The results revealed significant differences in the physicians' experience. Considering referrals, the majority (81.32%) felt that PHC physicians referred patients to specialized care when necessary, and the proportion was higher in PHC physicians themselves (92.73%). As for agreement, two-thirds of PHC physicians (67.27%) reported that they agreed with the treatment prescribed by the specialist, while only 33.86% of the specialists agreed with the PHC physician. Concerning clinical responsibility, 89.09% of PHC physicians reported that they were clinically responsible for the patient, compared to only 43.31% of the specialists. As for recommendations, most of the interviewees (63.19%) felt that the specialists did not issue recommendations, and this proportion was higher among PHC physicians (81.82%). For waiting time, the majority (82.42%) felt that patients waited too long for appointments in specialized care, and the proportion was higher among PHC physicians (98.18%) than among specialists (75.59%). Only 16.36% of PHC physicians felt that waiting time was too long in PHC, compared to 38.58% of the medical specialists. The study's results are consistent with similar studies and highlight the need to strengthen coordination between levels of care to achieve effective integration in healthcare networks.
本研究分析了医生对不同医疗级别之间临床管理协调的看法。这是一项横断面定量研究，使用了2017年对巴西伯南布哥州累西腓市基层医疗（PHC）和专科护理领域182名医生的调查数据。结果显示医生的经验存在显著差异。在转诊方面，大多数（81.32%）认为基层医疗医生在必要时会将患者转诊至专科护理，基层医疗医生自身的这一比例更高（92.73%）。在意见一致方面，三分之二的基层医疗医生（67.27%）报告称他们同意专科医生开出的治疗方案，而只有33.86%的专科医生同意基层医疗医生的方案。关于临床责任，89.09%的基层医疗医生报告称他们对患者负有临床责任，相比之下专科医生中只有43.31%这样认为。在建议方面，大多数受访者（63.19%）认为专科医生没有给出建议，基层医疗医生中的这一比例更高（81.82%）。在等待时间方面，大多数（82.42%）认为患者在专科护理中等待预约的时间过长，基层医疗医生中的这一比例（98.18%）高于专科医生（75.59%）。只有16.36%的基层医疗医生认为基层医疗中的等待时间过长，而医疗专科医生中的这一比例为38.58%。该研究结果与类似研究一致，并强调需要加强不同医疗级别之间的协调，以实现医疗网络的有效整合。
