Adequação dos pedidos de primeira consulta de Oftalmologia

Abstract

In the Portuguese National Health Service, General Practice is usually the first medical contact of the patient at primary health care level and the gateway for referral to other medical and surgical specialties. This referral process is complex and susceptible to errors, due to the frequent absence of guidelines. Thus, the aim of this study was to evaluate the referral process made by General Practice physicians to Ophthalmology. In this cross-sectional observational study, the electronic clinical records of 1,500 randomly selected first appointments of the Ophthalmology Department of the Centro Hospitalar Universitário do São João, and their respective P1 requests were analysed, out of a total of 9340 first appointments of the year 2019, and information was collected on the priority of the request, reason for the appointment, symptoms, signs, diagnoses, and clinical orientation. No predictor of the type of P1 priority was identified, namely regarding the patient's signs and symptoms or diagnosis suspected by the General Practitioners in the P1 request. A general lack of concordance was also observed between the signs and symptoms referred in the P1 request and those identified in the consultation. This study reinforces the need for the creation of objective protocols that help General Practitioners in decision making when referring patients to Ophthalmology, regarding the priority of the requests, as well as the destination of the referral (outpatient consultation or emergency department), in order to make the whole process more cost-effective, maximize available healthcare and ensure patient satisfaction.