Resolubilidade de problemas visuais em um serviço terciário triados por uma unidade móvel oftalmológica
Arquivos
Data
2017-08-17
Autores
Ferreira, Gabriel de Almeida [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: No Brasil o Sistema Único de Saúde (SUS) é responsável por prover assistência universal a saúde para toda a população. Contudo, o acesso ao atendimento oftalmológico é sabidamente deficitário. As Unidades Móveis Oftalmológicas (UMO) podem facilitar o acesso ao atendimento oftalmológico à população, sendo importante a interface com o serviço terciário, para onde devem ser referenciados os casos mais complexos e os que exigem tratamento cirúrgico. Objetivo: Verificar a efetividade do atendimento oftalmológico realizado em um centro de referência após triagem oftalmológica realizada pela UMO. Materiais e Métodos: Estudo prospectivo realizado com pacientes atendidos em 10 municípios do centro-oeste paulista em 2015. Os pacientes passaram por consulta oftalmológica completa na UMO e os com necessidade de procedimentos ou avaliações complementares foram encaminhados ao centro de referência da região, o Hospital das Clínicas de Botucatu (HCFMB). As informações dos pacientes encaminhados foram pesquisadas no prontuário eletrônico da instituição para verificar o comparecimento, tempo até a consulta, tratamento realizado e complicações. Além disso, foram utilizados dados demográficos do Instituto Brasileiro de Geografia e Estatística. Análise estatística realizada no SPSS 22.0, considerado significativo p<0,05. Resultados: Foram atendidos 1928 indivíduos pela UMO, sendo encaminhados 714 (37,0%) ao serviço especializado. A média de idade dos encaminhados foi 57,12±19,53 anos, sendo 59,9% do gênero feminino, com acuidade visual (AV) corrigida no melhor olho de 0,37±0,36 logMAR, sendo 47 (6,6%) cegos e 185 (26,5%) deficientes visuais, com maior prevalência nos mais idosos. O maior número de encaminhamentos foi ao ambulatório de catarata (48,6%) seguido pelo ambulatório de Plástica Ocular/Doenças Externas (28,3%), sendo o principal diagnóstico a catarata (44,7%) seguido por pterígio (14,7%). Dos pacientes encaminhados, 67,1% efetivamente compareceram ao serviço especializado, nos quais houve concordância do diagnóstico em 88,5% dos casos. Houve maior prevalência de cegos e deficientes visuais dentre os que compareceram, além de serem provenientes de municípios mais distantes, com maior número de habitantes e com mais oftalmologistas (p<0,05). O tratamento foi considerado concretizado em 65,6% dos pacientes, sendo a principal causa de não concretização a perda de seguimento (50,7%). Foram realizadas 313 cirurgias de catarata, com redução de 20 para 2 cegos e de 87 para 2 deficientes visuais (p<0,001). Conclusão: A taxa de comparecimento de pacientes encaminhados diretamente de uma UMO a um serviço especializado foi de 67,1%, com resolubilidade completa em 65,5% dos casos. Houve melhora significativa da AV e redução da prevalência de cegos e deficientes visuais após as cirurgias realizadas.
Introduction: In Brazil, the public health care (Sistema Único de Saúde - SUS) is responsible for providing universal health care for the entire population. However, access to ophthalmologic care is known to be deficient. Ophthalmologic Mobile Units (OMU) can facilitate access to ophthalmological services to the population, and it is important to interface with the tertiary service, where the more complex cases and those requiring surgical treatment should be referenced. Objective: To verify the effectiveness of ophthalmologic care performed at a reference center after ophthalmologic screening performed by the UMO. Materials and Methods: A prospective study was carried out with patients seen in 10 municipalities in the center-west of São Paulo in 2015. Patients underwent a complete ophthalmologic consultation in the OMU and those who needed complementary procedures or evaluations were referred directly to the to the reference center of the region, the Hospital das Clínicas de Botucatu (HCFMB). The information of the referred patients was searched in the electronic medical record of the institution to verify attendance, time to consultation, treatment performed and complications. In addition, demographic data from the Brazilian Institute of Geography and Statistics was used. Statistical analysis performed in SPSS 22.0, considered significant p <0.05. Results: 1928 individuals were attended by the UMO and 714 (37.0%) were referred to the specialized service. The mean age of the patients referred was 57.12±19.53 years, 59.9% of the female gender, with best corrected visual acuity (BCVA) of 0.37 ± 0.36 logMAR, of which 47 (6, 6%) blind and 185 (26.5%) visually impaired, with higher prevalence in the elderly. The highest number of referrals was to the cataract sub-specialty (48.6%) followed by the Ocular Plastic Surgery (28.3%), the main diagnosis was cataract (44.7%) followed by pterygium (14.7%). Of the referred patients, 67.1% actually attended the specialized service, in which the diagnosis was agreed in 88.5% of the cases. There was a higher prevalence of the blind and visually impaired among those who attended, besides coming from more distant municipalities, with more inhabitants and more ophthalmologists (p <0.05). The treatment was considered accomplished in 65.6% of the patients, being the main cause of non-accomplishment the loss of follow-up (50.7%). A total of 313 cataract surgeries were performed, ranging from 20 to 2 blind and 87 to 2 visually impaired (p <0.001). Conclusion: The attendance rate of patients referred directly from a UMO to a specialized service was 67.1%, with complete resolubility in 65.5% of the cases. There was a significant improvement in VA and a reduction in the prevalence of the blind and visually impaired after the surgeries.
Introduction: In Brazil, the public health care (Sistema Único de Saúde - SUS) is responsible for providing universal health care for the entire population. However, access to ophthalmologic care is known to be deficient. Ophthalmologic Mobile Units (OMU) can facilitate access to ophthalmological services to the population, and it is important to interface with the tertiary service, where the more complex cases and those requiring surgical treatment should be referenced. Objective: To verify the effectiveness of ophthalmologic care performed at a reference center after ophthalmologic screening performed by the UMO. Materials and Methods: A prospective study was carried out with patients seen in 10 municipalities in the center-west of São Paulo in 2015. Patients underwent a complete ophthalmologic consultation in the OMU and those who needed complementary procedures or evaluations were referred directly to the to the reference center of the region, the Hospital das Clínicas de Botucatu (HCFMB). The information of the referred patients was searched in the electronic medical record of the institution to verify attendance, time to consultation, treatment performed and complications. In addition, demographic data from the Brazilian Institute of Geography and Statistics was used. Statistical analysis performed in SPSS 22.0, considered significant p <0.05. Results: 1928 individuals were attended by the UMO and 714 (37.0%) were referred to the specialized service. The mean age of the patients referred was 57.12±19.53 years, 59.9% of the female gender, with best corrected visual acuity (BCVA) of 0.37 ± 0.36 logMAR, of which 47 (6, 6%) blind and 185 (26.5%) visually impaired, with higher prevalence in the elderly. The highest number of referrals was to the cataract sub-specialty (48.6%) followed by the Ocular Plastic Surgery (28.3%), the main diagnosis was cataract (44.7%) followed by pterygium (14.7%). Of the referred patients, 67.1% actually attended the specialized service, in which the diagnosis was agreed in 88.5% of the cases. There was a higher prevalence of the blind and visually impaired among those who attended, besides coming from more distant municipalities, with more inhabitants and more ophthalmologists (p <0.05). The treatment was considered accomplished in 65.6% of the patients, being the main cause of non-accomplishment the loss of follow-up (50.7%). A total of 313 cataract surgeries were performed, ranging from 20 to 2 blind and 87 to 2 visually impaired (p <0.001). Conclusion: The attendance rate of patients referred directly from a UMO to a specialized service was 67.1%, with complete resolubility in 65.5% of the cases. There was a significant improvement in VA and a reduction in the prevalence of the blind and visually impaired after the surgeries.
Descrição
Palavras-chave
Serviços de saúde ocular, Cegueira, Resultado do tratamento, Acesso aos serviços de saúde, Eye health services, Blindness, Treatment outcome, Health services accessibility