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Quality of referrals from the primary health care to a dermatology service

Abstract

Background

Dermatologic complaints are frequent, and are the most frequent diagnoses performed by non-specialist doctors.

Objective

This study aimed to analyze the proportion of patients referred to dermatology who could have received treatment in Primary Health Care (PHC), and the degree of agreement between the referral diagnoses of PHC physician and the diagnosis of the dermatologist.

Method

This is a retrospective and quantitative study. The team collected data from 194 medical records between 2014 and 2015. Kappa coefficient was used to calculate the degree of agreement, with a significance level of 5%.

Results

The mean age was 46.7 years (SD=17.9), most of them women. The most frequent diagnostic hypotheses made by the PHC physician were desquamative erythematous diseases (8.0%) and skin cancer (6.0%). There was no completion of the referral diagnosis in 40.3% of the cases. The most frequent diagnoses made by the dermatologist were premalignant lesions (15.6%) and benign tumors (12.4%). The proportion of referrals that could have been treated in primary care was 37.1%. The diagnostic agreement was moderate (Kapa coefficient).

Conclusion

These findings suggest difficulties in the diagnosis of skin diseases referenced to the dermatologist.

Keywords:
Primary Health Care; skin disease; referral

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E-mail: cadernos@iesc.ufrj.br