Do family doctors refer less? Impact of FCM training on the rate of PHC referrals

Rebolho, Ricardo Collar; Poli Neto, Paulo; Pedebôs, Lucas Alexandre; Garcia, Leandro Pereira; Vidor, Ana Cristina

doi:10.1590/1413-81232021264.06672019

Ricardo Collar Rebolho

Secretaria Municipal de Saúde de Florianópolis. Av. Prof. Henrique da Silva Fontes 6100, Trindade. 88036-700 Florianópolis SC Brasil. ricardo_rebolho@hotmail.com

http://orcid.org/0000-0002-7797-8037

Paulo Poli Neto

Departamento de Saúde Comunitária, Universidade Federal do Paraná. Curitiba PR Brasil.

http://orcid.org/0000-0003-1073-6583

Lucas Alexandre Pedebôs

Secretaria Municipal de Saúde de Florianópolis. Av. Prof. Henrique da Silva Fontes 6100, Trindade. 88036-700 Florianópolis SC Brasil. ricardo_rebolho@hotmail.com

http://orcid.org/0000-0001-6663-352X

Leandro Pereira Garcia

Secretaria Municipal de Saúde de Florianópolis. Av. Prof. Henrique da Silva Fontes 6100, Trindade. 88036-700 Florianópolis SC Brasil. ricardo_rebolho@hotmail.com

http://orcid.org/0000-0002-8601-7166

Ana Cristina Vidor

Secretaria Municipal de Saúde de Florianópolis. Av. Prof. Henrique da Silva Fontes 6100, Trindade. 88036-700 Florianópolis SC Brasil. ricardo_rebolho@hotmail.com

http://orcid.org/0000-0003-2518-6414

Collaborations

RC Rebolho was responsible for designing the work, reviewing the literature, collecting and analyzing data and writing the manuscript. P Poli Neto contributed to the bibliographic review, work design and revised the final version to be published.LA Pedebôs contributed to the collection and analysis of data and writing of the final manuscript. LP Garcia contributes to data analysis and writing the final manuscript. AC Vidro contributed to the conception of the work, data analysis and revised the final version to be published.

Chief Editors: Romeu Gomes, Antônio Augusto Moura da Silva

	Total (n=123)	Non FCM (n=47)	Residency (n=59)	p	Degree (n=17)	p
Doctors
Women	71(57.72%)	33(70.21%)	29(49.15%)	0.029	9(52.94%)	0.199
Age	40.43(10.41)	40.07(12.95)	37.14(6.82)	0.003	44.76(9.95)	0.626
Patients
Proportion of women	61.32(2.62)	61.79(2.36)	60.71(2.59)	0.03	62.14(3.06)	0.627
Age	40.27(4.10)	40.64(3.88)	39.2(3.80)	0.057	42.97(4.53)	0.047
Service
IBGE population	3756(1768)	3593(1171)	3395(1141)	0.383	5458(3399)	0.002
Working Population	2374(823)	2404(925)	2326(760)	0.636	2459(767)	0827

	Rate of Referrals (%)	r	95% CI	p
Doctors
Non-FCM (standard population)	10.92
Residency	8.06		(1.55;4.17)	<0.0001
Degree	11.04		(-2.25;2.02)	0.916
Men X Woman	8.76 X 10.16		(0.05;2.74)	0.042
Age		0.26		0.003
Patients
Proportion of women in the population		0.28		0.002
Age		0.36		<0.0001
Service
IBGE population		0.08		0.361
Working population		0.14		0.119

Variables	β_{1 crude} (95% CI)	p	β_{1 adjusted} (95% CI)	p

Gender of doctors
Female	1
Male	-1.26 (-2.60;0.05)		0.06
Mean age of doctors	0.10 (0.04;0.16)	< 0.01	0.06 (0.002;0.12)	0.04
Medical Residency
No	1		1
Yes	-2.75 (-4.00;-1.50)	< 0.01	-1.89 (-3.16;-0.62)	< 0.01
Population
Proportion women	0.36 (0.11;0.60)	< 0.01
Mean age	0.30 (0.14;0.45)	< 0.01	0.22 (0.07;0.37)	< 0.01
Service
IBGE population	0.0003 (-0.0002;0.0007)	0.25
Working population	0.0008 (-0.00004;0.002)	0.06

	Total	Non-FCM	Residency	Degree	p
Ophthalmology	29.41%	26.19%	32.42%	27.89%	< 0.0001
Orthopedics	6.99%	7.34%	6.67%	7.09%	0.63
Gynecology	6.54%	7.02%	5.42%	9.07%	0.003
Cardiology	5.85%	6.32%	5.54%	5.60%	0.432
Otorhinolaryngology	4.66%	4.66%	4.88%	3.91%	0.269
Small Surgeries	4.64%	5.16%	4.24%	4.61%	0.203
Dermatology	4.58%	4.32%	4.81%	4.47%	0.68
Urology	4.13%	4.37%	4.04%	3.77%	0.473
Vascular surgery	3.62%	3.64%	3.68%	3.33%	0.755
Neurology	3.27%	3.61%	2.99%	3.27%	0.204
General surgery	3.27%	3.09%	3.51%	2.95%	0.368
Acupuncture	3.06%	2.80%	3.26%	3.09%	0.744
Endocrinology	2.44%	2.39%	2.33%	3.00%	0.253
Infectology	2.05%	2.12%	2.00%	2.05%	0.926
Proctology	1.98%	1.90%	2.09%	1.88%	0.73
Psychiatry	1.86%	2.57%	1.16%	2.35%	0.018
Gastroenterology	1.61%	1.84%	1.50%	1.38%	0.313
Obstetrics / High Risk Pregnancy	1.49%	1.44%	1.50%	1.65%	0.85
Rheumatology	1.46%	1.49%	1.37%	1.64%	0.65
Pneumology	1.44%	1.45%	1.39%	1.56%	0.891
Ophthalmology / Pediatrics	1.42%	1.28%	1.59%	1.25%	0.397
Mastology	1.19%	1.09%	1.17%	1.55%	0.343
Pediatrics / Otorhinolaryngology	1.16%	1.44%	1.05%	0.78%	0.085
Nephrology	0.96%	0.95%	0.97%	0.99%	0.986
Pediatrics	0.91%	1.56%	0.41%	0.88%	0.005

[1] Collaborations

RC Rebolho was responsible for designing the work, reviewing the literature, collecting and analyzing data and writing the manuscript. P Poli Neto contributed to the bibliographic review, work design and revised the final version to be published.LA Pedebôs contributed to the collection and analysis of data and writing of the final manuscript. LP Garcia contributes to data analysis and writing the final manuscript. AC Vidro contributed to the conception of the work, data analysis and revised the final version to be published.

Brasil

Brasil

Do family doctors refer less? Impact of FCM training on the rate of PHC referrals

Abstract