Main reasons for medical consultations in family healthcare units in the city of Recife, Brazil: a cross-sectional study

ABSTRACT CONTEXT AND OBJECTIVE: Only a few studies have focused on the main reasons for consultations at primary healthcare units within the Family Health Program. The aim here was to describe the reasons that led patients to seek assistance at four primary healthcare units in the city of Recife, Brazil. DESIGN AND SETTING: Cross-sectional study at primary healthcare units in the city of Recife. METHODS: Among adult patients who were consecutively attended at four primary healthcare units in the city of Recife, their two main reasons for going there were recorded by medical students. The students did not interfere in the consultation dynamics. The data were gathered between September 2010 and March 2011 and between November 2012 and August 2013. The reasons for the consultations were grouped into broader categories in accordance with the International Classification of Primary Care (ICPC-2). RESULTS: 478 patients were included. Their mean age was 45.9 years (± 16 years) and 71% were female. Pain was the main reason for seeking medical attention (34%), followed by evaluation of tests, prescription renewal and medical certificates (17.6%). The most frequent types of pain were musculoskeletal pain (15.7%), headache (10.4%) and abdominal pain (8%). The main reasons for consultation according to ICPC-2 were in the general and nonspecific, musculoskeletal, nervous system-related and digestive tract categories. CONCLUSION: Pain was the most frequent reason for seeking medical attendance at these primary healthcare units.


INTRODUCTION
The Family Health Program (Programa de Saúde da Família, PSF) is put into practice through multiprofessional teams that are based at primary care facilities.Recife is the capital of the state of Pernambuco, in the northeastern region of Brazil.PSF was the strategy used by Recife's Public Health Department to reorganize its primary care provision.Recife is divided in six healthcare districts.District I has nine family health teams; district II, 17 teams; district III, 22 teams; district IV, 32 teams; district V, 15 teams; and district VI, 31 teams.According to data from the Primary Care Information System (SIAB), more than 200,000 families had been registered for attendance through the PSF in Recife up to August 2013. 1ly a few studies have focused on the main reasons for seeking consultations at primary care units.[4] Knowing what kind of illnesses are treated by PSF teams is extremely important for training the teams and planning primary care, thereby making it possible to create a list of priorities and alternatives for solving these problems.

OBJECTIVE
The purpose of this article was to describe the most frequent reasons for seeking consultations at four primary care facilities in the city of Recife, Brazil.

METHODS
This study was carried out from September 2010 to March 2011 and from November 2012 to August 2013 in four primary care facilities in the city of Recife (Santo Amaro, in healthcare district I; Chié, in district II; Alto do Maracanã, in district III; and Sinos, in district IV).These units are linked to Pernambuco University and to the "Professor Fernando Figueira" Integral Medicine Institute, and they were chosen because of their availability of structural conditions for receiving undergraduates.
Patients over the age of 18 who were consecutively attended during the study periods, at medical consultations that had previously been scheduled at the four primary care facilities, were included.The statistical analysis was carried out using Epi-Info 7. 1.3.10   for Windows.All the variables were analyzed descriptively.Means and standard deviations were calculated for quantitative variables.Absolute and relative frequencies were calculated for qualitative variables.Categorical variables were compared across groups using the chi-square test.

RESULTS
The total number of patients seen at the primary care units over the study period was 481.Three patients refused to participate in the study.Thus, 478 patients were included in the study, of whom 338 (71%) were female.The patients' mean age was 45.9 years (± 16 years).
Table 1 shows the reasons for seeking consultations at the primary care units.Pain was the most commonly reported complaint at all the primary care facilities.Table 2. Association of patients' characteristics and primary care unit with the reasons for seeking the medical consultation (1.1%; 5/478).The most frequent types of musculoskeletal pain were back pain (33%) and joint pain (33%).
Table 2 shows the associations between the sociodemographic variables, primary care facilities and reasons for seeking consultations.Older individuals had significantly less pain and asked for more evaluations of tests, prescription renewals and medical certificates.Women had significantly more pain and more reasons for seeking consultations.
Table 3 shows the reasons for seeking consultations, grouped according to ICPC chapters.The most common reasons were in the categories of the "general and unspecific", "musculoskeletal", "neurological" and "digestive" chapters.

DISCUSSION
Pain was the most frequent reason for seeking consultations at primary care units, according to our study.Other authors have also found that pain is an important reason for seeking consultations at primary care units. 2,4Magnago et al. found a different result, but they used a structured questionnaire that did not include pain among its options. 6though pain is a frequent reason why patients seek medical consultations, it is not being properly evaluated and treated. 4If primary care teams are trained to diagnose the causes of pain and to provide treatment for this symptom, the demand among patients for healthcare at levels dealing with cases of higher complexity, as well as overloading of emergency services, can be avoided.
A significant number of patients went to the primary care unit to request prescription renewals and have tests evaluated.
This was concordant with what was found in other studies. 4,6,7en though hypertension had previously been found to be one of the most frequent reasons for consultations, its frequency in our study was lower than what we had expected.
With the aim of providing attendance for hypertension and diabetes mellitus patients, a reorganized attendance plan for these diseases, known as HIPERDIA, was created in 2002.
This made it possible to register and attend to these patients through primary care. 8Attendance for hypertension and diabetes patients at these units follows the program's enrollment flow, with participation in weekly meetings with multidisciplinary teams.At these meetings, the doctor renews and modifies prescriptions, talks about healthy habits and lifestyles in order to improve clinical control over these illnesses and answers questions.Patients are enrolled in the program after the diagnosis of diabetes or hypertension has been confirmed through an earlier appointment.Through this procedure, patients attended within The data were recorded by medical undergraduates who did not interfere in the consultation dynamics and did not ask the patients any questions.The patients' two main reasons for seeking the consultation were logged through an open questionnaire during the medical consultation, based on what was said to the doctor.The students were trained for three months before the beginning of the study.All the patients gave their informed consent for their inclusion in the study.The study was approved by the Research Ethics Committees of the "Professor Fernando Figueira" Integral Medicine Institute and of the Oswaldo Cruz University Hospital.The reasons for seeking medical consultations were grouped into broader categories in accordance with the 17 chapters of the second edition of the International Classification of Primary Care (ICPC-2). 5

Table 1 .
The kinds of pain reported by patients were as follows, in fre-Patients' most frequent reasons for seeking medical consultations at primary care units

Table 3 .
All reasons for seeking medical consultations grouped according to the 17 chapters of the International Classification of Primary Care (ICPC-2)