Role of University Hospital in the rheumatological care network

ABSTRACT The objectives of this paper was to describe and analyze the role of a University Hospital in the Health Care Network for rheumatological patients of Pernambuco state. A transversal study with qualitative and quantitative approach was carried out. Key-informants from the Health State Secretary and Clinical Hospital of the Federal University of Pernambuco were interviewed. Secondary data were extracted from the National Registry of Health Establishments. In 2016, 4.530 patients with Rheumatologic Diseases were treated at the hospital, mean age of 52 years old, mostly women (79%), from 164 municipalities in Pernambuco with concentration in the 1st health region. Patients’ admission is regulated, with an access protocol to evaluate profile and indicate subspecialty of care in rheumatology. There is a single protocol in the hospital and laboratory and some imaging tests are assured; there is infusion of immunosuppressants in the service, when clinically indicated. As weaknesses, high absenteeism and difficulties in sharing care with primary care are pointed out, despite the high responsibility adopted. The University Hospital analyzed seems to fulfill its institutional mission and functionality, giving resolution to the cases for which it becomes responsible and filling, often, the assistance gaps of the average complexity of the Unified Health System.

摘要 本研究旨在描述并分析伯南布哥州某大学附属医院在该州风湿病患者医疗保健网络中的职能定位。本研究采用横断面研究设计，结合定性与定量研究方法，访谈了来自伯南布哥州卫生厅及伯南布哥联邦大学临床医院的关键知情人，并从国家卫生机构登记处获取了二手研究数据。2016年，该医院共收治风湿病患者4530例，患者平均年龄为52岁，其中女性占比79%，患者来自伯南布哥州164个市镇，且主要集中在第一卫生服务区。患者入院流程受规范管理，设有准入协议以评估患者病情并明确风湿病亚专科诊疗方向。该医院制定了统一的诊疗流程，可保障实验室检测与部分影像学检查服务；当临床指征明确时，可在科室开展免疫抑制剂输注治疗。尽管医院承担了较高的诊疗职责，但研究仍指出其存在两项主要短板：一是患者缺勤率偏高，二是与基层医疗机构的诊疗协作存在障碍。本研究分析的这所大学附属医院似乎已切实履行了其机构使命与职能：不仅妥善处置了其权责范围内的诊疗病例，还时常填补了统一卫生系统（Unified Health System）中平均复杂度层级的医疗服务缺口。