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RESUMO - Introdução: O livre acesso e circulação (LAC) no Serviço Nacional de Saúde (SNS) alterou o paradigma do acesso aos cuidados de saúde, permitindo ao utente em conjunto com o médico de família responsável pela referenciação optar por qualquer uma das unidades hospitalares do SNS onde exista a consulta de especialidade de que necessita. O presente trabalho tem como objetivo principal avaliar o efeito da implementação da medida do livre acesso e circulação nos pedidos de consulta e nas listas/tempos de espera do Centro Hospitalar São João (CHSJ).
Metodologia: Realizou-se um estudo observacional, descritivo com recolha de informação retrospetiva sobre uma amostra de 283.308 pedidos de primeira consulta de especialidade hospitalar referenciados pelos Cuidados de Saúde Primários (CSP), via Sistema de Informação de Consulta a Tempo e Horas (SICTH).
Resultados: Com a entrada em vigor do LAC, o CHSJ aumentou os pedidos de primeira consulta hospitalar referenciados pelos CSP, via SICTH, em 12,5%. O número de pedidos de primeira consulta de especialidade de utentes com proveniência fora da área de referência do CHSJ, em 2017, representava 26,4%, registando um aumento de 21.233 pedidos face a 2015.
À data de 31 de dezembro de 2017 havia mais 18.560 (+64,4%) utentes que aguardavam uma primeira consulta de especialidade no CHSJ, referenciados pelos CSP, face a 2015. O tempo médio de espera para uma primeira consulta de especialidade aumentou em 67 dias.
As especialidades que registaram maior aumento da procura de utentes com proveniência fora da área de referência foram Ortopedia, Oftalmologia, Otorrinolaringologia, Cirurgia Geral e Dermatologia.
Conclusão: O presente estudo mostrou que a medida teve um impacto na procura do CHSJ. Em 2017, a Instituição teve um aumento substancial da procura de primeira consulta de especialidade em resultado dos pedidos com origem fora da sua área de referência. Do aumento da procura adveio um agravamento dos tempos médios de espera, na maioria das especialidades e uma grande percentagem de primeiras consultas realizadas em 2017 estiveram acima do tempo máximo de resposta garantido (TMRG). O aumento da procura foi superior ao aumento da produção originando uma deterioração dos indicadores de acesso à consulta.
ABSTRACT - Introduction: Freedom of choice within the Portuguese National Health Service (SNS) allowed that patients, in agreement with their family physician, choose to be referred to any of the NHS hospitals, irrespective of their area of residence. This work aims at evaluating the effect of this measure on consultations requests and waiting times/lists of the São João Hospital Centre (CHSJ). Methodology: Observational and descriptive study, with collection of retrospective information from a sample of 283,308 requests for first medical consultations referred by the primary health care, via the Information System of Timely Consults (SI CTH). Results: The number of requests for first medical consultation referred by primary care, via SI CTH, increased by 12.5%. In 2017, the number of first specialty consultations requests, from patients out of the referral area, experienced a 26.4% increase, with 21,233 additional requests in comparison with 2015. By the 31st of December 2017, there were more than 18,560 (+64.4%) patients waiting for their first medical consultation referred by primary care, when compared to those in 2015. The average waiting time for a first medical consultation increased by 67 days. Orthopedics, Ophthalmology, Otorhinolaryngology, General Surgery and Dermato-venereology were the specialties that registered the highest growth in demand from patient out of the referral area. Conclusions: This study shows that the new policy had an impact on demand to the CHSJ. In 2017, the hospital suffered a substantial rise in demand for first specialty medical consultations, as a result of requests from patients out of the referral area. This rise of demand caused an aggravation of average waiting times for most specialties and a large number of first consultations were above the Guaranteed Maximum Answer Time. The increase of demand was larger than the increase of production, causing deterioration in consultation access indicators.
ABSTRACT - Introduction: Freedom of choice within the Portuguese National Health Service (SNS) allowed that patients, in agreement with their family physician, choose to be referred to any of the NHS hospitals, irrespective of their area of residence. This work aims at evaluating the effect of this measure on consultations requests and waiting times/lists of the São João Hospital Centre (CHSJ). Methodology: Observational and descriptive study, with collection of retrospective information from a sample of 283,308 requests for first medical consultations referred by the primary health care, via the Information System of Timely Consults (SI CTH). Results: The number of requests for first medical consultation referred by primary care, via SI CTH, increased by 12.5%. In 2017, the number of first specialty consultations requests, from patients out of the referral area, experienced a 26.4% increase, with 21,233 additional requests in comparison with 2015. By the 31st of December 2017, there were more than 18,560 (+64.4%) patients waiting for their first medical consultation referred by primary care, when compared to those in 2015. The average waiting time for a first medical consultation increased by 67 days. Orthopedics, Ophthalmology, Otorhinolaryngology, General Surgery and Dermato-venereology were the specialties that registered the highest growth in demand from patient out of the referral area. Conclusions: This study shows that the new policy had an impact on demand to the CHSJ. In 2017, the hospital suffered a substantial rise in demand for first specialty medical consultations, as a result of requests from patients out of the referral area. This rise of demand caused an aggravation of average waiting times for most specialties and a large number of first consultations were above the Guaranteed Maximum Answer Time. The increase of demand was larger than the increase of production, causing deterioration in consultation access indicators.
Descrição
Trabalho Final do Curso de Especialização em Administração Hospitalar
Palavras-chave
Liberdade de escolha Tempos de espera Acesso Free of choice Waiting time Access
Contexto Educativo
Citação
Editora
Universidade Nova de Lisboa, Escola Nacional de Saúde Pública