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Antecedentes: Las referencias permiten derivar usuarios y elementos diagnósticos de un establecimiento de salud (EESS) de menor a otro de mayor capacidad resolutiva. La Dirección de Redes Integradas de Salud (DIRIS) Lima Norte realizó un listado de diagnósticos no pertinentes de ser referidos a hospitales, permitiendo considerar “referencias injustificadas”, a todas aquellas con alguno de esos diagnósticos. Objetivo: Determinar la frecuencia de referencias injustificadas enviadas al servicio de consulta externa adultos del Hospital Cayetano Heredia (HCH) durante el periodo abril a diciembre del 2019 y describir sus características. Materiales y métodos: Estudio transversal, observacional y descriptivo. Se utilizaron datos del aplicativo “REFCON” con una población de 99 891 referencias. Las variables fueron “justificación de la referencia”, edad, sexo, grupo etario, especialidad de destino, categoría del EESS de origen, distrito de origen, y diagnóstico. Se realizó un análisis descriptivo. Resultados: La frecuencia de referencias injustificadas fue de 8.36 %. El 34.2% fueron de pacientes adultos y el 65.8%, de adultos mayores. 67% correspondía al sexo femenino. Los 5 servicios más referidos de forma injustificada fueron Cardiología, Geriatría, Medicina Interna, Medicina Familiar y Neurología. Los diagnósticos más frecuentes fueron Hipertensión esencial, Lumbago no especificado y Cefalea. Conclusión: En el 2019, se realizaron referencias injustificadas por diagnósticos no pertinentes al HCH en un 8.36%, pese a la emisión de una lista de diagnósticos que no deberían derivarse a hospitales de la DIRIS Lima Norte. Background: Referrals allow us to transfer users and diagnostic elements from primary care to higher levels of care. The entity of the Ministry of Health of Peru in charge of the Northern area of Lima, made a list of inappropriate diagnoses to be referred to hospitals, considering all referrals that include them as "unjustified". Objective: To determine the frequency of unjustified referrals sent to the adult outpatient clinic of Cayetano Heredia Hospital from April to December 2019, and to describe their features. Materials and methods: Cross-sectional, observational, and descriptive study. Data was collected from the Peruvian-referral-app using a population of 99 891 referrals. The variables were “justification for the referral”, age, sex, age group, specialty referred to, category of the health facility of origin, district of origin, and diagnosis. A descriptive analysis was made. Results: The frequency of unjustified referrals was of 8.36%. 34.2% were from adult patients and 65.8% were from elderly patients. 67% were from female patients. The 5 most unjustified referred specialties were Cardiology, Geriatrics, Internal Medicine, Family Medicine, and Neurology. The most frequent diagnoses were Primary Hypertension, Low back pain and Headache. Conclusion: In 2019, the unjustified referrals based on inappropriate diagnoses were an 8.36%, despite the issuance of a list of diagnoses that should not be referred to Northern Lima hospitals.

Background A community of clinical practice called the Online Communication Tool between Primary and Hospital Care (ECOPIH) was created to enable primary care and specialist care professionals to communicate with each other in order to resolve real clinical cases, thereby improving communication and coordination between care levels. The present work seeks to analyse whether ECOPIH makes it possible to reduce the number of referrals. To that end, the objectives are: (1) To find out the degree of loyalty among ECOPIH users, by comparing the medical professionals’ profiles in the tool’s implementation phase to those in its consolidation phase. (2) To evaluate the degree of fulfilment of users’ expectations, by establishing the determining factors that had an influence on the physicians’ intention to use ECOPIH in the implementation phase and observing whether its use had an effective, direct impact on the number of patient referrals that primary care physicians made to specialist care professionals. Methods Two studies were conducted. Based on a survey of all the physicians in a Primary Care area, Study 1 was a descriptive study in ECOPIH’s implementation phase. Study 2 was a randomised intervention study of ECOPIH users in the tool’s consolidation phase. The results from both studies were compared. Various bivariate and multivariate statistical techniques (exploratory factor analysis, cluster analysis, logistic regression analysis and ANOVA) were used in both studies, which were conducted on a sample of 111 and 178 physicians, respectively. Results We confirmed the existence of an ECOPIH user profile stable across both phases: under-50-year-old women. Regarding the second objective, there were two particular findings. First, the discriminant factors that had an influence on greater ECOPIH use were habitual Social media website and app use and Perceived usefulness for reducing costs. Second, PC professionals who were ECOPIH members made fewer referrals to SC professionals in Cardiology, Endocrinology and Gastroenterology than older PC professionals who were not ECOPIH members. Conclusions The use of a community of clinical practice by primary care and specialist care professionals helps to reduce the number of referrals among medical professionals.

Objective: to understand how repercussions of the referral and counter-referral of patients with indication/submitted to Coronary Artery Bypass Graft Surgery in the context of Primary Health Care. Method: qualitative research with a theoretical-methodological contribution anchored in the Grounded Theory. Theoretical sampling was performed with 41 participants, divided into three sample groups (patients, health professionals and managers) in the Metropolitan Region and Western Region of Santa Catarina State. Results: the need for improvement in the process of recording clinical data in the regulation system emerged to strengthen patient referral; and the absence of a formal process of counter-referral and adaptation of lifestyle with repercussion in the counter-referral. Final considerations: the repercussions of the referral and counter-referral of patients with indication/submitted to the CABGS in the context of Primary Care are experienced through professional guidance and, in particular, by family support. RESUMEN Objetivo: comprender cómo son vivenciadas las repercusiones del proceso de referencia y contrarreferencia del paciente con indicación o sometido a la Cirugía de Revascularización Miocárdica en la Atención Primaria a la Salud. Método: investigación cualitativa con aporte teórico-metodológico anclado en la Teoría Fundamentada en los Datos. Se alcanzó el muestreo teórico con 41 participantes, divididos en tres grupos muestrales (pacientes, profesionales de salud y gestores) en la Región Metropolitana y Región Oeste de Santa Catarina. Resultados: surgió la necesidad de mejora en el proceso de registro de los datos clínicos en el sistema de regulación para fortalecer la referencia del paciente; y ausencia de un proceso formal de contrarreferencia y adaptación del estilo de vida con repercusión en la contrarreferencia. Consideraciones finales: las repercusiones del proceso de referencia y la contrarreferencia del paciente con indicación o sometido a la CRM en el contexto de la atención primaria son vivenciadas por medio de las orientaciones profesionales y, en especial, por el apoyo de la familia. RESUMO Objetivo: compreender como são vivenciadas as repercussões do processo de referência e contrarreferência do paciente com indicação/submetido à Cirurgia de Revascularização Miocárdica na Atenção Primária à Saúde. Método: pesquisa qualitativa com aporte teórico-metodológico ancorado na Teoria Fundamentada nos Dados. Alcançou-se a amostragem teórica com 41 participantes, divididos em três grupos amostrais (pacientes, profissionais de saúde e gestores) na Região Metropolitana e Região Oeste de Santa Catarina. Resultados: emergiu a necessidade de melhoria no processo de registro dos dados clínicos no sistema de regulação para fortalecimento da referência do paciente; e ausência de um processo formal de contrarreferência e adaptação do estilo de vida com repercussão na contrarreferência. Considerações finais: as repercussões do processo de referência e contrarreferência do paciente com indicação/submetido à CRM no contexto da Atenção Primária são vivenciadas por meio das orientações profissionais e, em especial, pelo apoio da família.

Background The current reality of primary care (PC) makes it essential to have telemedicine systems available to facilitate communication between care levels. Communities of practice have great potential in terms of care and education, and that is why the Online Communication Tool between Primary and Hospital Care was created. This tool enables PC and non-GP specialist care (SC) professionals to raise clinical cases for consultation and to share information. The objective of this article is to explore healthcare professionals’ views on communities of clinical practice (CoCPs) and the changes that need to be made in an uncontrolled real-life setting after more than two years of use. Methods A descriptive-interpretative qualitative study was conducted on a total of 29 healthcare professionals who were users and non-users of a CoCP using 2 focus groups, 3 triangular groups and 5 individual interviews. There were 18 women, 21 physicians and 8 nurses. Of the interviewees, 21 were PC professionals, 24 were users of a CoCP and 7 held managerial positions. Results For a system of communication between PC and SC to become a tool that is habitually used and very useful, the interviewees considered that it would have to be able to find quick, effective solutions to the queries raised, based on up-to-date information that is directly applicable to daily clinical practice. Contact should be virtual – and probably collaborative – via a platform integrated into their habitual workstations and led by PC professionals. Organisational changes should be implemented to enable users to have more time in their working day to spend on the tool, and professionals should have a proactive attitude in order to make the most if its potential. It is also important to make certain technological changes, basically aimed at improving the tool’s accessibility, by integrating it into habitual clinical workstations. Conclusions The collaborative tool that provides reliable, up-to-date information that is highly transferrable to clinical practice is valued for its effectiveness, efficiency and educational capacity. In order to make the most of its potential in terms of care and education, organisational changes and techniques are required to foster greater use. Electronic supplementary material The online version of this article (10.1186/s12875-018-0739-0) contains supplementary material, which is available to authorized users.

La nefropatía diabética está reportada, a nivel local, como la primera causa de enfermedad renal crónica terminal; no se puede efectuar prevención secundaria en estos pacientes por la llegada inoportuna a la primera consulta nefrológica. Objetivos: Determinar la proporción de pacientes con nefropatía diabética que llegan en forma oportuna a la primera consulta nefrológica en el Hospital Cayetano Heredia. Material y Método: Se obtuvieron datos demográficos, clínicos y de laboratorio de 73 pacientes con diagnóstico de Diabetes mellitus 2 durante el periodo de enero de 2011 - enero 2012. Se describen tasas y proporciones. Resultados: De 73 pacientes evaluados, 50 (68,49%) llegaron en forma inoportuna (nefropatía diabética estadio IV y V de Mogensen), siendo predominante el estadio IV en 47(64,38%) y estadio V en 3 (4,11%). Sólo 7 (9,59 %) llegaron en estadio II y ningún paciente llegó en estadio I. 12 (92,31%) fueron transferidos de la Emergencia. Los niveles de depuración de creatinina tuvieron una media en 59,24 ± 43 2 cc/min x 1,73 m sc (1,86-293). Los valores de la proteinuria fueron 2,353 ± 3,291 gr/24 horas, con un rango (29 - 15103 gr) de los cuales 43 (61,43%) presentaron proteinuria significativa, 14 (20%) proteinuria masiva y 3 (4,29%) en rango maligno. Conclusiones: En esta serie la mayor proporción de pacientes con nefropatía diabética llegan en forma inoportuna o en estadios avanzados de enfermedad renal crónica a la consulta externa nefrológica. Diabetic nephropathy has been reported in Peru as the first cause for end-stage kidney disease; and secondary prevention cannot not take place because of patients coming so late for their first nephrology assessment. Objectives: To determine the proportion of patients with diabetic nephropathy who come on time for their first nephrology assessment in Cayetano Heredia Hospital. Material and Method: We obtained demographic, clinical, and laboratory data from 73 patients diagnosed with type 2 diabetes mellitus between January 2011 and January 2012. We describe rates and proportions. Results: Of these 73 patients assessed, 50 (68,49%) arrived with advanced kidney disease to the nephrology outpatient clinic (diabetic nephropathy, Mogensen stages IV and V), stage IV was the most frequent presentation, it was found in 47 patients (64,38%), and 3 (4,11%) arrived to the clinic with stage V diabetic nephropathy. Only 7 patients (9,59%) arrived in stage II, and no stage I patient ever arrived to the hospital. Twelve patients (92,31%) were referred from the Emergency Department. Mean creatinine clearance values were 59,24 ± 43 cc/min x 1,73 m2 body surface area (1,86-293). Proteinuria values were 2,353 ± 3,291 g/24 hours, within this range (29-15103 g), and 43 (61,43%) patients showed significant proteinuria, 14 (20%) had massive proteinuria, and 3 (4,29%) were considered to have malignant proteinuria. Conclusions: Most diabetic nephropathy patients in this report arrive late to the nephrology outpatient clinic, most frequently presenting with advanced kidney disease.

Background There has been created an online communication tool with the objective to improve the communication among different levels of care, between Primary Care clinicians and Specialists. This tool is web 2.0 based technology (ECOPIH project). It allows to review clinical cases and to share knowledge. Our study will evaluate its impact in terms of reduction on the number of referrals to three specialties two years after the use of this tool. Methods/Design Open, multicenter, controlled, non random intervention study over 24 months. Study population includes 131 Primary Care Physicians assigned to nine health centers. The study will compare the clinicians that use the ECOPIH with the ones that do not use the tool. Also, professionals that start to use the tool during the period time of the study will be included. The number of annual referrals during the first and second year will be analyzed and retrospectively compared with the previous year to the implementation of the tool. Moreover, it will be assessed the level of satisfaction of the professionals with the tool and to what extend the tool responds to their needs. Discussion The implementation of ECOPIH in the field of Primary Health Care can decrease the number of referrals from primary care to specialist care. It is expected that the reduction will be more noticeable in the group of professionals that use more intensively the tool. Furthermore, we believe that it can be also observed with the professionals that read the contributions of the others. We anticipate high degree of customer satisfaction as it is a very helpful resource never used before in our environment.

Trata-se de revisão integrativa da literatura com o objetivo de analisar a publicação, em periódico científico, sobre interconsulta de enfermagem psiquiátrica, enfocando base de dados de indexação, periódico, ano de publicação, delineamento metodológico e temática abordada. A busca dos artigos se deu nas bases de dados PubMed, MEDLINE e LILACS, com descritor interconsulta de enfermagem psiquiátrica e publicação no período de 1999 a 2010. Selecionaram-se dez artigos, a análise permitiu a identificação de que 50% dsesses estão indexados no PubMed, 20% se encontram no periódico Archives of a Psychiatric Nursing, 20% no International Journal of Mental Health Nursing e 20% em Perspectives in Psychiatric Care, sendo de 2008 a maioria das publicações; 40% foram estudos do tipo qualitativo/etnográfico. As temáticas mais prevalentes foram aplicação da interconsulta de enfermagem psiquiátrica em pacientes e opinião dos enfermeiros. Os resultados mostram a necessidade de mais estudos sobre o tema no Brasil e no mundo. This integrative literature review aimed to analyze what was published in scientific periodicals on the subject of consultation-liaison psychiatric nursing, focussing with a database of indexing, periodical, year of publication, methodological delineation and topic addressed. The article search was done with the PubMed, MEDLINE and LILACS databases, using the descriptor consultation-liaison psychiatric nursing and publication in the period 1999 – 2010. Ten articles were selected – the analysis permitted the identification that 50% of these were indexed in PubMed, 20% were found in the periodical Archives of Psychiatric Nursing, 20% in the International Journal of Mental Health Nursing and 20% in Perspectives in Psychiatric Care. The majority of publications were from 2008; 40% were qualitative or ethnographic studies. The most prevalent topics were application of consultation-liaison psychiatric nursing in patients and the opinion of nurses. The results show the necessity for more studies on the topic in Brazil and elsewhere in the world. Esta es una revisión integrativa de la literatura cuyo objetivo fue analizar la publicación, en periódico científico, acerca de interconsulta de enfermería psiquiátrica, con base en datos de indexación, periódico, año de publicación, delineación metodológica y temática abordada. La búsqueda de los artículos ocurrió en las bases de datos PubMed, MEDLINE y LILACS, con descriptor interconsulta de enfermería psiquiátrica y publicación en el periodo de 1999 a 2010. Fueron elegidos diez artículos y el análisis permitió la identificación de que 50% de eses están indexados en el PubMed, 20% están en el periódico Archives of a Psychiatric Nursing, 20% en el International Journal of Mental Health Nursing y 20% en Perspectives in Psychiatric Care, siendo de 2008 la mayoría de las publicaciones; 40% fueron estudios del tipo cualitativo/etnográfico. Las temáticas más prevalentes fueron aplicación de la interconsulta de enfermería psiquiátrica en pacientes y opinión de los enfermeros. Los resultados muestran la necesidad de más estudios sobre el tema en Brasil y en el mundo.