Problem-solving capacity for vitreoretinal diseases in a university health center.
OBJECTIVE
To evaluate the effectiveness of the tertiary care delivered to patients with vitreoretinal diseases in a defined urban population; to substantiate the planning and allocation of resources in order to improve the tertiary eye care delivery system in a specific area.


METHODS
Data were collected from consecutive first-time patients between June 1, 2003 and July 31, 2004 in the Department of Ophthalmology, State University of Campinas, São Paulo, Brazil. Problem-solving capacity values were calculated for vitreoretinal surgery and photocoagulation. Data were entered into the Statistical Package for the Social Sciences (version 10.0).


RESULTS
Of the 7500 patients referred to the Department, 641 were deemed suitable for analysis. The diagnoses analyzed were retinal detachment (26.0%), diabetic retinopathy (21.0%), and vitreous hemorrhage (7.7%). The median ages were 52, 59 and 57.5, respectively. Of all patients referred for retinal detachment, 26.5% were inoperable. The values obtained for the problem-solving capacity (PSC) showed that 38.1%, 33.0% and 93.5% of those eligible for an ophthalmic intervention (for retinal detachment, vitreous hemorrhage and diabetic retinopathy) had obtained treatment. The main reason for not giving treatment was the unavailability of operating room time and photocoagulation time (87.1%).


CONCLUSIONS
This was the first study of tertiary eye care service performance in Latin America. Sight-threatening conditions such as retinal detachment and diabetic retinopathy are not thoroughly covered by the health system in this area. Various ways to reduce the problem are considered. The study has provided valuable information on planning high-complexity eye services in the population in question.
Limeira-Soares
Paulo Henrique
PH
Department of Ophthalmology, School of Medical Sciences, State University of Campinas, São Paulo, Brazil. limeira@fcm.unicamp.br
Lira
Rodrigo Pessoa Cavalcanti
RP
Lupinacci
Alvaro
A
Paccola
Marcelo
M
Inoue
Lílian
L
Kara-José
Newton
N
Arieta
Carlos Eduardo Leite
CE
D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D001938:Brazil; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003906:Developing Countries; D003930:Diabetic Retinopathy / Q000601:surgery*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D017075:Laser Coagulation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000706:statistics & numerical data*; D040841:Resource Allocation; D012163:Retinal Detachment / Q000601:surgery*; D014823:Vitreous Hemorrhage / Q000601:surgery*