[Pediatric Otolaryngology at the Public Health System of a city in Southeastern Brazil].
OBJECTIVE
To assess the suitability of referral from primary to secondary care in pediatric Otolaryngology.


METHODS
The study was performed in the city of Belo Horizonte, in the state of Minas Gerais, from March 2004 to May 2005. A total of 408 pre-school children referred from primary care to secondary care in the department of Otolaryngology presenting with otitis, tonsillitis, sinusitis, allergic rhinitis, and tonsillar/adenoidal hypertrophy was assessed. The studied variables were: agreement between diagnoses in primary and secondary care; waiting time for doctor's appointment; follow-up, and professional (pediatrician or family physician) that examined children in primary care. Agreement of diagnoses was assessed using kappa statistics.


RESULTS
Patients were five years old on average, 214 (52.5%) were boys, mean waiting time for appointment was 3.7 months. Diagnoses in primary and secondary care were respectively: otitis (44%, 49%), tonsillar/adenoidal hypertrophy (22%, 33%), tonsillitis (18%, 23%), sinusitis (13%, 21%), allergic rhinitis (3%, 33%). Agreement analysis of kappa was 0.15 for otitis with effusion, 0.35 for recurrent otitis, 0.04 for tonsillar/adenoidal hypertrophy, 0.43 for tonsillitis, 0.05 for allergic rhinitis, and 0.2 for sinusitis. Diagnoses in primary care referred to secondary care were in agreement when given either by pediatrician or family physician.


CONCLUSIONS
Unsuitability of referrals from primary to secondary care in otolaryngology was expressed by the long time waiting for appointments and by the low agreement between diagnoses in different level of care for the same patients. Primary health care could be more efficient if professionals were better qualified in Otolaryngology.
Guerra
Angela Francisca Marques
AF
Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
Gonçalves
Denise Utsch
DU
Werneck Côrtes
Maria da Conceição Juste
Mda C
Alves
Claudia Regina Lindgren
CR
Lima
Tânia Mara Assis
TM
D000293:Adolescent; D001071:Appointments and Schedules; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010036:Otolaryngology / Q000592:standards* / Q000706:statistics & numerical data; D010038:Otorhinolaryngologic Diseases / Q000175:diagnosis / Q000453:epidemiology; D010372:Pediatrics / Q000592:standards* / Q000706:statistics & numerical data; D010821:Physicians, Family / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000592:standards* / Q000706:statistics & numerical data; D013997:Time Factors