title: Clinical and regulatory protocols for the management of impaired vision in the public health care network.
abstract: OBJECTIVE
  To describe the procedures used in developing Clinical and Regulatory Protocols for primary care teams to use in the management of the most common scenarios of impaired vision in Southern Brazil.
  
  
  METHODS
  A retrospective review of 1.333 referral forms from all primary care practitioners was performed in Ribeirão Preto city, during a 30-day period. The major ophthalmic diagnostic categories were evaluated from those referrals forms. The Clinical and Regulatory Protocols development process was held afterwards and involved scientific cooperation between a university and the health care system, in the form of workshops attended by primary care practitioners and regulatory system team members composed of health care administrators, ophthalmologists, and professors of ophthalmology and social medicine.
  
  
  RESULTS
  The management of impaired vision was chosen as the theme, since it accounted for 43.6% of the ophthalmology-related referrals from primary care providers of Ribeirão Preto. The Clinical and Regulatory Protocols developed involve distinctive diagnostic and therapeutic interventions that can be performed at the primary care level and in different health care settings. The most relevant clinical and regulatory interventions were expressed as algorithms in order to facilitate the use of the Clinical and Regulatory Protocols by health care practitioners.
  
  
  CONCLUSIONS
  These Clinical and Regulatory Protocols could represent a useful tool for health systems with universal access, as well as for health care networks based on primary care and for regulatory system teams. Implementation of these Clinical and Regulatory Protocols can minimize the disparity between the needs of patients with impaired vision and the treatment modalities offered, resulting in a more cooperative health care network.
authors.affiliation: Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto School of Medicine, Universidade de São Paulo, Ribeirão Preto, SP, Brazil. jspaula@fmrp.usp.br
authors.forename: Jayter Silva
authors.initials: JS
authors.lastname: Paula
authors.forename: João Marcello Fortes
authors.initials: JM
authors.lastname: Furtado
authors.forename: Fabiano Cade
authors.initials: FC
authors.lastname: Jorge
authors.forename: Eduardo Melani
authors.initials: EM
authors.lastname: Rocha
authors.forename: Ingrid U
authors.initials: IU
authors.lastname: Scott
authors.forename: Luciane Loures Dos
authors.initials: LL
authors.lastname: Santos
authors.forename: Maria de Lourdes Veronese
authors.initials: Mde L
authors.lastname: Rodrigues
authors.forename: José Sebastião Dos
authors.initials: JS
authors.lastname: Santos
mesh_terms: D001938:Brazil; D002985:Clinical Protocols; D006801:Humans; D011320:Primary Health Care / Q000592:standards*; D017150:Public Sector; D011785:Quality Assurance, Health Care; D012017:Referral and Consultation; D012189:Retrospective Studies; D014786:Vision Disorders / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy