title: Impact of a Reference Center on Leprosy Control under a Decentralized Public Health Care Policy in Brazil.
abstract: OBJECTIVE
  We evaluated the profile of patients referred to the Fiocruz Outpatient Clinic, a reference center for the diagnosis and treatment of leprosy in Rio de Janeiro, RJ, and analyzed the origins and outcomes of these referrals.
  
  
  METHODS
  This is an observational retrospective study based on information collected from the Leprosy Laboratory database at Fiocruz, Rio de Janeiro, RJ, Brazil. A total of 1,845 suspected leprosy cases examined at the reference center between 2010 and 2014 were included. The originating health service referrals and diagnostic outcomes were analyzed as well as the clinical and epidemiological data of patients diagnosed with leprosy.
  
  
  RESULTS
  Our data show that the profile of the patients treated at the Clinic has changed in recent years. There was an increase in both the proportion of patients with other skin diseases and those who had visited only one health service prior to our Clinic. Among the total 1,845 cases analyzed, the outcomes of 1,380 were linked to other diseases and, in 74% of these cases, a biopsy was not necessary to reach a diagnostic conclusion. A decrease in new leprosy case detection among our patients was also observed. Yet, among the leprosy patients, 40% had some degree of disability at diagnosis.
  
  
  CONCLUSIONS
  The results of the present study demonstrated the importance of referral centers in support of basic health services within the decentralization strategy. But, the success of the program depends on the advent of new developmental tools to augment diagnostic accuracy for leprosy. However, it should be emphasized that for new diagnostic methods to be developed, a greater commitment on the part of the health care system regarding research is urgently needed.
authors.affiliation: Laboratório de Hanseníase, Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, Rio de Janeiro, Brasil.
authors.forename: Raquel Rodrigues
authors.initials: RR
authors.lastname: Barbieri
authors.affiliation: Laboratório de Hanseníase, Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, Rio de Janeiro, Brasil.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Sales
authors.affiliation: Laboratório de Hanseníase, Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, Rio de Janeiro, Brasil.
authors.forename: Mariana Andrea
authors.initials: MA
authors.lastname: Hacker
authors.affiliation: Laboratório de Hanseníase, Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, Rio de Janeiro, Brasil.
authors.forename: José Augusto da Costa
authors.initials: JA
authors.lastname: Nery
authors.affiliation: Laboratório de Hanseníase, Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, Rio de Janeiro, Brasil.
authors.forename: Nádia Cristina
authors.initials: NC
authors.lastname: Duppre
authors.affiliation: Laboratório de Hanseníase, Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, Rio de Janeiro, Brasil.
authors.forename: Alice de Miranda
authors.initials: AM
authors.lastname: Machado
authors.affiliation: Laboratório de Hanseníase, Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, Rio de Janeiro, Brasil.
authors.forename: Milton Ozório
authors.initials: MO
authors.lastname: Moraes
authors.affiliation: Laboratório de Hanseníase, Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, Rio de Janeiro, Brasil.
authors.forename: Euzenir Nunes
authors.initials: EN
authors.lastname: Sarno
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration; D001938:Brazil / Q000453:epidemiology; D006801:Humans; D007918:Leprosy / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D011634:Public Health; D012017:Referral and Consultation; D012189:Retrospective Studies