Avaliação das inconsistências do Sistema Nacional de Regulação e seu impacto na marcação de consultas ambulatoriais eletivas em dermatologia em Juiz de Fora/Minas Gerais

Abstract

The purpose of Health Care Regulation is the production of health care actions, such as care regulation and health care assessment. It is organized into demands through software called National Regulatory System (SISREG), which considers individual risk classification and the number of vacancies. With the aim of identifying the inconsistencies found in SISREG and classifying them, the present work aims at strategies to speed up the process of scheduling outpatient consultations in Dermatology in the city of Juiz de Fora/Minas Gerais. The following inconsistencies were identified: errors in identification data and risk classification, incorrect typing of clinical data, inadequate responses to questions from the regulatory professional, barriers to carrying out teleconsultation and requests from users for care with a specific professional or in a specific unit without justification. Statistical analyses were performed using IBM SPSS software using the Chi-Square test, Mann-Whitney U test and Kruskall-Wallis ANOVA. Of the inconsistencies found, 28.5% were related to identification data, 21.9% to errors in classification and risk, 19.1% to the desired unit, 17.1% to typing errors in clinical data, 10.3% for inadequate responses to regulatory feedback, 1.7% for desired doctor and 1.4% for barriers imposed to teleconsultation. Furthermore, a high rate of appointment cancellations was identified (21.1% of the total sample). In Juiz de Fora, 10 of the 63 health centers concentrated most of the inconsistencies found (27.3%). As for the agreed municipalities (n=155), 10 of them were responsible for 18.5% of the inconsistencies. The median time for scheduling appointments was 96 days, and in 25% of cases it was close to 6 months, from the time the request was entered into the system. The estimated time that the regulating physician took to identify inconsistencies in SISREG, during the period of our study, had a median of 40 days, and in 25% of cases this time was greater than 2 months. When comparing the times to resolve inconsistencies in the system, the median time from the request to the identification of the error was longer in Juiz de Fora when compared to the other municipalities that participated in the agreement (p<0.001). Regarding the response time of the unit or to schedule an appointment, there was no statistical difference. The results found demonstrated ineffective communication between PHC, appointment booking centers (CMC) and specialized care (AE). Based on this analysis, it will be possible to assist in the development of public policies with the aim of reducing the time it takes to schedule appointments.