IMPROVEMENT OF THE REFERRAL SYSTEM AND COORDINATION

Introduction/ Objetive: A good Health System(HS) is achieved by strengthening the Primary Care(PC), the referral system(RS) and the health care coordination (HCC). This is a worldwide challenge and here we summarize the international experience in the topic. Method: Literature review with key words in Portuguese, French, and English. Results/ conclusions: The experience with different HS arrangements in the world suggests that the most useful recommendations are: training non-medical professionals in simple procedures; giving financial incentives for doctors to realize some procedures, and patients to search for them; working in multidisciplinary teams, using data to plan the services; offering administrative facilities and computing clinical decision support; continued medical education; periodical reevaluation of professional licenses; continued quality control of the clinical practice, and the use of guidelines. The RS itself should be organized on a national basis, with a central control able to select the most critical cases. The forms should go back to the generalist if not properly filled. The national waiting list should be monitored; the communication between specialists and generalists can be improved by the use of emails, letters, shared electronic health records and reminders. Standardized forms for referral and feedback are strongly recommended. The first should contain the history, clinical features, medication, laboratory tests, and the reason for referral. The second should contain a specific answer to the referral reason, changes in medication or care plan and follow up instructions.