TELECONSULTATION BY TELEPHONE AND REFERRALS REGULATION: REDUCING INEQUALITIES AND IMPROVING CLINICAL EFFECTIVENESS.

Introduction and objectives: An effective regulatory system aims to organize patients access with equity patterns and timely. Therefore, actions are strengthened by instruments based on evidence and by information and communication technologies. Teleconsultations in clinical setting can help decision making about referrals and also provide an education environment to physicians. It is important to evaluate teleconsultation effectiveness in improving access to outpatient specialized services and the impact in new referrals. Methods: All referrals from primary care to specialized services (endocrinology, nephrology, urology and pulmonology) at Porto Alegre city were regulated in 2014 and 2015, using referrals guidelines. Referrals without clinical criteria to be approved by the regulator doctor were selected for telephone teleconsultation with attending physician. We analyze canceled, approved and returned to health departments (due to lack information) referrals. The impact on the waiting list was measured by the amount of new referrals; in the same period of the year after project begin. Result: In endocrinology, 8119(57%) cases were selected for teleconsultation. Among finished cases, 3160(51%) were canceled, 1007(16%) approved and 2007(33%) returned. The average number of patients waiting for an endocrinology reduced from 508 to 333 (average reduction of 33%). In nephrology, urology and pulmonology there were 44%, 44% and 48% canceled referrals and a reduction of 46%, 12% and 34%, respectively. Conclusions: The teleconsultation act as a support tool to regulatory system, endorse clinical guidelines and qualifies the patient’s care. The reduction in new referrals reflects an incremental in medical effectiveness to treat patients with similar conditions.