Adna Thaysa Marcial da Silva. statement and In cases where a single patient presented two or more diagnoses, each of these was described separately. Springer Nature. ATMS, JMSJ, ECB, LCA and ICES, were involved with data management. Brazil's family health strategydelivering community-based primary care in a universal health system. Women's clinicalpreventive services in the United States: who is doing what? No special funding was required for this study. Non-inflammatory disorders of the female genital tract, including abnormal uterine bleeding, have a prevalence of 4060% in the reproductive period and may worsen in the late reproductive period due to progressive ovarian dysfunction [40, 41]. All the responses were collected in Excel. Accessed 16 Oct 2017. Milbank Q. Benign breast diseases are more likely to be diagnosed during the reproductive period, but their clinical management was mostly performed in medium- and high-complexity healthcare, demonstrated in our study with presence in the secondary and tertiary sectors. So Paulo: Universidade de So Paulo; 1997;1(5). da Silva, A.T.M., Menezes, C.L., de Sousa Santos, E.F. et al. endstream endobj startxref Revista de Cincias Mdicas. Trends in seeing an obstetriciangynecologist compared with a general physician among US women, 20002015. Male and female morbidity in general practice: the nature of sex differences. Women's clinicalpreventive services in the United States: who is doing what? Soc Sci Med. Interdependncia entre os nveis de ateno do Sistema nico de Sade (SUS): significado de integralidade apresentado por trabalhadores da Ateno Primria. 2004. http://bvsms.saude.gov.br/bvs/publicacoes/politica_nac_atencao_mulher.pdf. Trends in seeing an obstetriciangynecologist compared with a general physician among US women, 20002015. Thus, the objective is to analyze the clinical-demographic characteristics, main diagnoses in gynecological ambulatory settings, and their distribution in health services. Accessibility Referred patients may use the Mayo Clinic app to access their appointment schedule, view lab results, reports and notes, and message their Mayo Clinic care team through secure, simple messaging. From sneezes to adieux: stages of health for American men and women. This number is staffed 8:00 a.m. - 5:30 p.m., Monday through Friday. The main non-oncological gynecological diagnosis, described as non-inflammatory disorders of the female genital tract, impacts womens health in both sexual and labor activity, which causes health imbalances on psychological and social concepts [38, 40]. Starfield B, Shi L, Macinko J. Benign breast diseases are more likely to be diagnosed during the reproductive period, but their clinical management was mostly performed in medium- and high-complexity healthcare, demonstrated in our study with presence in the secondary and tertiary sectors. Our services are specially designed to accommodate the medical needs of all women. Concerning sexual activity, 70.47% (n=253) had an active sexual life. These patients are sexually and economically active, which creates psychological and social consequences. However, special attention is given to the need to optimize services and referral flows at different levels of attention to the quality of health care [13, 14], especially in womens health. 59 0 obj <> endobj Koo M, Chen CH, Tsai KW, MC L, Lin SC. REF1076: AMB Referral to MMP PSC Infectious Disease: p: 207-662-5522 f: 207-662-5526. Traditional inpatient operations are being rapidly replaced by office, outpatient or day surgery procedures. Portuguese [. (415) 353-2722 2017;26(2):13340. The authors wish to acknowledge the Dr. Claudio Leone, Associate Professor, Department of Public Health, University of Public Health of So Paulo. Dispe sobre as condies para a promoo, proteo e recuperao da sade, a organizao e o funcionamento dos servios correspondentes e d outras providncias. A p value <0.05 was considered to be statistically significant. Epub 2008 Jan 28. Adna Thaysa Marcial da Silva, Email: moc.liamtoh@asyahtanda. Demand for gynecologic and obstetric care services is projected to rise from 6 to 10% in developed and developing countries [10, 11], and 5081% of the time of checkups by obstetrician-gynecologists (OB-GYNs) is currently dedicated to women of reproductive age (1844years old) with a growth estimate of 7% in the non-reproductive period [12, 13]. Ministrio da Sade. No Nearby Gastroenterologist In some areas, there may not be a gastroenterologist close by. 2008:284351. 2007;13(2):11521. INRAE center Lyon-Grenoble Auvergne-Rhne-Alpes hb``g``x *`bd1q(f``g8iuBOFcL 02Y }E`F27MDQ Referral gynecological ambulatory clinic: principal diagnosis and distribution in health services Adna Thaysa Marcial da Silva, Camila Lohmann Menezes, Edige Felipe de Sousa Santos, Paulo Francisco Ramos Margarido, Jos Maria Soares Jr, Edmund Chada Baracat, Luiz Carlos de Abreu & Isabel Cristina Esposito Sorpreso Ambulation. We excluded patients diagnosed with pregnancy, childbirth, puerperium, and cancer, as well as those whose information was incomplete. 1994;116:1110. Use of health services associated with increased menstrual loss in the United States. The studied women presented non-inflammatory disorders of the female genital tract and diseases of the urinary system as determined by gynecological diagnoses. Simon and Uddin (2017) affirmed that the percentage of women who visit specialized services has decreased in the last decade and that in order to guarantee high quality and coordinated care, specialized physicians, among others, should offer all possible recommendations regardless of the level of health care [36]. 2011;377(9779):177897. What is AMB meaning in Medical? Assistncia de Mdia e Alta Complexidade no SUS/Conselho Nacional de Secretrios de Sade. PubMedGoogle Scholar. Van Wijk CMG, Kolk AM, Van Den Bosch WJ, Van Den Hoogen HJ. REFERRING TO PEDIATRIC GYNECOLOGY. ISSNe. Utilization of ambulatory medical care by women: United States, 1997-98. 2003;188:3438. Thus, the objective is analyze the clinical-demographic characteristics, main diagnoses in gynecological ambulatory care, and their distribution in health services. Dirio Oficial da Unio 1990. Health professionals working with womens health for low complexity issues should be aware of and be trained to provide care to women with non-oncological gynecological diagnoses for adequate clinical management, bringing benefits to reproductive and sexual health [6, 22]. The Chi-square test for qualitative variables, Crude Odds Ratio, and 95% confidence interval were performed to verify the difference between the frequency of the categories and the reproductive periods. We grouped the principal diagnoses in five disease categories [14]: 1) Diseases of the urinary system (N30 - N39) urinary incontinence, cystitis, neuromuscular disorders of the bladder, other disorders of the urinary system, urethritis and urethral syndrome, urethral stricture, other urethral disorders, bladder disorders; 2) Disorders of the breast (N60 - N64) - benign mammary dysplasias, inflammatory disorders of breast, hypertrophy of breast, unspecified lump in breast, fistula and fissure of the nipple, fatty necrosis of the breast, atrophy of breast, non-associated to birth galactorrhoea, mastodynia, solitary cyst of the breast; 3) Inflammatory diseases of female pelvic organs (N70 - N77) - lower genital tract infections (herpes, gonorrhea, chlamydia, Trichomonas, Candida, vulvovaginitis, syphilis), infectious vulvar lesions, inflammatory disease of the upper genital tract, such as disease of the uterus, ovaries, fallopian tubes including cervicitis, salpingitis, endometritis, and tube-ovarian abscess, diseases of Bartholin gland, vulvovaginal ulceration and inflammation; 4) Non-inflammatory disorders of the female genital tract (N80 - N99) genital dysplasia (precancerous lesions of the vulva, vagina, and cervix), menopausal disorders, menstrual disorders and hormonal dysfunction (dysfunctional uterine bleeding, ovarian hyperestrogenism, ovarian dysfunction, or irregular menstrual Cycles), endometriosis, malignancy of the reproductive tract (carcinoma in situ and invasive disease of the genital tract) benign disorders of the uterus and ovaries (benign ovarian cysts or tumors, leiomyomas, endometrialpolyps, orhyperplasia), infertility; 5) General physical examination, contraception and procreation (Z00 - Z31) general examination and investigation of people without complaints about contraception, general advice about contraception, insertion of contraceptive devices (intrauterine), sterilization and measures of procreation [10, 11]. sharing sensitive information, make sure youre on a federal Tsai MC, Goldstein SR. Office diagnosis and Management of Abnormal Uterine Bleeding. The use of ambulatory and hospital care services has limited results in the capacity to describe the search behavior of women in relation to obtaining integral health care [16, 17]; the gynecological concerns most often cited are menstrual disorders, other forms of normal bleeding of the female genital tract, inflammatory processes, and urogenital dysfunctions [1316]. Ultimately, it all depends on the doctor. ED, Fittipaldi JA. Obstet Gynecol. Shapley M, Jordan K, Croft PR. World Health Organization, 2003. An obstetrician-gynecologist, or OB-GYN, has expertise in female reproductive health, pregnancy, and childbirth. Social science & medicine, cial science & medicine. California Privacy Statement, PMC Int J Impot Res 2004;16(2):160166. 2012;120(6):12636. We excluded patients diagnosed with pregnancy, childbirth, puerperium, and cancer, as well as those whose information was incomplete. The distribution of the use of health services was considered adequate according to the literature [50] in countries that adopt hierarchical levels of health care and universal access (e.g., England and Canada). Solomon CG, Hu FB, Dunaif A, et al. Our study was conducted in a training program with an emphasis on womens health [18, 19], and the results therefore found in the main health diagnoses identified may be themes of continuing education. UR Medicine Internal Referrals For Physicians on e-RECORD. Best Pract Res Clin Obstet Gynaecol. An official website of the United States government. Brasil. Data were collected from the 428 medical records of women at their first visit according to clinical and gynecological factors; women were aged between 13 and 94years old, with an average age of 45.7 and a standard deviation (SD) of 14.3years old, as presented in Table1. The primary level of care represents access and low care complexity, carrying out prevention and health promotion actions. Clinical and demographic information, gynecological diagnoses (International Classification of Diseases), and distribution of health services (primary, secondary, and tertiary) were described. 2012;55(3):63550. This content is subject to copyright. OB stands for obstetrics or obstetrician, a physician who cares for women and their babies during pregnancy and childbirth. Estimated demand for women's health services by 2020. We excluded ectopic pregnancy because a major proportion of these cases are managed in the hospital rather than in an ambulatory clinic. Instead, descriptive studies of the use of health care services typically document higher per capita use by women during the adult reproductive period [14, 30,31,32]. The https:// ensures that you are connecting to the 0.23 miles away from Grand Rapids. The traditional health system information and care provided are limited due to lack of knowledge of the characteristics of those who do not seek health services. Int J Impot Res 2004;16(2):160166. The levels of secondary and tertiary care are responsible for performing diagnoses and specific treatments, as well as providing the primary level of continuing education in service [5,6,7]. Revista de Cincias Mdicas. Proportion of gynecology health diagnoses regarding the reproductive and non-reproductive periods of women seen at the Womens Health Ambulatory Clinic of the University Hospital at So Paulo University, So Paulo, Brazil (20122014), *Chi-square test for qualitative variables, **Crude Odds Ratio, 95% confidence interval. Before An OB-GYN is a doctor who specializes in pregnancy and female reproductive health. We also offer the latest information on birth control methods and managing menopause. We grouped the principal diagnoses in five disease categories [14]: 1) Diseases of the urinary system (N30 - N39) urinary incontinence, cystitis, neuromuscular disorders of the bladder, other disorders of the urinary system, urethritis and urethral syndrome, urethral stricture, other urethral disorders, bladder disorders; 2) Disorders of the breast (N60 - N64) - benign mammary dysplasias, inflammatory disorders of breast, hypertrophy of breast, unspecified lump in breast, fistula and fissure of the nipple, fatty necrosis of the breast, atrophy of breast, non-associated to birth galactorrhoea, mastodynia, solitary cyst of the breast; 3) Inflammatory diseases of female pelvic organs (N70 - N77) - lower genital tract infections (herpes, gonorrhea, chlamydia, Trichomonas, Candida, vulvovaginitis, syphilis), infectious vulvar lesions, inflammatory disease of the upper genital tract, such as disease of the uterus, ovaries, fallopian tubes including cervicitis, salpingitis, endometritis, and tube-ovarian abscess, diseases of Bartholin gland, vulvovaginal ulceration and inflammation; 4) Non-inflammatory disorders of the female genital tract (N80 - N99) genital dysplasia (precancerous lesions of the vulva, vagina, and cervix), menopausal disorders, menstrual disorders and hormonal dysfunction (dysfunctional uterine bleeding, ovarian hyperestrogenism, ovarian dysfunction, or irregular menstrual Cycles), endometriosis, malignancy of the reproductive tract (carcinoma in situ and invasive disease of the genital tract) benign disorders of the uterus and ovaries (benign ovarian cysts or tumors, leiomyomas, endometrialpolyps, orhyperplasia), infertility; 5) General physical examination, contraception and procreation (Z00 - Z31) general examination and investigation of people without complaints about contraception, general advice about contraception, insertion of contraceptive devices (intrauterine), sterilization and measures of procreation [10, 11]. Amb Referral To Perinatology. Call the Referring Provider Office to arrange. Shapley M, Jordan K, Croft PR. Worsham MJ, Abrams J, Raju U, Kapke A, Lu M, Cheng J, Mott D, Wolman SR. World Health Organization. (2000) in a Brazilian study regarding a medical audit on the prenatal care program in the south of the country noted that the use of the epidemiological methods to organize health services is important to the quality of care [37]. Regarding parity, 45.72% (n=187) had three or more children. Unable to load your collection due to an error, Unable to load your delegates due to an error. The .gov means its official. In the statistical analysis, the grouping of variables was performed, and these variables were described in tables, as well as measures of central tendency and dispersion. The primary level of care represents access and low care complexity, carrying out prevention and health promotion actions. Breast J. Inflammatory diseases of female pelvic organs, disorders of the breast, general physical examination, contraception and procreation were the most frequent gynecological diagnoses in the reproductive period of these patients, corresponding to demands related to the menstrual cycle and sexual activity present in the reproductive period of life [19, 22]. The Chi-square test was used for qualitative variables and Crude Relative Risk for the proportion of gynecology diagnosis in relation to the distribution of health sectors. To refer a patient: Phoenix/Scottsdale, Arizona Rawaf S, De Maeseneer J, Starfield B. Data were collected from medical records of the patients. 0 The average age of menarche was 13.0years old (sd2.20), onset of sexual activity was 18.3years old (sd8.70), and menopause was 49.0years old (sd6.0). AMB Neurosurgery Abbreviation Meaning With respect to the final destination of patients following the distribution of health services utilization since the referral ambulatory clinic in gynecology, it is highlighted that they return to the primary health care sector. Appointments | Duke Department of Obstetrics and Gynecology World Health Organization, 2003. http://www.who.int/whr/2003/en/whr03_en.pdf?ua=1. Interface (Botucatu). Read before you think. Foreman H, Weber L, Thacker HL. N Engl J Med. Bookshelf Dias Costa et al. Terms and Conditions, The ethics committee waived the need for informed consent by participants in the current study. Telephone consultations are available in most medical and surgical specialties at Mayo Clinic 24 hours a day, seven days a week. J Women's Health. To make a referral via eRecord to one of our physicians, simply type ref endo and choose AMB REFERRAL TO ENDOCRINOLOGY.Then choose Endocrinology followed by any location and complete the form as directed. Physis, Rio de Janeiro. ClinObstet Gynecol. 2 It may not be possible to make an appointment with a gastroenterologist without a referral. Macedo LM, Martin STF. Provided by the Springer Nature SharedIt content-sharing initiative. Simon AE, Uddin SFG. 1Division of Gynecology, Medical School, University of So Paulo, So Paulo, SP Brazil, 2Laboratory of Study Design and Scientific Writing, ABC Medical School, So Paulo, SP Brazil, 3Avenida Enas de Carvalho Aguiar, 255 10 andar sala 10166, So Paulo, SP CEP: 05403000 Brazil. In Brazil, the health system is organized at levels of attention according to the complexity of care services, seeking to provide universal access, equity and equality [1,2,3,4]. Nedel et al. The ecology of gynecological care for women. Van Wijk CMG, Kolk AM, Van Den Bosch WJ, Van Den Hoogen HJ. Modify order details, such as the reason for referral and any required items NOTE: make sure to update the performing region The average age of menarche was 13.0years old (sd2.20), onset of sexual activity was 18.3years old (sd8.70), and menopause was 49.0years old (sd6.0). Initial assessment. Catholic Churches in Grenoble, Auvergne-Rhne-Alpes Users of CareLink, our referring physician portal, will have immediate access to their patients' records and will not receive mailed or faxed reports. The gynecological and obstetric histories found that the patients resemble those described by other authors in the national territory, such as menarche and menopausal ages [2224] and the presence of sexual dysfunctions [25], with no variation among other studies performed in developed countries [26]. In womens health, studies that associate gynecological diagnoses and their distribution at different levels of complexity and health services are scarce [13, 14], although they provide benefits in health promotion, medical and interdisciplinary education, as well as rationalization according to level-of-care complexity [15, 16]. Primary care physicians and specialists, both medical and surgical, are in a position to diagnose and provide some level of care to these patients. We use cookies to ensure that we give you the best experience on our website. This may corroborate with the specificity of this entity and the importance of the medical specialist in the care assistance of this entity [49]. Lancet. Forman MR, Mangini LD, Thelus-Jean R, Hayward MD. 2013;24(11):18736. 3. The association between gynecological diagnoses and their distribution in the health sectors provides benefits in the field of womens health promotion and in medical and interdisciplinary education, along with rationalization according to level of care complexity. (2008) described that the admission conditions of primary care and the main diagnosis of hospitalization are due to one of the following conditions: being female, schooling, health unit operating time, residing in a family health area and using free care, and medical consultation using research and inpatient hospitalization [33]. Dias-da-Costa JS, Presser AD, Zanolla AF, et al. BMC Womens Health. SHMG Gynecologic Surgical Specialties. Data were checked regarding information consistency after data collection, and the medical records were re-read when discrepancies were present. Brazil's family health strategydelivering community-based primary care in a universal health system. In addition, the qualification of health professionals in relation to these priority themes and opportunities remains limited for health care in interdisciplinary services. 2013;4:121. Therefore, population-based prevalence studies, when representative, have an advantage and allow estimates of epidemiological behavior for the entire community in which they were performed [16]. The traditional health system information and care provided are limited due to lack of knowledge of the characteristics of those who do not seek health services. Breast cancer incidence in a cohort of women with benign breast disease from a multiethnic, primary health care population. The variables were grouped by demographic characteristics (age, ethnicity, profession) and clinical characteristics (main complaint, clinical and gynecological diagnosis, concomitant diseases multimorbidity, age of menarche and menopause, onset of sexual activity, parity and smoking). The group was based on similarities in clinical symptoms and patient presentation and similarities in management or diagnostic assessment. For Example "Ambulatory Referral to Urogynecology" Open Order Ensure Performing Region is Set to: External Order as the order is leaving your facility Ct I, Jacobs P, Cumming DC. In the national context, especially in the primary sector, the gynecologist acts as an educating care service for other health professionals (family and community doctors, general pediatricians, and general practitioners) [6, 9]. In conclusion, the attended and referenced women are in the late-reproductive period. HHS Vulnerability Disclosure, Help Update: a review of Womens health fellowships, their role in interdisciplinary health care, and the need for accreditation. 2007;24(6):5327. Thus, the clinical control of these patients through the incorporation of drug therapy, which can be performed in the primary and tertiary sectors, is fundamental to avoid high costs and reduce morbidities. In Brazil, the health system is organized at levels of attention according to the complexity of care services, seeking to provide universal access, equity and equality [14]. Contribution of primary care to health systems and health. BMC Health Serv Res,2016;16(1):576. Lynn AM, Lai LJ, Lin MH, Chen TJ, Hwang SJ, Wang PH. Jha S, Moran P, Blackwell A, Greenham H. Integrated care pathways: the way forward for continence services? If you would like to see a Duke Ob/Gyn physician, please contact the Duke Consultation and Referral Center toll-free at 855-855-6484, or visit the Duke Health for a list of providers, locations and specialties.
