Decentralizing referral prioritization to general practitioners at the primary care level: A qualitative case study based on the Grounded Theory

BACKGROUND: Patient referral prioritizations is an essential process in coordinating healthcare delivery, since it organizes the waiting lists according to priorities and availability of resources. OBJECTIVE: This study aims to highlight the consequences of decentralizing ambulatory patient referral...

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Veröffentlicht in:Work (Reading, Mass.) Mass.), 2024-01, Vol.77 (4), p.1189-1203
Hauptverfasser: Jatobá, Alessandro, Bellas, Hugo, Arcuri, Rodrigo, Sobral, André Luiz Avelino, Bulhões, Bárbara, Vianna, Jaqueline, de Castro Nunes, Paula, d’Avila, Adriana Lourenço, de Carvalho, Paulo Victor Rodrigues
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container_end_page 1203
container_issue 4
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container_title Work (Reading, Mass.)
container_volume 77
creator Jatobá, Alessandro
Bellas, Hugo
Arcuri, Rodrigo
Sobral, André Luiz Avelino
Bulhões, Bárbara
Vianna, Jaqueline
de Castro Nunes, Paula
d’Avila, Adriana Lourenço
de Carvalho, Paulo Victor Rodrigues
description BACKGROUND: Patient referral prioritizations is an essential process in coordinating healthcare delivery, since it organizes the waiting lists according to priorities and availability of resources. OBJECTIVE: This study aims to highlight the consequences of decentralizing ambulatory patient referrals to general practitioners that work as family physicians in primary care clinics. METHODS: A qualitative case study was carried out in the municipality of Rio de Janeiro. The ten health regions of Rio de Janeiro were visited during fieldwork, totalizing 35 hours of semi-structured interviews and approximately 70 hours of analysis based on the Grounded Theory. RESULTS: The findings of this study show that the obstacles to adequate referrals are beyond the management of vacancies, ranging from the standardization of prioritization criteria to ensuring the proper employment of referral protocols in diverse locations assisted by overloaded health workers with different backgrounds and perceptions. Efforts in decentralizing patient referral to primary care still face the growing dilemmas and challenges of expanding the coverage of health services while putting pressure on risk assessment, as well as sustaining the autonomy of physicians’ work while respecting the eligibility when ordering waiting lists. CONCLUSION: A major strength of this work is on the method to organize and aggregate qualitative data using visual representations. Limitations concerning the reach of fieldwork in vulnerable and hardly accessible areas were overcame using snowball sampling techniques, making more participants accessible.
doi_str_mv 10.3233/WOR-230228
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OBJECTIVE: This study aims to highlight the consequences of decentralizing ambulatory patient referrals to general practitioners that work as family physicians in primary care clinics. METHODS: A qualitative case study was carried out in the municipality of Rio de Janeiro. The ten health regions of Rio de Janeiro were visited during fieldwork, totalizing 35 hours of semi-structured interviews and approximately 70 hours of analysis based on the Grounded Theory. RESULTS: The findings of this study show that the obstacles to adequate referrals are beyond the management of vacancies, ranging from the standardization of prioritization criteria to ensuring the proper employment of referral protocols in diverse locations assisted by overloaded health workers with different backgrounds and perceptions. Efforts in decentralizing patient referral to primary care still face the growing dilemmas and challenges of expanding the coverage of health services while putting pressure on risk assessment, as well as sustaining the autonomy of physicians’ work while respecting the eligibility when ordering waiting lists. CONCLUSION: A major strength of this work is on the method to organize and aggregate qualitative data using visual representations. 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Efforts in decentralizing patient referral to primary care still face the growing dilemmas and challenges of expanding the coverage of health services while putting pressure on risk assessment, as well as sustaining the autonomy of physicians’ work while respecting the eligibility when ordering waiting lists. CONCLUSION: A major strength of this work is on the method to organize and aggregate qualitative data using visual representations. 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subjects Accessibility
Case studies
Family physicians
Field study
Fieldwork
Grounded theory
Health care
Health services
Medical personnel
Medical referrals
Physicians
Primary care
Qualitative analysis
Resource availability
Risk assessment
Standardization
title Decentralizing referral prioritization to general practitioners at the primary care level: A qualitative case study based on the Grounded Theory
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