Qualidade dos encaminhamentos da atenção primária a um serviço de dermatologia / Quality of referrals from the primary health care to a dermatology service

Resumo Introdução Queixas dermatológicas são frequentes e em sua maioria são avaliadas por médicos não especialistas. Objetivo Analisar a proporção de pacientes encaminhados para dermatologia que poderiam ter sido tratados na Atenção Primária à Saúde e o grau de concordância entre o diagnóstico de encaminhamento do médico da Atenção Primária à Saúde e o diagnóstico do dermatologista. Método Estudo retrospectivo com abordagem quantitativa, com dados coletados de 194 prontuários, entre 2014 e 2015. O grau de concordância foi analisado pelo coeficiente Kappa, com significância de 5%. Resultados A média de idade foi 46,7 anos (dp = 17,9), sendo a maioria mulheres. Os diagnósticos de encaminhamento mais frequentes relatados pelos médicos da Atenção Primária à Saúde foram doenças eritemato-descamativas (8,0%) e câncer de pele (6,0%). Em 40,3% dos casos não havia o preenchimento do diagnóstico de encaminhamento. Os diagnósticos mais frequentes relatados pelo dermatologista foram lesões pré-malignas (15,6%) e tumores benignos (12,4%). A proporção de pacientes encaminhados que poderia ter sido tratada na Atenção Primária à Saúde foi de 37,1%. O grau de concordância Kappa foi moderado. Conclusão Os resultados sugerem dificuldades no diagnóstico das dermatopatias que foram referenciadas ao serviço de dermatologia.

Abstract Background Dermatologic complaints are frequent, and are the most frequent diagnoses performed by non-specialist doctors. Objective This study aimed to analyze the proportion of patients referred to dermatology who could have received treatment in Primary Health Care (PHC), and the degree of agreement between the referral diagnoses of PHC physician and the diagnosis of the dermatologist. Method This is a retrospective and quantitative study. The team collected data from 194 medical records between 2014 and 2015. Kappa coefficient was used to calculate the degree of agreement, with a significance level of 5%. Results The mean age was 46.7 years (SD=17.9), most of them women. The most frequent diagnostic hypotheses made by the PHC physician were desquamative erythematous diseases (8.0%) and skin cancer (6.0%). There was no completion of the referral diagnosis in 40.3% of the cases. The most frequent diagnoses made by the dermatologist were premalignant lesions (15.6%) and benign tumors (12.4%). The proportion of referrals that could have been treated in primary care was 37.1%. The diagnostic agreement was moderate (Kapa coefficient). Conclusion These findings suggest difficulties in the diagnosis of skin diseases referenced to the dermatologist.

Attention deficit hyperactivity disorder and drug addiction rehabilitation patients.

OBJECTIVE: Attention deficit hyperactivity disorder (ADHD) is characterized by a persistent pattern of inattention or hyperactivity. This study aimed to investigate the relationship between ADHD and drug dependence. METHODS: The presence and severity of ADHD and substance use were evaluated through questionnaires in 80 adult patients in therapeutic communities. RESULTS: No difference in drug use or dependence prevalence between ADHD and non-ADHD patients was found. However, ADHD patients had lower ages on admission (p = 0.004) and at first contact with cocaine (p = 0.033). In ADHD patients, there was a negative correlation between the age at first use of cannabis and the subsequent severity of cannabis use (p = 0.017) and cocaine use (p = 0.033). CONCLUSIONS: Though there was no difference in prevalence of drug use among groups, results show that ADHD in patients in therapeutic communities may cause different addiction patterns, such as earlier use of cocaine and admission, and a more severe use of cocaine correlated to earlier contact with cannabis.

Attention deficit hyperactivity disorder and drug addiction rehabilitation patients / Transtorno de Déficit de Atenção e Hiperatividade e pacientes em reabilitação de drogadição

ABSTRACT Objective Attention deficit hyperactivity disorder (ADHD) is characterized by a persistent pattern of inattention or hyperactivity. This study aimed to investigate the relationship between ADHD and drug dependence. Methods The presence and severity of ADHD and substance use were evaluated through questionnaires in 80 adult patients in therapeutic communities. Results No difference in drug use or dependence prevalence between ADHD and non-ADHD patients was found. However, ADHD patients had lower ages on admission (p = 0.004) and at first contact with cocaine (p = 0.033). In ADHD patients, there was a negative correlation between the age at first use of cannabis and the subsequent severity of cannabis use (p = 0.017) and cocaine use (p = 0.033). Conclusions Though there was no difference in prevalence of drug use among groups, results show that ADHD in patients in therapeutic communities may cause different addiction patterns, such as earlier use of cocaine and admission, and a more severe use of cocaine correlated to earlier contact with cannabis.

RESUMO Objetivo O Transtorno de Déficit de Atenção e Hiperatividade (TDAH) é caracterizado por um padrão de desatenção ou hiperatividade. Este estudo investigou relações entre TDAH e dependência de substância. Métodos Prevalência e gravidade de TDAH e de uso de substância foram avaliadas em oitenta pacientes adultos de comunidades terapêuticas. Resultados Não houve diferença de prevalência de uso e dependência de substância entre pacientes com e sem TDAH. Pacientes TDAH tiveram menor idade de admissão (p = 0,004) e de primeiro contato com cocaína (p = 0,033). Em pacientes TDAH, houve correlação negativa entre idade de primeiro uso de cannabis e gravidade do uso de cannabis (p = 0,017) e cocaína (p = 0,033). Conclusões Mesmo sem haver diferença na prevalência de uso de substância entre os grupos, conclui-se que o TDAH nos pacientes de comunidade terapêutica pode ter induzido padrão diferente da drogadição, como idade precoce de admissão e de uso de cocaína, e uso mais grave de cocaína relacionado a contato precoce com cannabis.