The authors wish to acknowledge the Dr. Claudio Leone, Associate Professor, Department of Public Health, University of Public Health of So Paulo. 1), the non-oncological gynecological diagnoses mostly referred to the tertiary sector and the non-inflammatory disorders of the female genital tract (93.3%). Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 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). Paim J, Travassos C, Almeida C, Bahia L, Macinko J. Patient Information Fellowship Opportunities Learn more about fellowship opportunities within the Division of Maternal Fetal Medicine. The non-inflammatory disorders of the female genital tract were 71.52% (n=236); diseases of the urinary system were 13.33% (n=44); inflammatory diseases of female pelvic organs were 6.67% (n=22); general physical examination, contraception and procreation were 4.85% (n=16) and diseases of the breast were 3.64% (n=12); these are the most frequent non-oncological gynecological diagnoses during the reproductive period in the visits of these women. In this review, a brief assessment of current ambulatory gynaecological practice is attempted, followed by a discussion of audit and quality assessment methods. Trends in seeing an obstetriciangynecologist compared with a general physician among US women, 20002015. Abnormal uterine bleeding is also a risk factor for acute hemorrhage and cardiovascular disease, which implies morbidity and mortality [43]. Prevalence of sexual dysfunctions and correlated conditions in a sample of Brazilian women--results of the Brazilian study on sexual behavior (BSSB). Obstet Gynecol. We calculated the power of the sample test, considering a 95% confidence level, a desired maximum error of 5%, and a population of women over 15years old [20] who visit the gynecology outpatient clinic each year, with an expected sample size of 227 cases. Accessed 16 Oct 2017. In addition, the chances of having disorders of the breast and non-inflammatory disorders of the female genital tract during the reproductive period corresponds to being 3.61 (CI 1.0016.29) and 2.56 times (CI 1.004.16) higher, respectively, than the chance of having the disease in the non-reproductive period (p<0.001). Menstrual cycle irregularity and risk for future cardiovascular disease. 2004. http://bvsms.saude.gov.br/bvs/publicacoes/politica_nac_atencao_mulher.pdf. Assistncia de Mdia e Alta Complexidade no SUS/Conselho Nacional de Secretrios de Sade. 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 authors wish to acknowledge the Dr. Claudio Leone, Associate Professor, Department of Public Health, University of Public Health of So Paulo. Cad SaudePublica. The characterization of the assisted population in the different levels of health services contributes to the quality of health care [17], which results in topics pertinent to womens health in outpatient interdisciplinary training [18, 19] and fundamental points in the hierarchy of health services in which promotion and treatment measures are still incipient. This is a research project of retrospective audit study design with a chart review of data from 428 women treated at University Ambulatory Clinic of Womens Health, the facility in gynecology and training for Family and Community Medical Residents, So Paulo, Brazil, from 2012 to 2014. 2007 Jun;16(6):1109-17. doi: 10.1111/j.1365-2702.2007.01548.x. sharing sensitive information, make sure youre on a federal ; To make a referral via eRecord to see one of our Diabetes Educators, simply type ref diab and choose AMB . From Alma-Ata to Almaty: a new start for primary health care. MeSH IntUrogynecol J. 2012, Article ID 432892, 22 pages, 2012. http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, http://www.who.int/whr/2003/en/whr03_en.pdf?ua=1, http://bvsms.saude.gov.br/bvs/publicacoes/politica_nac_atencao_mulher.pdf, http://bvsms.saude.gov.br/bvs/publicacoes/assistencia_integral_saude_mulher.pdf, Inflammatory diseases of female pelvic organs (N70-N77), Non-inflammatory disorders of female genital tract (N80-N99), General physical examination, contraception and procreation (Z0031). dos Santos Fernandes AM, Yamada EM, de Azevedo Sollero C, Lemes LCP. Revista de Cincias Mdicas. Poltica Nacional de Ateno integral Sade da Mulher: princpios e diretrizes. Lancet 2008; 372:1365_7. Am J ObstetGynecol. This is a research method of retrospective audit study design with chart review of women who attended the Womens Health Ambulatory Clinic of the University Hospital of the University of So Paulo, So Paulo, Brazil, from 2012 to 2014. The datasets generated during and/or analyzed during the current study can be obtained by request. Stormo AR, Saraiya M, Hing E, Henderson JT, Sawaya GF. Premenstrual syndrome and increased blood pressure: a new risk factor for cardiovascular disease in women? This fact brings benefits in the field of health promotion in womens health, in the field of medical and interdisciplinary teaching highlighting current issues in the daily life of women, and in public health enabling this ongoing source for health care complexity. Inclusion in an NLM database does not imply endorsement of, or agreement with, 1. Macinko J, Harris MJ. Rev Saude Publica. Rodrigues et al. Correspondence to (2001) in a national cross-sectional study in the USA concluded that specific gynecologic diagnoses are associated with the use of emergency departments or hospital outpatient. SHMG Gynecologic Surgical Specialties. Provided by the Springer Nature SharedIt content-sharing initiative. In our study, 66.5% of cases referred to medium complexity received clinical treatment, reinforcing the importance of training health professionals in the treatment and follow-up of the main diagnoses in womens health. When the categories of the variables were analyzed, there were fields that were not filled. From gynecologic cancers to pregnancy to menopause, our goal is to ensure you're well informed about all aspects of your body. Others focus on the medical care of the female reproductive system. Forman MR, Mangini LD, Thelus-Jean R, Hayward MD. Simon AE, Uddin SFG. Symptoms related to changes in the menstrual cycle can lead to anemia [42]. The aim of ambulatory gynaecology is to admit, treat and discharge the patient on the same day in an outpatient setting. 228/13. Lynn AM, Lai LJ, Lin MH, Chen TJ, Hwang SJ, Wang PH. Scientifica, vol. 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). The importance of knowledge about levels of the health system and diagnoses improve support for the unified health system in Brazil, whereas the decrease in the tertiary level is consistent with improvement in primary health care [34].The future of the unified health system in Brazil, its sustained expansion to the remaining urban centers, and its effective integration into secondary and tertiary care will require continued engagement by health care providers and the public and continued financial, technical, and intellectual investments [35]. Nedel FB, Facchini LA, Martn-Mateo M, Vieira LAS, Thum E. Family health program and ambulatory care-sensitive conditions in southern Brazil. Arrow. J Women's Health. The chances of having benign breast disease and non-inflammatory disorders of the female genital tract during the reproductive period corresponds to being 3.61 (CI 1.0016.29) and 2.56 times (CI 1.584.16) higher, respectively, than during the non-reproductive period. Cheon C, Maher C. Economics of pelvic organ prolapse surgery. The features were static data with demographic, medical history, and snapshots in time information. Update: a review of Womens health fellowships, their role in interdisciplinary health care, and the need for accreditation. 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. 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. Rodrigues et al. Some OB-GYNs offer a wide range of general health services similar to your primary care doctor. Thus, the objective is to analyze the clinical-demographic characteristics, main diagnoses in gynecological ambulatory settings, and their distribution in health services. Nicholson et al. The https:// ensures that you are connecting to the Vital and health statistics. 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. J Women's Health (Larchmt). 887 Congress St, Suite 300, Portland, ME 04102. Disclaimer. Assistncia integral sade da mulher: bases de ao programtica Ministrio da Sade. When the categories of the variables were analyzed, there were fields that were not filled. Dias-da-Costa JS, Madeira AC, Luz RM, Britto MA. Proportion of the number of patients in relation to the distribution of health services to the sector of destination. Tsai MC, Goldstein SR. Office diagnosis and Management of Abnormal Uterine Bleeding. Talbott EO. Schappert SM. AMB REF TO UROLOGY- AMC Urology REF106 F64.9 (ICD-10-CM) - Gender dysphoria Dr. Paul Maroni Hysterectomy Ambulatory referral to adult endocrinology practice Or AMB REF TO OB/GYN- AMC OBGYN Faculty REF 22 or REF51 F64.9 (ICD-10-CM) - Gender dysphoria Dr. Veronica Alaniz Dr. Patricia Huguelet Electrolysis AMB REF TO DERMATOLOGY- Aurora CU National Ambulatory Medical Care Survey: 1991 summary. 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]. In conclusion, the attended and referenced women are in the late-reproductive period. Work loss associated with increased menstrual loss in the United States. For Example "Ambulatory Referral to Urogynecology" Open Order Ensure Performing Region is Set to: External Order as the order is leaving your facility Rawaf S, De Maeseneer J, Starfield B. Fellowship Information Contact Us For additional information, please contact the administrative office for the Division of Maternal Fetal Medicine at 734-764-1406. Part of O difcil acesso a servios de mdia complexidade do SUS: o caso da cidade de So Paulo, Brasil. 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]. In addition, the qualification of health professionals in relation to these priority themes and opportunities remains limited for health care in interdisciplinary services. Abdo CH, Oliveira Jr. WM, MoreiraJr. Descriptive and retrospective studies have their own limitations when data from medical records are analyzed, especially considering the quality of sociodemographic information recording and in determination of racial classification in Brazil, reflecting non-homogeneous criteria. http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. The intensity of health services utilization in womens care may not represent the demand in the unified health system, since it addresses an ambulatory clinic accredited for a teaching and learning facility unit. Ct I, Jacobs P, Cumming DC. CAS An obstetrician-gynecologist, or OB-GYN, has expertise in female reproductive health, pregnancy, and childbirth. Mayo Clinic in Rochester, Minnesota, has been ranked among the best Gynecology hospitals in the nation for 2022-2023 by U.S. News & World Report. By referral based on medical need: use REF126 - AMB REFERRAL TO OBSTETRICS AND PERINATOLOGY Specify reason for referral in Reason for Referral Field. With respect to the relationship between the main health diagnoses in gynecology and the distribution of health services (Table3 and Fig. and transmitted securely. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 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. Vital and health statistics Series 13, Data from the National Health Survey. Obstet Gynecol. World Health Organization. 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]. Solomon CG, Hu FB, Dunaif A, et al. These include: Ambulatory referral to Mass General Pediatric Speech, Language and Swallowing; Ambulatory referral to Mass General Speech Language Swallowing The female patients present non-inflammatory disorders of the female genital tract (81.07%, n=347) and diseases of the urinary system (22.66%, n=97) among the gynecological diagnoses. Lei no 8.080, de 19 de setembro de 1990. and transmitted securely. Paim J, Travassos C, Almeida C, Bahia L, Macinko J. Dirio Oficial da Unio 1990. This service receives female patients with unsatisfactory or unexpected clinical management from seven Basic Health Units at Unify Health System - So Paulo, Brazil. Obstetrician-gynecologists have been specialist physicians in delivering care to women, especially regarding health promotion and high complexity for specific treatments [8, 9]. The main health diagnoses in gynecology found in our study, as non-inflammatory disorders of the female genital tract and diseases of the urinary system, have negative influences both on the health and quality of life of women in a late and non-reproductive period [38, 39]. Obstetric evaluation focuses on issues related to pregnancy. 2015;372(23):217781. The .gov means its official. The distribution in health services was the following: 71.30% (n=305) in the primary sector, 21.70% (n=93) in the secondary sector and 7% (n=30) in the tertiary sector. The ethics committee waived the need for informed consent by participants in the current study. Adequate clinical management of this entity in primary care becomes relevant to avoid aggravations to womens health [44, 45]. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Mayo encourages referring physicians to register for a portal account. Dall TM, Chakrabarti R, Storm MV, Elwell EC, Rayburn WF. Perinatologists are highly specialized doctors who provide comprehensive care throughout the entire prenatal period. 2008;42(6):104152. Foreman H, Weber L, Thacker HL. Distrito de sade de origem e caractersticas sociodemogrficas das mulheres atendidas em unidade secundria de referncia do Sistema nico de Sade em Campinas. https://doi.org/10.1590/S0034-89102008000600010. With regard to the destination of the patients, following the distribution of health services utilization since the Womens Health Ambulatory Clinic of the University Hospital at So Paulo University (Fig. 8600 Rockville Pike 1), the non-oncological gynecological diagnoses mostly referred to the tertiary sector and the non-inflammatory disorders of the female genital tract (93.3%). Clinical and demographic characteristics and non-oncological gynecological diagnoses initially were described. Suggest. Conselho Nacional de Secretrios de Sade. Int Urogynecol J Pelvic Floor Dysfunct. Records will be sent via mail or fax for those providers who do not use the portal. Ambulatory medical services utilization for menstrual disorders among female personnel of different medical professions in Taiwan: a nationwide retrospective cohort study. The chances of diagnosis of non-inflammatory disorders of the female genital tract and general physical examination, contraception and procreation are significantly different (p<0.05) during the non- reproductive period. The chances of diagnosis of non-inflammatory disorders of the female genital tract and general physical examination, contraception and procreation are significantly different (p<0.05) during the non- reproductive period. ATMS, JMSJ, ECB, LCA and ICES were involved with editing the manuscript. 2013;24(11):18736. https://doi.org/10.1186/s12905-017-0498-4, DOI: https://doi.org/10.1186/s12905-017-0498-4. The novelty of this study correlates the main diagnoses in womens health and the hierarchy of the health services levels, associating the demands brought by women and the need of health that is addressed in the different levels of health care. 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]. What is an OB-GYN? The final destination of patients mostly to the primary sector is considered satisfactory. In: Giovanella L, et al., editors. Data from the gynecological diagnoses collected were standardized according to the International Classification of Diseases in its tenth revision [21]. All rights reserved. Diseases of the urinary system, general physical examination, contraception and procreation are health diagnoses that remain in the primary and secondary sectors in the distribution of health services. Referral gynecological ambulatory clinic: principal diagnosis and distribution in health services, https://doi.org/10.1186/s12905-017-0498-4, http://www.who.int/whr/2003/en/whr03_en.pdf?ua=1, https://doi.org/10.1590/1807-57622013.0597, https://doi.org/10.1590/S0103-73312010000300014, http://bvsms.saude.gov.br/bvs/publicacoes/politica_nac_atencao_mulher.pdf, http://bvsms.saude.gov.br/bvs/publicacoes/assistencia_integral_saude_mulher.pdf. Jos Maria Soares, Jr, Email: moc.liamtoh@514seraosj. The survey of our patients identifies the main themes that need investments, such as health education for professionals and the stimulation of multiprofessional work. (1998) highlighted the importance to provide an empirical context for the ongoing investigation of equity in the distribution of health care [29]. Located in a very diverse region rich in assets, not only geographically (relief, climate), but also economic and human, the Lyon-Grenoble Auvergne-Rhne-Alpes is the latest INRAE centre to be created. Health services were characterized by the type of provided care; this analysis focused on three different sectors: primary sector (basic health unit and school health center), secondary sector (university hospital, hospital of medium complexity, and specialty ambulatory clinics), and tertiary sector (hospital of high complexity and hospital with cancer support). Thus, the objective is analyze the clinical-demographic characteristics, main diagnoses in gynecological ambulatory care, and their distribution in health services. official website and that any information you provide is encrypted Terms and Conditions, Social science & medicine, cial science & medicine. (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]. Worsham MJ, Abrams J, Raju U, Kapke A, Lu M, Cheng J, Mott D, Wolman SR. The standardizing data abstraction tool had responses for categorical variables specify single responses, multiple responses or coded responses. This research project was analyzed and approved by the Ethics Committee of the Medical School of the University of So Paulo, according to protocol no.228/13. The non-inflammatory disorders of the female genital tract were 71.52% (n=236); diseases of the urinary system were 13.33% (n=44); inflammatory diseases of female pelvic organs were 6.67% (n=22); general physical examination, contraception and procreation were 4.85% (n=16) and diseases of the breast were 3.64% (n=12); these are the most frequent non-oncological gynecological diagnoses during the reproductive period in the visits of these women. 2015;24(5):33640. 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. Further evaluation of the connection between changes in the health system and the observed trends and guidelines could not be assessed given that several different guidelines on womens health screening were issued in our country [27, 28]. 10a rev. 2012;14(4):2318897. 2014;174(9):15124. 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]. Google Scholar. ED, Fittipaldi JA. This fact brings benefits in the field of health promotion in womens health, in the field of medical and interdisciplinary teaching highlighting current issues in the daily life of women, and in public health enabling this ongoing source for health care complexity. Google Scholar. 94 0 obj <>stream Gipsa-lab is a CNRS research unit joint with Grenoble-INP (Grenoble Institute of Technology), Universit Joseph Fourier and Universit Stendhal. From sneezes to adieux: stages of health for American men and women. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Concerning sexual activity, 70.47% (n=253) had an active sexual life. The aim of ambulatory gynaecology is to admit, treat and discharge the patient on the same day in an outpatient setting. GYN stands for gynecology or gynecologist, a physician who specializes in treating female reproductive conditions. World Health Organization, 2003. 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]. When demographic factors were analyzed, it was verified that 56.64% (n=251) were White, and in relation to remunerate activity, 57.42% (n=236) were economically active. Wang ET, Cirillo PM, Vittinghoff E, Bibbins-Domingo K, Cohn BA, Cedars MI. Nicholson et al. Would you like email updates of new search results? Data were checked regarding information consistency after data collection, and the medical records were re-read when discrepancies were present. Interdependncia entre os nveis de ateno do Sistema nico de Sade (SUS): significado de integralidade apresentado por trabalhadores da Ateno Primria. Botucatu, 2014;18 (51): 647 660; 10.1590/1807-57622013.0597. Traditional inpatient operations are being rapidly replaced by office, outpatient or day surgery procedures. 2005;83:457502. 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. However, in order to generate reliable data from the experimental empirical basis, they were transformed into a missing category. Surgical outpatients: challenges and responses.
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