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Original research
Residency training in family medicine and its impact on coordination and continuity of care: an analysis of referrals to secondary care in Rio de Janeiro
  1. Adelson Guaraci Jantsch1,
  2. Bo Burström2,
  3. Gunnar H Nilsson3,
  4. Antônio Ponce de Leon4
  1. 1Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Maracanã, Brazil
  2. 2Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden
  3. 3Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Stockholm, Sweden
  4. 4Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Antônio Ponce de Leon; antonio.ponce.de.leon.2{at}ki.se

Abstract

Objective To measure the effect that residency training in family medicine (RTFM) has on continuity and coordination of care.

Design Observational cohort study using electronic health records.

Setting Rio de Janeiro, Brazil, public primary care system.

Participants 504 940 patients, 633 generalists (physicians without RTFM) and 204 family physicians (FP—doctors with 2 years of RTFM) from one health district between January 2015 and December 2018.

Intervention Two years of RTFM.

Main outcome measures Relative risks of patients being referred to secondary care for outpatient consultations and diagnostics tests; and having a follow-up medical consultation in primary care within 3 and 6 months after being referred.

Results We examined 2 414 508 medical consultations and 284 754 referrals to secondary care. FPs were less likely to request ambulatory care services (including surgical specialties), but were more likely to request ophthalmology, physiotherapy, rehabilitationand surgical evaluations for their patients. Patients referred to secondary care by FPs were more likely to have a follow-up visit in primary care for almost every service requested. If all medical consultations were performed by FPs, a 37.6% (95% CI 32.4% to 42.4%) increased demand for rehabilitation services would be noticed. Oppositely, 1532 (95% CI 1458 to 1602) fewer requests for dermatology would happen every year.

Conclusions RTFM improves coordination and continuity of care by making FPs more competent to retain those health conditions that can be properly managed in primary care and making FPs more competent to detect health conditions that require specific biomedical technologies and skills, increasing the demand for those services. Besides, it increases the chances of patients having follow-up visits in primary care. Policy-makers in low-income and middle-income countries must consider investing in RTFM to make primary care systems more comprehensive, with better coordination and continuity of care.

  • primary care
  • general medicine (see Internal Medicine)
  • medical education & training

Data availability statement

Data may be obtained from a third party and are not publicly available. All data used in this research represent patients, healthcare providers and medical consultation information that are under the protection of the Rio de Janeiro Municipal Health Department. These data can be obtained from the Rio de Janeiro Superintendence of Primary Care (sapsmsrj@gmail.com) under the authorisation of the Rio de Janeiro Municipal Health Department Research Ethics Committee (cepsmsrj@yahoo.com.br).

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Data availability statement

Data may be obtained from a third party and are not publicly available. All data used in this research represent patients, healthcare providers and medical consultation information that are under the protection of the Rio de Janeiro Municipal Health Department. These data can be obtained from the Rio de Janeiro Superintendence of Primary Care (sapsmsrj@gmail.com) under the authorisation of the Rio de Janeiro Municipal Health Department Research Ethics Committee (cepsmsrj@yahoo.com.br).

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Footnotes

  • Contributors This study was designed and conceived by AGJ, BB, GHN and APdL. AGJ conducted the first data analysis and wrote the first draft of this manuscript. AGJ and APdL performed the multilevel analysis. AGJ, BB, GHN and APdL discussed the results from the multilevel analysis and decided together what relevant information should be reported in the manuscript. BB, GHN and APdL reviewed and made comments on the manuscript. AGJ, BB, GHN and APdL wrote and have agreed to submit the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.