Regulação do acesso à assistência ambulatorial especializada em sistemas públicos de saúde: uma revisão de escopo

Abstract

Introduction: Coordinating access to consultations and diagnostic and therapeutic support services (DTS) is one of the main challenges faced by public health systems around the world. The growing demand for specialized services, combined with the scarcity of resources and unequal access, makes it difficult to efficiently manage care flows. Objectives: To map the knowledge and evidence available in the literature on regulating access to consultations and diagnostic and therapeutic support services in health systems, identifying patient referral strategies with a view to timely access to specialized outpatient care. Method: This scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, based on the question: what knowledge and evidence is available in the literature on regulating access to consultations and diagnostic and therapeutic support services in health systems? The search was carried out in the scientific databases PubMed, Scopus and SciELO in two stages. The first, between 2021-2022 and the second in 2024, using terms in English and Portuguese related to “Secondary Health Care”, “Outpatient Care”, “Waiting Lists”, “Appointment Scheduling” and “Diagnostic Techniques and Procedures”. The articles were not limited by language, country or year of publication. The use of chatGPT was used as support for constructing the text. Results: Of the 1,618 articles initially identified, a further 30 publications were added in a second stage, resulting in 105 included in this review. At the end of the complete reading, the studies were conceptualized and divided into 3 domains: Interventions to improve referral from Primary to Secondary Care (PACU); in Specialized Outpatient Care (SEA) and in the Patient Care Pathway (PASP). The review shows that there are numerous interventions proposed with the aim of increasing access to consultations and SADT in public systems. These include evaluation and adjustments to the service, control of waiting times, evaluation of barriers and challenges, coordination and collaboration systems between levels of care, holistic approaches andapplication of care protocols and guidelines. Conclusions: the implementation of interventions that combine information technologies with strategies to strengthen PHC are recommended, in addition to electronic triage and referral systems such as ePROs, STAT, e-consults, SharedCare, e-Referral and HWGs; telehealth; rapid access clinics; complex case management and chronic disease programs with specialized professionals, and care navigation; and finally, continuing education for professionals. Future research should further explore the impacts, feasibility and applicability of interventions in different contexts of public systems with universal health coverage, in order to ensure greater equity in access to specialized outpatient services.