Duplication of family health services - expression of user's dissatisfaction

This descriptive and exploratory study aimed to determine a methodology to identify the duplication and simultaneous use of two health services: a District Reference Unit (URB) and a Family Health Unit (USF), as well as to analyze the usage pattern of these services in a city in Southeast Brazil. Secondary data were collected in two stages: 1 -Identification of Medical Care Cards (FAM) at the URD in June 2006, 2 - verification of 149 medical records at the selected USF, for users who attended the URD. Four of them demanded medical care more than twice for the same problem at the two health services; 31 went back to the USF and URD the same day or week with the same health problem; 91 users did not turn to the USF in the period equivalent to the studied month; 12 demanded care at the two units, although for different reasons; records for 11 users could not be analyzed because FAM notes on the performed treatment were insufficient. Duplication in the use of health services was identified for 2.68% of users, and simultaneous use for 20.8%. Despite the lack of parameters for comparison with other health units, simultaneous use levels can be considered high, since primary health care units are expected to present a user problem-solving rate of 85%. The duplicated use of health services is regarded as an indirect indicator for the analysis of user satisfaction, that is, its analysis can be understood as an expression of user dissatisfaction. Using this kind of methods can allow health units to monitor the quality of care delivery.