A Medical Regulation Office in a University Hospital: A Search for Equity of Access

This paper describes the experience of a Medical Regulation Office, based on the principles of Brazil's Unified National Health System. It was instituted in 1988 and organized into a network of increasing complexity, regionalized hierarchies that guarantee that the principles of equity in access to health resources, universality and integration of care are ensured for all citizens. Nevertheless, these legal measures have failed to provide solutions for daily difficulties, especially within the emergency care system. The knowledge of this fact induced us to put into action the Medical Regulation Office, aiming to promote and ensure universal access and equity of care for patients in urgent / emergency. The Medical Regulation Office has created in 2000, under a partnership of the Regional Healthcare Division of the State of São Paulo and the Faculty of Medicine, University of São Paulo (UNESP). It was situated in the central-west region of São Paulo, with 68 municipalities and 1,646,604 inhabitants, 47.06% of municipalities with less 10,000 inhabitants. The study conducted a retrospective analysis of the medical records of 59,285 requests for transfers of patients in emergency conditions made to the Medical Regulation Office of the Hospital of the University of UNESP, during the period January 2005 to February 2011. Of these 58.7% were men with mean age of 38.6 years. The most frequent diagnoses were injuries and poisonings (n = 20,709, 34.9%), circulatory diseases (n = 9639, 16.3%), mental and behavioral disorders (4639, 16.3%). Conditions were classified as sensitive to performance in the primary care in 5327 (9%) of cases. 50% of all requests had their outcomes defined in less than 6 minutes. The implementation of the Medical Regulation contributed to directing patients with higher gravity scores to the right Emergency Care Unit, demonstrating the potential of these services for hierarchical structuring networks and referrals.