Factors associated with delayed diagnosis and referral of women with chronic pelvic pain to a specialized service and the importance of the participation of primary care physicians

Abstract

Chronic pelvic pain in women is one of the most frequent causes of recurring demand for health services and therefore a public health problem. We recently conducted a study where we observed that the prevalence of the disease in Ribeirão Preto is 11.5% and abdominal surgery (particularly cesarean), among others, is one of the main risk factors associated with the condition. This study was properly assessed by the Ethics Committee in Research of the HC-FMRP-USP and approved on 22/11/2006, Document No. 12964/2006. This study included only women interviewed in the community. We note that although 90% of them were met in regular primary health care and complained of clinical condition, only 4% were aware of diagnosis and none had been referred to a referral service, even though the average duration of symptoms of approximately 52 months. At the same time, analyzing the profile of the women interviewed and the patients treated at the specialized clinic HCFMRPUSP, we note that this group differs in three fundamental requirements: pain intensity, duration of symptoms and additional clinical symptoms (dyspareunia, dysmenorrhea, urinary and intestinal) - more frequent in the latter group. It is known that these elements are a major complicating factors in women with CLD approach, making the diagnosis and, not infrequently, making treatment difficult. In parallel, we developed another study that was recently submitted for publication and is being evaluated, in which we study the expectations of medical professionals outside the service of women with chronic pelvic pain. And the results were surprising: almost all have difficulty understanding the problem holistically and attributed this to limited information acquired during the medical degree. Thus, we developed initially forward some hypotheses for our results: 1 - women with chronic pelvic pain are not receiving the early diagnosis of the disease, 2 - women with chronic pelvic pain are being evaluated later in specialized services. Objectives: 1 - Identify the characteristics that distinguish these two populations (women with DPC met in a specialized unit, and women with the DPC met the basic health network), 2 - Check that the knowledge network professionals have on municipal health the CPS. Methods: A cross-sectional study. Expected results: to characterize epidemiologically pelvic pain in our country providing bases for further intervention studies to reduce its impact. Awareness of health professionals about the importance of early diagnosis and appropriate referral to specialist services. Increasing problem solving in specialized services. We intend to complete two undergraduate research guidelines and present the study on specific event undergraduates and a national or international congress of gynecology and obstetrics. The study has important social, scientific and training of staff and has the potential for publication in a journal The International qualis (Medicine III).