Análise do absenteísmo a consultas ambulatoriais especializadas oferecidas pelo Instituto de Puericultura e Pediatria Martagão Gesteira agendadas pelo sistema de regulação do ministério da saúde município do Rio de Janeiro

Abstract

Introduction: Absenteeism in specialized healthcare appointments constitutes a barrier to healthcare performance, generating delays in diagnosis and treatment, inefficiencies in resources allocation, and inequities in health access. This study aims to analyze the determinants of absenteeism in specialized pediatric outpatient appointments. Methods: A retrospective cohort study was conducted based on data from 35,610 medical appointments scheduled through the municipal referral system (SISREG) of Rio de Janeiro for the Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG) of the Federal University of Rio de Janeiro (UFRJ). Appointment outcomes were classified as attendance or no-show. Independent variables included waiting time referral to appointment, referenced clinical area, month of the appointment, weekday of the appointment, programmatic area of the referring unit, and Human Development Index (HDI) of the patient’s area of residence. Descriptive analyses, bivariate tests, and multivariate logistic regression were applied. Results: A total of 35,610 scheduled patients were included. The overall absenteeism rate was 58%. The median waiting time between scheduling and appointment was 29 days (interquartile range [IQR]: 65; minimum: 0; maximum: 1,295; p < 0.01) for attendees and 43 days (IQR: 82; minimum: 0; maximum: 1,198; p < 0.01) for absentees. Ophthalmology showed the highest non-attendance rate (83.78%, p < 0.01), whereas Infectious Diseases had the lowest (50.64%, p < 0.01). Marked territorial disparities were observed, with some areas presenting more than a threefold higher risk of absenteeism compared with others. Socioeconomic inequalities were also evident: patients from intermediate HDI quartiles exhibited the highest risk of non-attendance. Temporal patterns were identified, with December (68.41%, p < 0.01) and Tuesdays (63.74%, p < 0.01) showing the highest absenteeism rates, whereas August (52.08%, p < 0.01) and Wednesdays (51.79%, p < 0.01) showed the lowest. Conclusion: Absenteeism is a multifactorial phenomenon influenced by structural, socioeconomic, temporal, and territorial determinants, with significant implications for resource allocation, continuity of care, and the development of evidence-based management strategies. The findings provide a foundation for constructing predictive models to support more efficient scheduling policies in tertiary pediatric care.