unbalanced care: trends in emergency care and acute care visits in talcahuano, chile
TRANSCRIPT
Unbalanced care: trends in emergency care visits and acute care visits in
Talcahuano, ChileDr. Jorge Pacheco
Family Physician, Ms. Social Research and DevelopmentUniversidad de Concepción
• Talcahuano is a port city located in the south of Chile.• It has a population of 178.052 inhabitants.• 78,6% of the population is covered by
public health insurance (FONASA).• The territorial primary care facilities for this
population are:• 4 Family Health Centers (CESFAM)• 4 Community Health Centers (CECOSF)• 1 Rural Health Station (Posta Rural)
• Each primary care facility (healthcare center) has interdisciplinary working teams. These teams are integrated by:• Physicians• Professional Nurses (university level)• Obstetricians• Physical Therapists• Psychologists• Social workers• Dentists
• Each center provide acute care, chronic care, mental health care, among others.• One of the main difficulties at the Family and
Community Health centers is the lack of medical hours to attend acute care.
• Additionally, there are four Emergency Primary Care Services (SAPU).• Two of them were implemented in 2011.• SAPUs provide emergency care, different
from the integral care delivered in the Family and Community Health Centers. • Usually visits takes less than 10 minutes,
during which physicians do not have access to clinical records.• Since SAPUs’ implementation we have
observed a shift in the medical demand pattern towards an increase in emergency visits and a decrease in acute care visits.
Acute care in “Family and Community Health Centers”
Emergency Care in “Emergency Primary Care Services”
08:00 to 20:00 hours 17:00 to 24:00 hours 17:00 to 08:00 hours
Telephone scheduling for acute care appointments at 06:00 AM
Not scheduled acute care appointments
Acute care appointments until quotas are filled
All receive medical attention
Visits takes 15-20 minutes Visits takes less than 10 minutes
Access to clinical record Not access to clinical record
Referral to interdisciplinary working teams
Referral to acute care in Family and Community Health Centers
2010 2011 2012 2013 2014 20150
20000
40000
60000
80000
100000
120000
140000
160000
180000
Número de consultas médicas anuales en servicios de urgencias (SAPU, Hospital) y morbilidad aguda (CESFAM y CECOSF). Tal-
cahuano, 2010-2015.
Consultas urgencias SAPU TalcahuanoConsultas urgencias Hospital HiguerasConsultas de morbilidad CESFAM y CECOSF Talc-ahuano
Núm
ero
de co
nsul
tas m
édic
as a
nual
es
↑ Emergency care in Emergency Primary Care Services
↓ Acute Morbidity Care in Family and Community Health Centers
↓ Emergency care in referral hospital
2010 2011 2012 2013 2014 20150
50001000015000200002500030000350004000045000
N° de consultas médicas anuales en SAPU, CESFAM y CECOSF San Vicente 2010-2015.
Atención de morbilidadAtención SAPU
Núm
ero
de c
onsu
ltas m
édic
as a
nua-
les
2010 2011 2012 2013 2014 20150
50001000015000200002500030000350004000045000
N° de consultas médicas anuales en SAPU, CESFAM y CECOSF Paulina Avendaño Pereda 2010-2015.
Atención de morbilidadAtención SAPU
Núm
ero
de c
onsu
ltas m
édic
as a
nua-
les
Since SAPUs’ implementation in 2011, we have seen a shift in the medical demand patterns towards an increase in emergency visits
and a decrease in acute care visits.
2011 2012 2013 2014 20150
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
Número de consultas de morbilidad aguda según grupo de edad en CESFAM y CECOSF San Vicente, 2011-2015.
0 a 9 años10 a 14 años15 a 19 años20 a 24 años25 a 64 años65 años y más
Núm
ero
de c
onsu
ltas a
nual
es
2011 2012 2013 2014 20150
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
Número de consultas de urgencias según grupo de edad en SAPU San Vicente 2011-2015.
0 a 9 años10 a 14 años15 a 19 años20 a 24 años25 a 64 años65 años y más
Núm
ero
de c
onsu
ltas a
nual
es
Children and middle age adults ↑ their emergency visits and ↓ their acute care visits.
Children and middle age adults ↑ their emergency visits and ↓ their acute care visits.
2011 2012 2013 2014 20150
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
Número de consultas de morbilidad aguda según grupo de edad en CESFAM y CECOSF Paulina Avendaño, 2011-2015.
0 a 9 años10 a 14 años15 a 19 años20 a 24 años25 a 64 años65 años y más
Núm
ero
de co
nsul
tas a
nual
es
2011 2012 2013 2014 20150
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
Número de consultas de morbilidad aguda según grupo de edad en SAPU Paulina Avendaño, 2011-2015.
0 a 9 años10 a 14 años15 a 19 años20 a 24 años25 a 64 años65 años y más
Núm
ero
de c
onsu
ltas a
nual
es
2011 2012 2013 20140
5000
10000
15000
20000
25000
30000
35000
40000
45000
Número de consultas anuales a profesionales de la salud no médicos en CESFAM y CECOSF. Talcahuano, 2012-2015.
Psicólogo/aAsistente socialNutricionistaEnfermera/oMatron/aOdontólogo/a
Núm
ero
de co
nsul
tas a
nual
es ↓ Nurse visits
↓ Obstetrician visits
↓ Psychologist visits
↓ Acute morbidity visits = ↓ Referral
to other health professionals
• Public health users are preferring Emergency Primary Care Services to receive immediate care.• This preference is decreasing the number of
acute care visits and possibly the referrals to other health professionals.• This unbalanced care increases the access to
immediate care, however it has a negative impact in the integrality.• There are strong local and national incentives to
promote the implementation of Emergency Primary Care Services.• Similar process is occurring in other Chilean
cities.
2008 2009 2010 2011 2012 20130
20000
40000
60000
80000
100000
120000
140000
Número de consultas anuales en servicios de urgencias (SAPU, Hos-pital) y morbilidad aguda (CESFAM y CECOSF). Quillota, 2008-2013.
Atención de morbilidad agudaAtención en SAPUAtención en Hospital
Núm
ero
de co
nsul
tas a
nual
es
2008 2009 2010 2011 2012 20130
20000
40000
60000
80000
100000
120000
140000
Número de consultas anuales en servicios de urgencias (SAPU, Hospital) y morbilidad aguda (CESFAM y CECOSF). La Serena, 2008-2013.
Atención de morbilidad agudaAtención en SAPUAtención en Hospital
Núm
ero
de co
nsul
tas a
nual
es
In demanding contexts… How can we achieve a sustainable increase in access to
primary care services without
reducing their quality?