Article

Y si adaptáramos los servicios hospitalarios de urgencias a la demanda social y no a las necesidades de salud?

Emergencias (Impact Factor: 2.9). 01/2008; 20(4).
Source: OAI

ABSTRACT

El incremento producido en la utilización de los servicios de urgencias hospitalarios (SUH), en estos últimos años y en todos los países desarrollados �incluso para situaciones de baja complejidad que podrían ser atendidas en niveles inferiores� no obedece simplemente a los cambios demográficos (aumento de la población por envejecimiento y movimientos migratorios) ni epidemiológicos, sino que parecen existir otros factores que intentan explicar y se asocian a esta conducta, como la necesidad percibida de atención inmediata, la dificultad de acceso a otros recursos del sistema, la falta se aseguramiento público y el nivel socioeconómico y cultural. España no ha sido ajena a ese fenómeno que, sin duda, contribuye a la masificación de estos departamentos, pérdida de continuidad asistencial y de calidad, insatisfacción de profesionales, inadecuación y demora en la atención a las urgencias verdaderas, mayor gasto sanitario y repercusiones muy importantes sobre la gestión del resto del hospital. Investigadas las causas de ese incremento, tanto desde el punto de vista de la oferta como de la demanda, y analizadas las intervenciones realizadas hasta la actualidad para disuadir o evitar el aumento de la frecuentación a los SUH (facilitar la accesibilidad a la atención primaria, mejoras educativas, instauración de barreras, reformas organizativas) derivando buena parte de la misma a los centros extrahospitalarios, se ha comprobado su escasa efectividad cuando no su inutilidad. Dados estos resultados, y entendiendo las diferencias entre necesidad, demanda y oferta de salud, desde un punto de vista antropológico y social �y, por tanto, los intentos de justificación de las percepciones de los ciudadanos ante una urgencia� cabría plantearse el rediseño funcional de la asistencia a estos procesos en un nuevo escenario, donde el hospital fuera adaptado al modelo de gestión del SUH y no a la inversa.

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    • "The rationale for such actions is based on the fact that in Spain, as in most other countries, around 30% of ED consultations are identified as inadequate demand, using objective tools of measurement [41–43]. On the other hand, greater efforts have been made to adapt the physical structure and human resources to cope with this increasing demand [44]. One of the most remarkable initiatives has been the implementation of triage systems for prioritizing patient assistance based on the severity of their condition [45]. "
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    ABSTRACT: Spain has universal public health care coverage. Emergency care provisions are offered to patients in different modalities and levels according to the characteristics of the medical complaint: at primary care centers (PCC), in an extrahospital setting by emergency medical services (EMS) and at hospital emergency departments (ED). We have more than 3,000 PCCs, which are run by family doctors (general practitioners) and pediatricians. On average, there is 1 PCC for every 15,000 to 20,000 inhabitants, and every family doctor is in charge of 1,500 to 2,000 citizens, although less populated zones tend to have lower ratios. Doctors spend part of their duty time in providing emergency care to their own patients. While not fully devoted to emergency medicine (EM) practice, they do manage minor emergencies. However, Spanish EMSs contribute hugely to guarantee population coverage in all situations. These EMS are run by EM technicians (EMT), nurses and doctors, who usually work exclusively in the emergency arena. EDs dealt with more than 25 million consultations in 2008, which implies, on average, that one out of two Spaniards visited an ED during this time. They are usually equipped with a wide range of diagnostic tools, most including ultrasonography and computerized tomography scans. The academic and training background of doctors working in the ED varies: nearly half lack any structured specialty residence training, but many have done specific master or postgraduate studies within the EM field. The demand for emergency care has grown at an annual rate of over 4% during the last decade. This percentage, which was greater than the 2% population increase during the same period, has outpaced the growth in ED capacity. Therefore, Spanish EDs become overcrowded when the system exerts minimal stress. Despite the high EM caseload and the potential severity of the conditions, training in EM is still unregulated in Spain. However, in April 2009 the Spanish Minister of Health announced the imminent approval of an EM specialty, allowing the first EM resident to officially start in 2011. Spanish emergency physicians look forward to the final approval, which will complete the modernization of emergency health care provision in Spain.
    Full-text · Article · Dec 2010 · International Journal of Emergency Medicine
  • Article: Response.

    No preview · Article · Feb 2009 · Revista Espanola de Cardiologia

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