ABSTRACT
INTRODUCCIÓN. El enfoque de atención primaria en el diseño de servicios de salud sigue siendo importante. La coordinación asistencial y la continuidad de la atención son ejes fundamentales para el abordaje de las enfermedades crónicas no transmisibles como la diabetes mellitus, que ha sido catalogada como enfermedad susceptible de cuidados ambulatorios. Las tasas de hospitalización elevadas por este tipo de condiciones reflejan una atención ambulatoria deficiente e inadecuada para el problema de salud estudiado, lo que implica que la población no accedió a la atención, o que esta no es resolutiva. MATERIALES Y MÉTODOS. Se analizaron todas las consultas de emergencia, en 12 meses en un hospital de Quito, se buscaron consultas externas de pacientes en todos los establecimientos de primer nivel del MSP antes de la consulta por emergencia, desde el 1 de enero de 2015 hasta un día antes de la consulta por emergencia. RESULTADOS. De 41 pacientes atendidos con diagnóstico de enfermedades evitables 58% eran mujeres, 43% (18) requirió hospitalización. El promedio de días de hospitalización fue 6,51, con una dispersión de 13,0; el de consultas externas previo a la emergencia fue 3,07, con máximo 22 consultas. Los hospitalizados tuvieron, en promedio, 5,05 consultas externas antes de la emergencia y hospitalización, aproximadamente 4 más que el promedio (0,95) de los pacientes no hospitalizados. DISCUSIÓN. las elevadas tasas de hospitalización podrían reflejar una atención primaria deficiente, lo que implica que la población no accedió a la atención, sin embargo, habría que analizar la gravedad de los pacientes.
INTRODUCTION. Primary care services are important for the delivery of comprehensive health services. The coordination and continuity of care are the main characteristics to approach non-communicable diseases like diabetes mellitus, which has been classified as ambulatory care sensitive condition. The high hospitalization rate might reveal poor and inadequate out-patient care, implying that the population did not access care, or that care was not effective. MATERIALS AND METHODS. All emergency consultations within 12 months in one hospital in Quito were analyzed according to their ICD-10 codes. They were compared with the consultations at the first level of care facilities of the Ministry of Public Health, from January 1st, 2015 until one day before the emergency consultation. RESULTS. Of 41 patients who attended with a diagnosis of preventable diseases 58% were wo-men, 43% (18) required hospitalization. The average number of days of hospitalization was 6.51, with a dispersion of 13.0; the number of external consultations prior to the emergency was 3.07, with a maximum of 22 consultations. The hospitalized patients had, on average, 5.05 outpatient visits before the emergency and hospitalization, approximately 4 more than the average (0.95) of the non-hospitalized patients. DISCUSSION. The high hospitalization rate, due to this condition, might reveal poor and inadequate ambulatory care, nevertheless it is necessary to analyze the severity of the cases in the studs.
Subject(s)
Primary Health Care/organization & administration , Continuity of Patient Care/statistics & numerical data , Ambulatory Care/statistics & numerical data , Hospitalization/statistics & numerical data , Quality of Health Care , Risk Factors , Continuity of Patient Care/organization & administration , Diabetes Mellitus, Type 2 , Ecuador , Emergency Medical Services/organization & administration , Emergency Medical Services/statistics & numerical data , Ambulatory Care/organization & administration , Health Services Misuse/prevention & control , Hospitalization/economicsABSTRACT
Resumen En Medicina es clave "ofrecer el 100% de lo que se precisa y evitar el 100% de lo que no se precisa". Lamentablemente, es difícil cumplir con esta cuestión clave y generalmente se ofrece más de lo que se precisa y no se evita todo lo que no se precisa. Este texto es una revisión no sistemática con objetivo docente en que se revisa el problema general en atención primaria y se proponen formas de evitar los excesos y defectos respecto a intervenciones preventivas, diagnósticas, terapéuticas y de rehabilitación. Saber no hacer es ciencia y arte que se enseña poco y se practica menos. Los excesos que dañan son parte casi diaria de la práctica clínica, en prevención, diagnóstico, tratamiento y rehabilitación. Es imprescindible fomentar "el arte y la ciencia de no hacer".
Abstract In Medicine, it is critical "to offer 100% of what is needed and avoid 100% of what is not needed." Unfortunately, this primary issue is challenging, and generally, more than required is offered, and everything that is unnecessary is not avoided. This is a nonsystematic review with a teaching objective that reviews the general issue in primary care and suggests ways to avoid overuse and shortcomings concerning preventive, diagnostic, therapeutic, and rehabilitative interventions. Knowing not to do is science and art that is hardly taught and practiced less. The overuse that harm are an almost daily part of clinical practice in prevention, diagnosis, treatment, and rehabilitation. It is essential to promote "the art and science of not doing".
Subject(s)
Humans , Community Medicine , Family Practice , Health Services Misuse/prevention & control , Physician-Patient Relations , Primary Prevention/ethics , Rehabilitation , Therapeutics , Unnecessary Procedures , Diagnostic Techniques and ProceduresSubject(s)
Humans , Primary Health Care , Diagnostic Imaging/statistics & numerical data , Low Back Pain/diagnosis , Health Services Misuse/prevention & control , Diagnostic Imaging/economics , Review Literature as Topic , Reminder Systems , Health Care Costs , Practice Guidelines as Topic , Decision Support Systems, Clinical , Information Dissemination , Feedback , Systematic Reviews as Topic , Medical AuditABSTRACT
A partir de uma campanha conduzida pela Fundação American Board of Internal Medicine (ABIM),teve início em 2011 a Iniciativa Choosing Wisely, quando várias associações norte-americanas de distintas especialidades médicas apresentaram listas de procedimentos utilizados de maneira excessiva e, consequentemente, inapropriada. Neste artigo, buscou-se destacar as relações entre a qualidade do cuidado, a variação injustificada na oferta de procedimentos e as iniciativas para redução da sobreutilização desses procedimentos. Além de uma metodologia adequada, alguns critérios devem ser levados em conta para se avaliar se o uso de determinados procedimentos é, ou não, recomendável. Entre os principais,encontram-se: a transparência e a participação de um grupo mais amplo de profissionais, incluindo diversas especialidades; a seleção de procedimentos de modo a evitar os que têm utilidade cientificamente questionável no tocante à melhora da saúde, além de custos impactantes, desproporcionais aos possíveis benefícios, para os serviços de saúde; a possibilidade de medir e avaliar esses procedimentos; ausência de conflito de interesses ou corporativismos...
From a campaign driven by the American Board of Internal Medicine (ABIM) Foundation, the ChoosingWisely Initiative began in 2011 when several US societies from different medical specialties presented listsof procedures that are used excessively and therefore inappropriate. In this article we sought to highlightthe relationship between healthcare quality, unjustified variation in supply of low-value procedures and theinitiatives to reduce the overuse of those procedures. In addition to appropriate methodology, one shouldtake account of criteria to evaluate whether or not the use of given procedures is recommended. The mostimportant criteria are: the transparency and participation of a broader group of professionals, includingdifferent specialties; selection of procedures whose utility with regard to improving health is scientificallyquestionable and its costs to health services are excessive relative to benefits; the possibilty to measure andevaluate these procedures; the absence of any conflict of interest or corporatism...
A partir de una campaña llevada a cabo por la Fundación American Board of Internal Medicine (ABIM),iniciada en 2011, la Iniciativa Choosing Wisely cuando distintas asociaciones norteamericanas dedistintas especialidades médicas presentaran listas de procedimientos utilizados de forma excessiva e, porconsiguiente, inapropriada. En este artículo hemos tratado de poner de relieve las relaciones entre la calidadde la atención, la variación injustificada en la oferta de los procedimientos y las iniciativas para reducir lasobreutilización de ellos. Además de una metodología adecuada, deben tenerse en cuenta ciertos criteriospara evaluar si es recomendado el uso de ciertos procedimientos. Entre los principales, están: la transparenciay la participación de un grupo más amplio de profesionales, incluyendo diversas especialidades; la selecciónde procedimientos con el fin de evitar aquellos que tienen utilidad científicamente cuestionable con relacióna la mejora de la salud, y los costes desproporcionados a los beneficios potenciales, impactantes para losservicios de salud; la posibilidad de mensurar y evaluar estos procedimentos; ausencia de conflicto deintereses o corporativismos...