Variabilidad de la práctica médica: a 80 años del efecto Glover / Variability of medical practice: at 80 years since the Glover effect

ABSTRACT

At this moment, it seems to be clear, that the application of the epidemiological logic to the sanitary administration, by one side, to specify which are the diseases or the needs that have a greater importance in a determined population to identify which individuals are at risk situation or with unnoticed requeriments to focuse resources mainly in them, and on the other side, to planify politics at macro level or logistic to supply resources and at level meso or micro through the analysis of the configuratiion of the employement of services or their polinomic terms: patient, providers and mediating organizations. Rarefieds, however a little the atmosphere of the called variability phenomen in the medical practice, prefigurted by Glover in the decade of the 30 th. It has been however a fundational basis the study of Allison Glover on the amigdalectomies in the British school districts, chronologically the first call for attention on the wide variation over the poblational rates of the interventions (Glover 1938), to such an extent that it was coined the concept "Glover effect" to refer to this fact. These facts showd that there was in England and Wale a rate of tonsillectomies between 50% and 70%, and indication 3 times more frequent in children from more accommodated class, a higher incidence in boys than in girls, an age of higher incidence between 5 to 7 years of age, and the absence of correlatively with the so called impersonal facts as accumulation , powerty, deficient dwelling or clime. In our analysis it was proved that in the practice the Glover effect continues producing fullness. These aspects are anayzed in the study