Violence and burnout in health care emergency workers in Santiago, Chile: A survey-based cross-sectional study.

Shortage of quantitative studies regarding health risks for emergency services workers is a concern for Chilean's occupational health organizations. OBJECTIVE: To explore the incidence of violence and burnout in emergency services of the Metropolitan Region of Chile, and associations with workers' characteristics and workplace conditions. METHODS: A cross-sectional study was carried out from January to August 2016. A self-reported questionnaire explored about frequency and seriousness of violence episodes and about symptoms of burnout with the Maslach Burnout Inventory. RESULTS: Of the 565 workers participating, 71% (95% CI 66.7-74.5) said violence episodes occurred at least once a week; 71.3% (95% CI 67.3-75.0) were victims of some aggression in the previous 12 months. Patients companions, relatives or friends arose as the main aggressors and the severity of the episodes was considered slight or moderate by more than 50% of participants. Fifty-seven respondents (10.5%, CI 95% 8.1-13.5) classified as having a burnout syndrome. Having been a victim of violence was associated to high emotional exhaustion (ORadj = 1.7, 95% CI: 1.1-2.8) and depersonalization (ORadj = 2.0, 95% CI 1.3-3.3). CONCLUSIONS: Violence is a problem in the emergency departments of Chile's Metropolitan Region. Burnout is also present and independently associated to violence.

Determining the Operating Costs of a Medical Surveillance Program for Copper Miners Exposed to High Altitude-Induced Chronic Intermittent Hypoxia in Chile Using a Combination of Microcosting and Time-Driven Activity-Based Costing.

BACKGROUND: Copper mining installations in Chile use a large number of workers who do their jobs at high altitudes, exposing them to the conditions of chronic intermittent hypobaric hypoxia. The Chilean Safety Association implements the surveillance program. OBJECTIVE: This organization, under the sponsorship of the Chilean Superintendency of Social Security, was interested in determining the costs involved in this program to support its decision-making processes and to improve its performance. METHODS: Direct operating costs of the Hypoxia Medical Surveillance Program were determined through on-site surveys applied to the organization's local agencies in charge. The microcosting method was used, quantifying personnel costs, consumables, and equipment and overhead costs. Time-driven activity-based costing was partially adapted for the allocation of personnel and equipment costs. Costs concerning activities, groups of activities and items, and average cost per exposed worker were determined. RESULTS: The annual costs of the program were $127 299.58. The highest costs corresponded to the assessment activities, which were $89 192.13, representing 60.06% of the total. The labor factor costs were $77 568.50, which represents 60.93% of the total. The average cost per worker in the program is $21.17. CONCLUSIONS: The partial adaptation of the time-driven activity-based costing method in combination with the microcosting method provides a suitable solution to determine the total costs of running a healthcare program of this kind. The information generated by this study will aid in the decision-making and management processes of the Hypoxia Medical Surveillance Program.

Policy strategies to reduce waiting times for elective surgery: A scoping review and evidence synthesis.

OBJECTIVES: The purpose of this evidence-based review is to identify and describe the interventions that have been implemented to reduce waiting times for major elective surgery. METHODS: Scoping review and presentation of the results according to the SUPPORT tools. We searched MEDLINE/PubMed, Embase, Cochrane Library, SciELO, DARE-HTA, and Google Scholar. The inclusion criteria for research design were comprehensive. RESULTS: We identified 5200 records. After eliminating duplicates and screening by title and abstract, 171 records remained for full-text assessment, of which 12 were ultimately included for this review because they reported specific interventions and 96 records were included for further reference. The included studies show significant variability regarding elective procedures, population, and type of provider, as well as in the characteristics of the interventions and the settings. All the studies had methodological limitations. We graded the certainty of the evidence as very low. CONCLUSIONS: According to the evidence found for this review, interventions most likely should be multidimensional, with prioritization strategies on the waiting lists to incorporate equity criteria, together with quality management improvements of the surgical pathways and the use of operating rooms, as well as improvements in the planning of the surgical schedule.

[Public health infrastructure investment difficulties in Chile: concessions and public tenders]. / Dificultades de la inversión en infraestructura pública de salud en Chile: concesiones y licitación pública.

This paper seeks to highlight the problems of gaps in health infrastructure in Chile, and to analyze the mechanisms by which it is provided. In Chile this is done in two ways: the first is through competitive bidding or sector-wide modality. The second way is through hospital concessions. Both mechanisms have had difficulties in recent years, which are reported. Finally, we propose ways to improve the provision of health infrastructure in Chile.

El presente trabajo busca evidenciar los problemas de brechas en infraestructura sanitaria en Chile, así como analizar los mecanismos mediante los cuales ésta se provee. Ello se realiza mediante dos modalidades, la primera es la licitación competitiva o modalidad sectorial. La segunda forma es la concesión hospitalaria. En los últimos años ambos mecanismos presentan dificultades, las cuales se relatan en este documento. Finalmente, se plantean propuestas con el fin de mejorar la provisión de infraestructura sanitaria en Chile.

Análisis del presupuesto 2013 para atención primaria ¿estamosgastando lo necesario? / Analysis of 2013 finance for primary health care

A nivel mundial, ha sido demostrado que los países que fortalecen la Atención Primaria de Salud (APS) obtienen mejores resultados, mayor equidad y menores costos. En la APS de nuestro país, se busca implementar el Modelo de Atención Integral con Enfoque Familiar y Comunitario, orientado a dar respuesta integral, continua, oportuna, eficaz, accesible y de calidad. La última reforma de salud se comprometía a dar un impulso inédito a la APS con el fin de solucionar el mayor número de problemas en la consulta médica e implementar programas de promoción, prevención, atención y rehabilitación, pero lamentablemente existen una serie de problemas no abordados que amenazan el éxito de este proceso, por ejemplo no existe una política para incentivar a los médicos a permanecer en este nivel. El Ministerio de Salud reconoce el insuficiente presupuesto que aporta para la APS y existen estudios que dan cuenta de esta escasez, por ejemplo la Universidad Católica asigna un valor mínimo per cápita, actualizado a junio de 2010, de $3.777. En cuanto los recursos para la inversión sectorial en APS para el 2013 aumentan en 13,7 por ciento, pero preocupa que actualmente de los 34 proyectos de construcción, normalización y reposición, 24 de ellos se encuentren con 0 por ciento de avance. En este contexto, el presupuesto destinado a la APS, cobra especial relevancia y resulta fundamental que los legisladores consideren que para dar respuesta a los problemas de salud de los usuarios, la APS necesita los recursos suficientes y un mecanismo de financiamiento adecuado, así como de una fiscalización efectiva.

Globally, it has been shown that countries that streng then Primary Health Care (PHC) get better results, greater equity and lower costs.APS In our country, seeks to implement the comprehensive care model with family and community focus, aimed at responding comprehensive, continuous, timely, efficient, affordable and quality. The final health reform agreed to unprecedented boost to the APS in order to solve the most problems in the medical and implement programs of promotion, prevention, care and rehabilitation, but unfortunately there are a number of problems not addressed that threaten the success of this process, for example there is no policy to encourage physicians to remain at this level. The Ministry of Health recognizes the insufficient budget that provides for the APS and studies that account for this shortage, for example the Catholic University assigns a minimum value per capita, updated to June 2010, of $ 3,777. As for the resources sector investment in APS for 2013 increased by 13.7 percent, but worried that the 34 projects currently in construction, standardization and replacement, 24 of them are with 0 percent complete.In this context, the budget for the APS, especially relevant and crucial that lawmakers consider that to address the health problems of users, the APS requires sufficient resources and adequate funding mechanism, as well as effective oversight.