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

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↑ 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

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onsu

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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

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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

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onsu

ltas a

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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

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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

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nsul

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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

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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

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2008 2009 2010 2011 2012 20130

20000

40000

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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

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In demanding contexts… How can we achieve a sustainable increase in access to

primary care services without

reducing their quality?