Propuesta de priorización quirúrgica patología ginecológica no GES Hospital Dr. Gustavo Fricke servicio Viña del Mar Quillota año 2021
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2021
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es
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Universidad Andrés Bello
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Antecedentes: En el año 2005 se implementa en Chile, un sistema de salud que prioriza patologías en acceso, oportunidad y protección financiera llamado GES, produciéndose una división con aquellas patologías no incorporadas llamadas No GES creándose una brecha en su atención y resolución. El investigador propondrá una estrategia de priorización para la resolución quirúrgica de las patologías NO GES por subespecialidad ginecológica, en el contexto de un hospital público, a la luz de la hipótesis subyacente que un número de patologías son desplazadas por patologías que han logrado ser priorizadas en otros regímenes de cobertura.
Metodología: Estudio de tipo mixto cuantitativo y cualitativo. El componente cuantitativo es de tipo observacional descriptivo retrospectivo de cohorte transversal. Se utilizarán los registros de cirugías realizadas y los de la lista de espera quirúrgica ginecológica en los años 2018 y 2019 de la Unidad de Ginecologia del Hospital Dr.Gustavo Fricke obtenidos desde el SIH y REM 21 del DEIS. Los datos serán evaluados desde la perspectiva de la oferta y demanda quirúrgica o lista de espera. El componente cualitativo estará enfocado en el proceso de validación de la estrategia de priorización propuesta por el investigador con base en el marco conceptual explorado en el marco teórico. Se realizará una metodología de entrevista semi estructurada a expertos que cumplirán con criterios de inclusión y exclusión.
Resultados: En la muestra inicial de 980 pacientes operadas en los años 2018 y 2019 un 26% corresponde a patologías GES y el 74% a No GES. La muestra No GES Nº 726, promedio de edad 50 años, comuna más frecuente de origen: Viña del Mar (64%), seguro salud Fonasa más frecuente: B (55% ), comorbilidades crónicas asociadas: (51%). Las cirugías más frecuentes en la muestra estudiada son: Histerectomías (24%), Histeroscopias (20%) y cirugía de Prolapso más cirugía de Incontinencia de orina (15%).El TE promedio para cirugía es de 222 días, con un min. de 1 día y máx. de 2770 días. La LEQ Nº 518, promedio edad 45 años, comuna más frecuente: Viña de Mar (62%),seguro salud Fonasa más frecuente: B (47%).Las patologías más frecuentes según CIE10: Tumor maligno del ovario (14%),Infertilidad No especificada (11%) y Problemas relacionadas con la multiparidad.
Conclusión: Las patologías No GES son mucho más frecuentes y en mayor cantidad que las GES. Requieren estrategias adicionales para lograr su resolución en forma priorizada, dado que no tienen tiempo limite máximo como las GES.
Background: In 2005, a health system was implemented in Chile that prioritizes pathologies in access, opportunity and financial protection called GES, producing a division with those unincorporated pathologies called No GES, creating a gap in their care and resolution. The researcher will propose a prioritization strategy for the surgical resolution of NON-GES pathologies by gynecological subspecialty, in the context of a public hospital, light of the underlying hypothesis that several pathologies are displaced by pathologies that have managed to be prioritized in other coverage regimes. Methodology: A mixed quantitative and qualitative study. The quantitative component is of the observational descriptive retrospective cross-sectional cohort type. The records of surgeries performed and those of the gynecological surgical waiting list in the years 2018 and 2019 of the Gynecology Unit of the Dr Gustavo Fricke Hospital obtained from the SIH and REM 21 of the DEIS will be used. The data will be evaluated from the perspective of supply and demand for surgery or the waiting list. The qualitative component will be focused on the validation process of the prioritization strategy proposed by the researcher based on the conceptual framework explored in the theoretical framework. A semi-structured interview methodology will be carried out with experts who will meet the inclusion and exclusion criteria. Results: In the initial sample of 980 patients operated on in 2018 and 2019, 26% correspond to GES pathologies and 74% to No GES. Sample No GES No. 726, average age 50 years, most frequent commune of origin: Viña del Mar (64%), most frequent Fonasa health insurance: B (55%), associated chronic comorbidities: (51%). The most frequent surgeries in the studied sample are: Hysterectomies (24%), Hysteroscopies (20%) and Prolapse surgery plus Urine Incontinence surgery (15%). The average wait time for surgery is 222 days, with one minimum of 1 day and maximum of 2770 days. LEQ Surgery waiting list No. 518, average age 45 years, most frequent commune: Viña de Mar (62%), most frequent health insurance Fonasa: B (47%). The most frequent pathologies according to ICD10: Malignant tumor of the ovary (14%), Unspecified infertility (11%) and Problems related to multiparity. Conclusion: Non-GES pathologies are much more frequent and in greater quantity than GES pathologies. Additional strategies are required to achieve their resolution in a prioritized way since, unlike GES pathologies, they do not have a maximum wait time limit.
Background: In 2005, a health system was implemented in Chile that prioritizes pathologies in access, opportunity and financial protection called GES, producing a division with those unincorporated pathologies called No GES, creating a gap in their care and resolution. The researcher will propose a prioritization strategy for the surgical resolution of NON-GES pathologies by gynecological subspecialty, in the context of a public hospital, light of the underlying hypothesis that several pathologies are displaced by pathologies that have managed to be prioritized in other coverage regimes. Methodology: A mixed quantitative and qualitative study. The quantitative component is of the observational descriptive retrospective cross-sectional cohort type. The records of surgeries performed and those of the gynecological surgical waiting list in the years 2018 and 2019 of the Gynecology Unit of the Dr Gustavo Fricke Hospital obtained from the SIH and REM 21 of the DEIS will be used. The data will be evaluated from the perspective of supply and demand for surgery or the waiting list. The qualitative component will be focused on the validation process of the prioritization strategy proposed by the researcher based on the conceptual framework explored in the theoretical framework. A semi-structured interview methodology will be carried out with experts who will meet the inclusion and exclusion criteria. Results: In the initial sample of 980 patients operated on in 2018 and 2019, 26% correspond to GES pathologies and 74% to No GES. Sample No GES No. 726, average age 50 years, most frequent commune of origin: Viña del Mar (64%), most frequent Fonasa health insurance: B (55%), associated chronic comorbidities: (51%). The most frequent surgeries in the studied sample are: Hysterectomies (24%), Hysteroscopies (20%) and Prolapse surgery plus Urine Incontinence surgery (15%). The average wait time for surgery is 222 days, with one minimum of 1 day and maximum of 2770 days. LEQ Surgery waiting list No. 518, average age 45 years, most frequent commune: Viña de Mar (62%), most frequent health insurance Fonasa: B (47%). The most frequent pathologies according to ICD10: Malignant tumor of the ovary (14%), Unspecified infertility (11%) and Problems related to multiparity. Conclusion: Non-GES pathologies are much more frequent and in greater quantity than GES pathologies. Additional strategies are required to achieve their resolution in a prioritized way since, unlike GES pathologies, they do not have a maximum wait time limit.
Notas
Tesina de Postgrado (MBA con Especialización en Salud)
Palabras clave
Hospital Dr. Gustavo Fricke (Viña del Mar, Chile)., Hospitales, Listas de Espera, Cirugía Ginecológica, Administración, Chile, Viña del Mar