Presentación para congreso WONCA 2016. Rio de Janeiro, Brasil.

1. Unbalanced care: trends in
emergency care visits and acute
care visits in Talcahuano, Chile
Dr. Jorge Pacheco
Family Physician, Ms. Social Research and Development
Universidad de Concepción

2. • 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)

3. • 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.

4. • 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.

5. 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

6. 0
20000
40000
60000
80000
100000
120000
140000
160000
180000
2010 2011 2012 2013 2014 2015
Númerodeconsultasmédicasanuales
Número de consultas médicas anuales en servicios de urgencias (SAPU,
Hospital) y morbilidad aguda (CESFAM y CECOSF). Talcahuano, 2010-
2015.
Consultas urgencias SAPU
Talcahuano
Consultas urgencias Hospital
Higueras
Consultas de morbilidad CESFAM
y CECOSF Talcahuano
↑ Emergency care in Emergency Primary
Care Services
↓ Acute Morbidity Care in Family and
Community Health Centers
↓ Emergency care in referral hospital

7. 0
5000
10000
15000
20000
25000
30000
35000
40000
45000
2010 2011 2012 2013 2014 2015
Númerodeconsultasmédicas
anuales
N° de consultas médicas anuales en SAPU, CESFAM y
CECOSF San Vicente 2010-2015.
Atención de morbilidad
Atención SAPU
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
2010 2011 2012 2013 2014 2015
Númerodeconsultasmédicas
anuales
N° de consultas médicas anuales en SAPU, CESFAM y
CECOSF Paulina Avendaño Pereda 2010-2015.
Atención de morbilidad
Atención SAPU
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.

8. 0
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
2011 2012 2013 2014 2015
Númerodeconsultasanuales
Número de consultas de morbilidad aguda según grupo de
edad en CESFAM y CECOSF San Vicente, 2011-2015.
0 a 9 años
10 a 14 años
15 a 19 años
20 a 24 años
25 a 64 años
65 años y más
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
2011 2012 2013 2014 2015
Númerodeconsultasanuales
Número de consultas de urgencias según grupo de edad en
SAPU San Vicente 2011-2015.
0 a 9 años
10 a 14 años
15 a 19 años
20 a 24 años
25 a 64 años
65 años y más
Children and middle age adults ↑ their emergency visits and ↓ their acute care visits.

9. Children and middle age adults ↑ their emergency visits and ↓ their acute care visits.
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
2011 2012 2013 2014 2015
Númerodeconsultasanuales
Número de consultas de morbilidad aguda según grupo de edad en
CESFAM y CECOSF Paulina Avendaño, 2011-2015.
0 a 9 años
10 a 14 años
15 a 19 años
20 a 24 años
25 a 64 años
65 años y más
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
2011 2012 2013 2014 2015
Númerodeconsultasanuales
Número de consultas de morbilidad aguda según grupo de
edad en SAPU Paulina Avendaño, 2011-2015.
0 a 9 años
10 a 14 años
15 a 19 años
20 a 24 años
25 a 64 años
65 años y más

10. 0
5000
10000
15000
20000
25000
30000
35000
40000
45000
2011 2012 2013 2014
Númerodeconsultasanuales
Número de consultas anuales a profesionales de la salud no médicos en
CESFAM y CECOSF. Talcahuano, 2012-2015.
Psicólogo/a
Asistente social
Nutricionista
Enfermera/o
Matron/a
Odontólogo/a
↓ Nurse visits
↓ Obstetrician visits
↓ Psychologist visits
↓ Acute morbidity visits = ↓
Referral to other health
professionals

11. • 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.

12. 0
20000
40000
60000
80000
100000
120000
140000
2008 2009 2010 2011 2012 2013
Númerodeconsultasanuales
Número de consultas anuales en servicios de urgencias (SAPU,
Hospital) y morbilidad aguda (CESFAM y CECOSF). Quillota, 2008-2013.
Atención de morbilidad aguda
Atención en SAPU
Atención en Hospital

13. 0
20000
40000
60000
80000
100000
120000
140000
2008 2009 2010 2011 2012 2013
Númerodeconsultasanuales
Número de consultas anuales en servicios de urgencias (SAPU, Hospital) y
morbilidad aguda (CESFAM y CECOSF). La Serena, 2008-2013.
Atención de morbilidad aguda
Atención en SAPU
Atención en Hospital

14. In demanding
contexts… How can we
achieve a sustainable
increase in access to
primary care services
without reducing their
quality?